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参与团队医疗照护:从诊断起重新定义癌症生存。

Engaging TEAM Medicine in Patient Care: Redefining Cancer Survivorship From Diagnosis.

机构信息

Northwell Health Cancer Institute, New York, NY.

Institute of Health System Science, Feinstein Institutes for Medical Research, New York, NY.

出版信息

Am Soc Clin Oncol Educ Book. 2022 Apr;42:1-11. doi: 10.1200/EDBK_349391.

Abstract

New approaches to cancer survivorship care must address the rising number of survivors who need complex care; the need to personalize care to improve health equity; workforce shortages and clinician knowledge deficits about the long-term and late effects of cancer; the need to engage and coordinate oncology, primary care, and a large multidisciplinary team of subspecialists and programs to meet survivors' needs; and the need to control costs and deliver better value. This review proposes eight core tenets of an evolved standard of care to meet these needs by starting at diagnosis and continuing throughout oncology and into follow-up to: (1) facilitate team medicine by connecting oncology, primary care, subspecialists and programs, researchers, and patients and caregivers; (2) educate patients and support them in self-management; (3) mitigate toxicities; (4) manage comorbidities; (5) promote healthy behaviors and wellness; (6) improve health equity; (7) provide clear personalized follow-up; and (8) provide ongoing opportunities for participation in research as the standard of care. Strategies to successfully implement this care are discussed from the perspectives of oncology, primary care, and health care administration.

摘要

癌症生存者照护必须采用新方法,以满足以下需求:需要照护的生存者人数不断增加,他们需要复杂的照护;需要个性化照护以提高健康公平性;劳动力短缺,临床医生对癌症的长期和晚期影响的知识不足;需要让肿瘤学、初级保健以及多学科专家团队和项目共同参与并协调,以满足生存者的需求;以及需要控制成本并提供更高的价值。本综述提出了八项核心原则,以通过在诊断时开始并贯穿肿瘤学以及进入随访来满足这些需求,从而建立一个演进后的照护标准:(1)通过连接肿瘤学、初级保健、亚专科和项目、研究人员以及患者和照护者来促进团队医学;(2)教育患者并支持他们进行自我管理;(3)减轻毒性;(4)管理合并症;(5)促进健康行为和健康;(6)提高健康公平性;(7)提供明确的个性化随访;(8)作为照护标准,持续提供参与研究的机会。本文从肿瘤学、初级保健和医疗保健管理的角度讨论了成功实施这种照护的策略。

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