Ke Yu, Tan Yung Ying, Neo Patricia Soek Hui, Yang Grace Meijuan, Loh Kiley Wei-Jen, Ho Shirlynn, Tan Yee Pin, Ramalingam Mothi Babu, Quah Daniel Song Chiek, Chew Lita, Si Phebe En Hui, Tay Beng Choo, Chan Alexandre
Division of Supportive and Palliative Care, National Cancer Centre Singapore, SG.
Duke-NUS Medical School Singapore, SG.
Int J Integr Care. 2023 Mar 17;23(1):14. doi: 10.5334/ijic.6480. eCollection 2023 Jan-Mar.
Supportive care models considering inclusivity and community services to improve integrated care for cancer survivors are limited. In this case study, we described the implementation of a multidisciplinary care model employing routine distress screening and embedded integrated care pathways to integrate care across disciplines and care sectors, while remaining inclusive of the multi-ethnic and multilingual population in Singapore. We reported implementation outcomes after 18 months of implementation.
We reviewed the model's process indicators from September 2019 to February 2021 at the largest public ambulatory cancer centre. Outcomes assessed included penetration, fidelity to screening protocol, and feasibility in three aspects - inclusiveness of different ethnic and language groups, responsiveness to survivors reporting high distress, and types of community service referrals.
DISCUSSION/CONCLUSION: We elucidated opportunities to promote access to community services and inclusivity. Integration of community services from tertiary settings should be systematic through mutually beneficial educational and outreach initiatives, complemented by their inclusion in integrated care pathways to encourage systematic referrals and care coordination. A hybrid approach to service delivery is crucial in ensuring inclusivity while providing flexibility towards external changes such as the COVID-19 pandemic. Future work should explore using telehealth to bolster inclusiveness and advance community care integration.
考虑到包容性和社区服务以改善癌症幸存者综合护理的支持性护理模式有限。在本案例研究中,我们描述了一种多学科护理模式的实施情况,该模式采用常规痛苦筛查和嵌入式综合护理路径,以整合跨学科和护理部门的护理,同时兼顾新加坡的多民族和多语言人群。我们报告了实施18个月后的实施成果。
我们在最大的公立门诊癌症中心回顾了2019年9月至2021年2月该模式的过程指标。评估的结果包括渗透率、对筛查方案的依从性以及在三个方面的可行性——不同种族和语言群体的包容性、对报告高度痛苦的幸存者的反应能力以及社区服务转诊的类型。
讨论/结论:我们阐明了促进获得社区服务和包容性的机会。三级医疗机构的社区服务整合应通过互利的教育和外展举措进行系统化,并将其纳入综合护理路径以鼓励系统转诊和护理协调。混合服务提供方式对于确保包容性同时应对诸如COVID-19大流行等外部变化的灵活性至关重要。未来的工作应探索使用远程医疗来增强包容性并推进社区护理整合。