Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
Faculty of Social and Behavioural Sciences, Department of Education, Utrecht University, Utrecht, The Netherlands.
Patient. 2022 Jan;15(1):121-130. doi: 10.1007/s40271-021-00535-x. Epub 2021 Jun 25.
Patients with cancer require specialized care from different care providers, challenging continuity of care in terms of information, relationships, and/or management. The recognition of discontinuity of care has led to different initiatives by the healthcare system over the years. Yet, making use of the theory on boundary objects and brokers, this research explores the active role of patients themselves in resolving discontinuity along their care trajectories.
Semi-structured interviews were conducted with 33 patients to unravel the discontinuities that they experience and their attempts to resolve these. Interview data were analyzed using directed-content analysis informed by concepts from boundary crossing literature (i.e., data were searched for potential boundary objects and brokers).
To re-establish continuity of care, patients actively use the objects and people provided by the healthcare system when these meet their needs. Patients also introduce own objects and people into the care trajectory. As such, information and management discontinuity can typically be resolved. Relational continuity appears to be more difficult to resolve, in some cases leaving patients to take drastic measures, such as changing care providers.
The use of boundary crossing theory in improving care from a patient perspective is relatively novel. When patients and providers together address the objects and people that support establishing continuity of care, a continuous care process may be encouraged. We advocate an integrated approach, rather than provider or healthcare system initiatives exclusively, to patient care and continuity.
癌症患者需要来自不同护理提供者的专业护理，这对信息、关系和/或管理方面的护理连续性提出了挑战。对护理连续性的认识导致多年来医疗保健系统采取了不同的举措。然而，本研究利用边界对象和经纪人理论，探索了患者自身在解决护理轨迹中断过程中的积极作用。
对 33 名患者进行了半结构化访谈，以揭示他们所经历的不连续性以及他们试图解决这些问题的尝试。使用受边界跨越文献概念（即，搜索潜在的边界对象和经纪人）启发的定向内容分析方法对访谈数据进行了分析。
为了重新建立护理连续性，患者在满足需求时会主动利用医疗保健系统提供的对象和人员。患者还会将自己的对象和人员引入护理轨迹中。因此，信息和管理的不连续性通常可以得到解决。关系连续性似乎更难解决，在某些情况下，患者不得不采取激烈的措施，例如更换护理提供者。
从患者角度出发，利用边界跨越理论来改善护理是相对新颖的。当患者和提供者共同解决支持建立护理连续性的对象和人员时，可能会鼓励连续的护理过程。我们主张采取综合方法，而不是仅依赖提供者或医疗保健系统的举措，来实现患者护理和连续性。
