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癌症治疗的连续性和家庭医生与肿瘤学家之间的协作:一项随机临床试验的结果。

Continuity of Cancer Care and Collaboration Between Family Physicians and Oncologists: Results of a Randomized Clinical Trial.

出版信息

Ann Fam Med. 2021 Mar-Apr;19(2):117-125. doi: 10.1370/afm.2643.

Abstract

PURPOSE

Collaboration between family physicians (FPs) and oncologists can be challenging. We present the results of a randomized clinical trial of an intervention designed to improve continuity of care and interprofessional collaboration, as perceived by patients with lung cancer and their FPs.

METHODS

The intervention included (1) supplying FPs with standardized summaries related to each patient, (2) recommending that patients see their FP after receiving the cancer diagnosis, (3) supplying the oncology team with patient information resulting from FP visits, and (4) providing patients with priority access to FPs as needed. A total of 206 patients with newly diagnosed lung cancer were randomly assigned to the intervention (n = 104) or control group (n = 102), and 86.4% of involved FPs participated. Perceptions of continuity of care and interprofessional collaboration were assessed every 3 months for patients and at baseline and at the end of the study for FPs. Patient distress and health service utilization were also assessed.

RESULTS

Patients and FPs in the intervention group perceived better interprofessional collaboration (patients: <.0001; FPs: = .0006) than those in the control group. Patients reported better informational continuity ( = .001) and management continuity ( = .05) compared to the control group, but no differences were found for FPs (information: = .22; management: = .13). No effect was found with regard to patient distress or health service utilization.

CONCLUSIONS

This intervention improved patient and FP perception of interprofessional collaboration, but its effectiveness on continuity of care was less clear for FPs than for patients. Additional strategies should be considered to sustainably improve continuity of care and interprofessional collaboration.

摘要

目的

家庭医生(FPs)和肿瘤医生之间的协作可能具有挑战性。我们报告了一项旨在改善肺癌患者及其 FPs 感知的连续性护理和跨专业协作的干预措施的随机临床试验结果。

方法

该干预措施包括(1)为 FPs 提供与每位患者相关的标准化摘要,(2)建议患者在接受癌症诊断后看他们的 FP,(3)向肿瘤团队提供源自 FP 就诊的患者信息,以及(4)为患者提供按需优先访问 FPs 的机会。总共 206 名新诊断为肺癌的患者被随机分配到干预组(n = 104)或对照组(n = 102),并邀请了 86.4%的相关 FPs 参与。患者每 3 个月评估一次连续性护理和跨专业协作的感知,FPs 在基线和研究结束时评估。还评估了患者的痛苦和卫生服务利用情况。

结果

干预组的患者和 FPs 比对照组感知到更好的跨专业协作(患者:<.0001;FPs:=.0006)。与对照组相比,患者报告了更好的信息连续性(=.001)和管理连续性(=.05),但 FPs 没有发现差异(信息:=.22;管理:=.13)。患者痛苦或卫生服务利用方面没有发现效果。

结论

该干预措施改善了患者和 FP 对跨专业协作的感知,但对 FP 的连续性护理效果不如对患者的效果明显。应该考虑采取其他策略来可持续地改善连续性护理和跨专业协作。

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