College of Education and Human Ecology, The Ohio State University, Columbus, OH.
Comprehensive Cancer Center, The Ohio State University, Columbus, OH.
JCO Oncol Pract. 2023 May;19(5):e706-e713. doi: 10.1200/OP.22.00712. Epub 2023 Feb 13.
The 21st Century Cures Act mandates the immediate release of clinical information (IRCI) to patients. Immediate sharing of sensitive test results to patients with cancer might have serious unintended consequences for patients and providers.
A 22-question REDCap survey was designed by the Association of American Cancer Institutes Physician Clinical Leadership Initiative Steering Committee to explore oncology providers' opinions on IRCI policy implementation. It was administered twice in 2021 with a 3-month interval. A third survey with a single question seeking providers' opinions about their adaptation to the IRCI mandate was administered 1 year later to those who had responded to the earlier surveys. The data were analyzed using descriptive statistics such as chi-squared or Fisher's exact tests for categorical variables. The survey was sent to all Association of American Cancer Institutes cancer center members. In the first or second administration, 167 practitioners answered the survey; 31 responded to the third survey.
Three quarters of the providers did not favor the new requirement for IRCI and 62% encountered questions from patients about results being sent to them without provider interpretation. Only half of the hospitals had a plan in place to deal with the new IRCI requirements. A third survey, for longitudinal follow-up, indicated a more favorable trend toward adoption of IRCI.
IRCI for patients with cancer was perceived negatively by academic oncology providers after its implementation. It was viewed to be associated with higher levels of patient anxiety and complaints about the care delivered. Providers preferred to discuss test results with patients before release.
《21 世纪治愈法案》要求将临床信息（IRCI）立即向患者发布。立即将敏感的测试结果与癌症患者共享可能会对患者和提供者产生严重的意外后果。
美国癌症协会医师临床领导倡议指导委员会设计了一个包含 22 个问题的 REDCap 调查，以探讨肿瘤学提供者对 IRCI 政策实施的看法。该调查于 2021 年进行了两次，间隔 3 个月。一年后，对之前的调查做出回应的人员进行了第三次调查，其中包含一个问题，询问他们对 IRCI 授权的适应情况。使用描述性统计方法（例如卡方检验或 Fisher 精确检验）分析数据。该调查发送给所有美国癌症协会癌症中心成员。在第一次或第二次管理中，有 167 名从业者回答了调查；31 人回答了第三次调查。
四分之三的提供者不赞成新的 IRCI 要求，62%的提供者遇到了患者关于结果未经提供者解释就发送给他们的问题。只有一半的医院有计划应对新的 IRCI 要求。第三次调查（纵向随访）表明，对采用 IRCI 的趋势更为有利。
实施后，学术肿瘤学提供者对癌症患者的 IRCI 持负面看法。它被认为与更高水平的患者焦虑和对所提供护理的投诉有关。提供者希望在发布之前与患者讨论测试结果。
