在初级保健中提供结肠癌生存者护理；全科医生经验的定性研究。
Delivering colon cancer survivorship care in primary care; a qualitative study on the experiences of general practitioners.
机构信息
Department of General Practice, Amsterdam UMC, University of Amsterdam, Postbox 22660, Amsterdam, 1100 DD, the Netherlands.
Program of Personalized Medicine & Quality of Care, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
出版信息
BMC Prim Care. 2022 Jan 17;23(1):13. doi: 10.1186/s12875-021-01610-w.
BACKGROUND
With more patients in need of oncological care, there is a growing interest to transfer survivorship care from specialist to general practitioner (GP). The ongoing I CARE study was initiated in 2015 in the Netherlands to compare (usual) surgeon- to GP-led survivorship care, with or without access to a supporting eHealth application (Oncokompas).
METHODS
Semi-structured interviews were held at two separate points in time (i.e. after 1- and 5-years of care) to explore GPs' experiences with delivering this survivorship care intervention, and study its implementation into daily practice. Purposive sampling was used to recruit 17 GPs. Normalisation Process Theory (NPT) was used as a conceptual framework.
RESULTS
Overall, delivering survivorship care was not deemed difficult and dealing with cancer repercussions was already considered part of a GPs' work. Though GPs readily identified advantages for patients, caregivers and society, differences were seen in GPs' commitment to the intervention and whether it felt right for them to be involved. Patients' initiative with respect to planning, absence of symptoms and regular check-ups due to other chronic care were considered to facilitate the delivery of care. Prominent barriers included GPs' lack of experience and routine, but also lack of clarity regarding roles and responsibilities for organising care. Need for a monitoring system was often mentioned to reduce the risk of non-compliance. GPs were reticent about a possible future transfer of survivorship care towards primary care due to increases in workload and financial constraints. GPs were not aware of their patients' use of eHealth.
CONCLUSIONS
GPs' opinions and beliefs about a possible future role in colon cancer survivorship care vary. Though GPs recognize potential benefit, there is no consensus about transferring survivorship care to primary care on a permanent basis. Barriers and facilitators to implementation highlight the importance of both personal and system level factors. Conditions are put forth relating to time, reorganisation of infrastructure, extra personnel and financial compensation.
TRIAL REGISTRATION
Netherlands Trial Register; NTR4860 . Registered on the 2nd of October 2014.
背景
随着越来越多的患者需要肿瘤治疗，人们对将生存护理从专科医生转移到全科医生（GP）的兴趣日益浓厚。正在进行的 I CARE 研究于 2015 年在荷兰启动，旨在比较（常规）外科医生主导的生存护理，以及是否可以使用支持电子健康的应用程序（Oncokompas）。
方法
在两个不同的时间点（即护理 1 年和 5 年后）进行半结构化访谈，以探讨全科医生提供这种生存护理干预的经验，并研究其在日常实践中的实施情况。采用目的抽样法招募了 17 名全科医生。采用规范过程理论（NPT）作为概念框架。
结果
总的来说，提供生存护理并不困难，而且处理癌症的影响已经被认为是全科医生工作的一部分。尽管全科医生很容易认识到对患者、护理人员和社会的好处，但他们对干预的承诺以及是否认为自己参与其中是正确的存在差异。患者主动规划、由于其他慢性护理而没有症状以及定期检查，被认为有助于护理的提供。突出的障碍包括全科医生缺乏经验和常规，还包括对组织护理的角色和责任缺乏明确性。由于担心不遵守规定，经常提到需要一个监测系统。由于工作量增加和财务限制，全科医生对未来将生存护理转移到初级保健持保留态度。全科医生不知道他们的患者是否使用电子健康。
结论
全科医生对未来在结肠癌生存护理中可能扮演的角色的意见和信念存在差异。尽管全科医生认识到潜在的好处，但对于将生存护理永久转移到初级保健，还没有达成共识。实施的障碍和促进因素强调了个人和系统层面因素的重要性。提出了与时间、基础设施的重新组织、额外人员和财务补偿有关的条件。
试验注册
荷兰试验注册处；NTR4860。于 2014 年 10 月 2 日注册。
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