Alchin Joseph Elliot, Signorelli Christina, McLoone Jordana Kathleen, Wakefield Claire Elizabeth, Fardell Joanna Elizabeth, Johnston Karen, Cohn Richard J
Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia.
School of Women's and Children's Health,UNSW Medicine, University of New South Wales, Sydney, NSW, Australia.
J Multidiscip Healthc. 2022 Aug 12;15:1719-1734. doi: 10.2147/JMDH.S363653. eCollection 2022.
Ongoing survivorship care allows childhood cancer survivors the opportunity to address treatment-related health problems and improve their quality of life. However, many survivors do not adhere to their healthcare professionals' recommendations and the factors supporting their adherence remain unclear.
Long-term childhood cancer survivors completed the "Re-engage" program, which assessed survivors' heath needs and provided individualised recommendations for health interventions and surveillance developed by an expert multi-disciplinary team (MDT). We measured survivors' recall of, and adherence to, their individualised healthcare recommendations at one and six months post-intervention. We conducted a series of univariate negative binomial regressions to investigate factors associated with the total number of recommendations that were correctly recalled and adhered to.
We analysed the data of 25 childhood cancer survivors who participated in Re-engage (mean age = 31.9 years). On average, survivors were provided with 6.6 recommendations (range = 1-11). Survivors accurately recalled receiving 3.0 recommendations at one month post-intervention and 1.9 at six months. Survivors had adhered to an average of 1.3 recommendations by six-month follow-up. In total, 56% of participants reported that they did not adhere to any recommendations. By six-month follow-up, greater adherence to MDT recommendations was associated with having a history of a second cancer ( = 1.391; 95% confidence interval [CI], 0.686 to 2.097; 0.001) and reporting a greater level of worry about late effects ( = 1.381; 95% CI, 0.494 to 2.269; 0.002).
Survivors reported sub-optimal levels of adherence and demonstrated limited recall of their healthcare recommendations. Effective communication of recommendations and clear discussion of barriers limiting adherence, coupled with late effects education, may be critical to ensure that survivors engage with their recommendations, to improve their quality of life and health outcomes.
ACTRN12618000194268.
持续的幸存者护理使儿童癌症幸存者有机会解决与治疗相关的健康问题并改善其生活质量。然而，许多幸存者并未遵循医疗保健专业人员的建议，且支持他们遵循建议的因素仍不明确。
长期儿童癌症幸存者完成了“重新参与”项目，该项目评估了幸存者的健康需求，并为由多学科专家团队（MDT）制定的健康干预和监测提供个性化建议。我们在干预后1个月和6个月测量了幸存者对其个性化医疗保健建议的回忆和遵循情况。我们进行了一系列单变量负二项回归分析，以调查与正确回忆和遵循的建议总数相关的因素。
我们分析了25名参与“重新参与”项目的儿童癌症幸存者的数据（平均年龄 = 31.9岁）。幸存者平均收到6.6条建议（范围 = 1 - 11条）。幸存者在干预后1个月准确回忆起收到3.0条建议，6个月时回忆起1.9条。到6个月随访时，幸存者平均遵循了1.3条建议。总体而言，56%的参与者报告称他们未遵循任何建议。到6个月随访时，对MDT建议的更高遵循程度与有二次癌症病史相关（ = 1.391；95%置信区间[CI]，0.686至2.097； 0.001），且报告对晚期效应的担忧程度更高也与之相关（ = 1.381；95%CI，0.494至2.269； 0.002）。
幸存者报告的遵循水平不理想，对其医疗保健建议的回忆有限。有效传达建议并明确讨论限制遵循的障碍，再加上晚期效应教育，对于确保幸存者遵循建议、改善其生活质量和健康结果可能至关重要。
ACTRN12618000194268。
