NICM Health Research Institute, Western Sydney University, Penrith, Australia.
South-Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Liverpool, Australia.
J Altern Complement Med. 2021 Mar;27(S1):S89-S98. doi: 10.1089/acm.2020.0299.
This study aimed to explore barriers and facilitators to integrative oncology (IO) service provision and access in Australia. The study design was mixed method with two substudies: a cross-sectional national cancer service survey of public and private sectors; and focus group interviews and an online survey of cancer survivors. Triangulation analysis of qualitative and quantitative data was used to identify and interrogate meta-themes. The cancer service response rate was 93.2% ( = 275/295); 71/275 (25.8%) provided IO. Thirty-three cancer survivors from Anglo-European, Arabic, Vietnamese, and Chinese backgrounds were interviewed, and 121 survivors answered the online survey. IO gaps were substantial, with no services in many regions and cities; a lack of diversity and availability of therapeutic options, including culturally appropriate services; and a mismatch between the high use of natural health products by survivors and types of IO services provided. Two overlapping meta-themes were identified: "barriers and facilitators" and "peoples and institutions"; each with four subthemes, respectively, "access/provision, affordability/funding, information/evidence, and culture/values" and "cancer survivors, healthcare professionals, organizations, and policies." While affordability/funding was the greatest barrier to survivors and providers, solutions varied (e.g., building a stronger evidence-base, business model advice) and often conflicted (e.g., public verses private sector funding). The most insidious barrier was professional/corporate cultures and values that influenced hospital policies (or lack thereof), conceptions of evidence and the therapeutic alliance. Survivors called for a change of mindset in the culture of medicine and value-based health care. The barriers and facilitators to IO services were more complex than building the evidence-base and demonstrating value to justify funding. To achieve a better alignment of patients' preferences with service provision, providers require more guidance on clinical governance, business models, local service gaps, and interprofessional collaboration. National strategies and funding models are needed to ensure appropriate, equitable IO service provision.
本研究旨在探索澳大利亚综合肿瘤学（IO）服务提供和获取的障碍和促进因素。研究设计采用混合方法，包括两项子研究：对公共和私营部门的全国癌症服务进行横断面调查；以及对癌症幸存者进行焦点小组访谈和在线调查。对定性和定量数据进行三角分析，以确定和探讨元主题。癌症服务的回复率为 93.2%（=275/295）；71/275（25.8%）提供 IO。来自盎格鲁-欧洲、阿拉伯、越南和华裔背景的 33 名癌症幸存者接受了访谈，121 名幸存者回答了在线调查。IO 差距很大，许多地区和城市都没有服务；治疗选择的多样性和可用性不足，包括文化上合适的服务；以及幸存者高度使用天然保健品与提供的 IO 服务类型之间不匹配。确定了两个重叠的元主题：“障碍和促进因素”和“人和机构”；每个主题都有四个子主题，分别是“获取/提供、可负担性/资金、信息/证据和文化/价值观”以及“癌症幸存者、医疗保健专业人员、组织和政策”。虽然可负担性/资金是幸存者和提供者面临的最大障碍，但解决方案各不相同（例如，建立更强的证据基础、商业模式建议），并且经常存在冲突（例如，公共部门与私营部门的资金）。最阴险的障碍是影响医院政策（或缺乏政策）、对证据和治疗联盟的看法的专业/企业文化和价值观。幸存者呼吁改变医学文化和基于价值的医疗保健的思维模式。IO 服务的障碍和促进因素比建立证据基础和证明价值以证明资金合理更为复杂。为了更好地使患者的偏好与服务提供保持一致，提供者需要更多关于临床治理、商业模式、当地服务差距和跨专业合作的指导。需要制定国家战略和融资模式，以确保提供适当、公平的 IO 服务。
