VA Center for Innovation to Implementation, Menlo Park, CA, United States of America.
California Northstate University College of Medicine, Elk Grove, CA, United States of America.
PLoS One. 2023 Nov 20;18(11):e0294599. doi: 10.1371/journal.pone.0294599. eCollection 2023.
Interdisciplinary teams are often leveraged to improve quality of cancer care in the perioperative period. We aimed to identify the team structures and processes in interdisciplinary interventions that improve perioperative patient-reported outcomes for patients with cancer.
We searched PubMed, EMBASE, and CINAHL for randomized control trials published at any time and screened 7,195 articles. To be included in our review, studies needed to report patient-reported outcomes, have interventions that occur in the perioperative period, include surgical cancer treatment, and include at least one non physician intervention clinical team member: advanced practice providers, including nurse practitioners and physician assistants, clinical nurse specialists, and registered nurses. We narratively synthesized intervention components, specifically roles assumed by intervention clinical team members and interdisciplinary team processes, to compare interventions that improved patient-reported outcomes, based on minimal clinically important difference and statistical significance.
We included 34 studies with a total of 4,722 participants, of which 31 reported a clinically meaningful improvement in at least one patient-reported outcome. No included studies had an overall high risk of bias. The common clinical team member roles featured patient education regarding diagnosis, treatment, coping, and pain/symptom management as well as postoperative follow up regarding problems after surgery, resource dissemination, and care planning. Other intervention components included six or more months of continuous clinical team member contact with the patient and involvement of the patient's caregiver.
Future interventions might prioritize supporting clinical team members roles to include patient education, caregiver engagement, and clinical follow-up.
多学科团队常被用来提高围手术期癌症护理的质量。我们旨在确定改善癌症患者围手术期患者报告结局的跨学科干预措施中的团队结构和流程。
我们在 PubMed、EMBASE 和 CINAHL 中搜索了任何时间发表的随机对照试验，并筛选了 7195 篇文章。为了纳入我们的综述，研究需要报告患者报告的结果，干预措施发生在围手术期，包括手术癌症治疗，并包括至少一名非医生干预临床团队成员：高级实践提供者，包括护士从业者和医师助理、临床护理专家和注册护士。我们对干预组件进行了叙述性综合，特别是干预临床团队成员所承担的角色和跨学科团队流程，以根据最小临床重要差异和统计学意义比较改善患者报告结局的干预措施。
我们纳入了 34 项研究，共 4722 名参与者，其中 31 项研究报告了至少一项患者报告结局的临床有意义改善。没有纳入的研究总体上存在高偏倚风险。常见的临床团队成员角色包括针对诊断、治疗、应对和疼痛/症状管理的患者教育，以及针对手术后问题、资源传播和护理计划的术后随访。其他干预组件包括与患者接触和患者照顾者参与的六个或更多月的连续临床团队成员联系。
未来的干预措施可能需要优先支持临床团队成员的角色，包括患者教育、照顾者参与和临床随访。
