Brenne Anne-Tove, Løhre Erik Torbjørn, Knudsen Anne Kari, Thronæs Morten, Lund Jo-Åsmund, Kongshaug Nina, Neverdal Marte Nilssen, Rystad Kristina, Johansen Marianne Haug, Braseth Tone Inga, Kaasa Stein
Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Postbox 8905, NO-7491, Trondheim, Norway.
Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
Oncol Ther. 2021 Dec;9(2):671-693. doi: 10.1007/s40487-021-00176-y. Epub 2021 Nov 3.
To improve quality across levels of care, we developed a standardized care pathway (SCP) integrating palliative and oncology services for hospitalized and home-dwelling palliative cancer patients in a rural region.
A multifaceted implementation strategy was directed towards a combination of target groups. The implementation was conducted on a system level, and implementation-related activities were registered prospectively. Adult patients with advanced cancer treated with non-curative intent were included and interviewed. Healthcare leaders (HCLs) and healthcare professionals (HCPs) involved in the development of the SCP or exposed to the implementation strategy were interviewed. In addition, HCLs and HCPs exposed to the implementation strategy answered standardized questionnaires. Hospital admissions were registered prospectively.
To assess the use of the SCP, 129 cancer patients were included. Fifteen patients were interviewed about their experiences with the patient-held record (PHR). Sixty interviews were performed among 1320 HCPs exposed to the implementation strategy. Two hundred and eighty-seven HCPs reported on their training in and use of the SCP. Despite organizational cultural differences, developing an SCP integrating palliative and oncology services across levels of care was feasible. Both HCLs and HCPs reported improved quality of care in the wake of the implementation process. Two and a half years after the implementation was launched, 28% of the HCPs used the SCP and 41% had received training in its use. Patients reported limited use and benefit of the PHR.
An SCP may be a usable tool for integrating palliative and oncology services across care levels in a rural region. An extensive implementation process resulted in improvements of process outcomes, yet still limited use of the SCP in clinical practice. HCLs and HCPs reported improved quality of cancer care following the implementation process. Future research should address mandatory elements for usefulness and successful implementation of SCPs for palliative cancer patients.
为提高各级医疗服务质量，我们制定了一种标准化护理路径（SCP），将姑息治疗和肿瘤服务整合起来，用于农村地区住院及居家的姑息性癌症患者。
针对多个目标群体实施了多方面的实施策略。在系统层面开展实施工作，并对与实施相关的活动进行前瞻性记录。纳入了接受非治愈性治疗的晚期癌症成年患者并进行访谈。对参与SCP制定或接触实施策略的医疗保健领导者（HCL）和医疗保健专业人员（HCP）进行访谈。此外，接触实施策略的HCL和HCP回答标准化问卷。前瞻性记录医院入院情况。
为评估SCP的使用情况，纳入了129名癌症患者。对15名患者就其使用患者持有的记录（PHR）的体验进行了访谈。在1320名接触实施策略的HCP中进行了60次访谈。287名HCP报告了他们在SCP方面的培训及使用情况。尽管存在组织文化差异，但在各级医疗服务中制定整合姑息治疗和肿瘤服务的SCP是可行的。HCL和HCP均报告在实施过程后护理质量有所提高。实施启动两年半后，28%的HCP使用了SCP，41%接受了SCP使用方面的培训。患者报告PHR的使用和益处有限。
SCP可能是农村地区跨护理级别整合姑息治疗和肿瘤服务的可用工具。广泛的实施过程带来了流程结果的改善，但SCP在临床实践中的使用仍然有限。HCL和HCP报告实施过程后癌症护理质量有所提高。未来的研究应探讨姑息性癌症患者SCP有用性和成功实施的必备要素。
