在新加坡实施基于社区的乳腺癌生存者共同照护模式：初级保健从业者的定性研究。
Implementing a community-based shared care breast cancer survivorship model in Singapore: a qualitative study among primary care practitioners.
机构信息
Department of Pharmacy, National University of Singapore, Singapore, Singapore.
Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.
出版信息
BMC Prim Care. 2022 Apr 8;23(1):73. doi: 10.1186/s12875-022-01673-3.
BACKGROUND
The adaptability of existing recommendations on shared care implementation to Asian settings is unknown. This qualitative study aims to elicit public- and private-sectors primary care practitioners' (PCPs) perspectives on the sustainable implementation of a shared care model among breast cancer survivors in Singapore.
METHODS
Purposive sampling was employed to engage 70 PCPs from SingHealth Polyclinics, National University Polyclinics, National Healthcare Group Polyclinics, and private practice. Eleven focus groups and six in-depth interviews were conducted between June to November 2018. All sessions were audio-recorded and transcribed verbatim. Guided by the RE-AIM framework, we performed deductive thematic analysis in QSR NVivo 12.
RESULTS
PCPs identified low-risk breast cancer survivors who demonstrated clear acceptability of PCPs' involvement in follow-up as suitable candidates for shared care. Engagement with institution stakeholders as early adopters is crucial with adequate support through PCP training, return pathways to oncologists, and survivorship care plans as communication tools. Implementation considerations differed across practices. Selection of participating PCPs could consider seniority and interest for public and private practice, respectively. Proposed adoption incentives included increased renumeration for private PCPs and work recognition for public PCPs. Public PCPs further proposed integrating shared care elements to their existing family medicine clinics.
CONCLUSIONS
PCPs perceived shared care favorably as it echoed principles of primary care to provide holistic and well-coordinated care. Contextual factors should be considered when adapting implementation recommendations to Asian settings like Singapore. With limited competitive pressure, the government is then pivotal in empowering primary care participation in survivorship shared care delivery.
背景
现有的关于共同照护实施的建议在亚洲环境下的适应性尚不清楚。本 qualitative study 旨在了解新加坡的公共和私营部门初级保健医生（PCPs）对乳腺癌幸存者实施共同照护模式的可持续性的看法。
方法
采用目的抽样法，于 2018 年 6 月至 11 月，从 SingHealth Polyclinics、National University Polyclinics、National Healthcare Group Polyclinics 和私人诊所共招募了 70 名 PCPs。共进行了 11 次焦点小组和 6 次深入访谈，所有会议均进行了录音并逐字记录。本研究以 RE-AIM 框架为指导，在 QSR NVivo 12 中进行了演绎主题分析。
结果
PCPs 确定了低风险的乳腺癌幸存者，他们对 PCP 参与随访的明确可接受性表现出适宜性，是共同照护的合适候选者。与机构利益相关者尽早接触并提供足够的支持，包括 PCP 培训、与肿瘤医生的返回途径以及生存护理计划作为沟通工具，这一点至关重要。实施方面的考虑因实践而异。在公共和私人实践中，分别可以考虑资深程度和兴趣来选择参与的 PCPs。拟议的采用激励措施包括增加私人 PCPs 的报酬和为公共 PCPs 提供工作认可。公共 PCPs 还提议将共同照护元素整合到他们现有的家庭医学诊所中。
结论
PCPs 对共同照护持积极态度，因为这呼应了初级保健的原则，即提供全面和协调良好的护理。在将实施建议适应亚洲环境（如新加坡）时，应考虑到背景因素。在竞争压力有限的情况下，政府在授权初级保健参与生存共享护理服务方面具有关键作用。
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