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初级保健中癌症的症状表现:癌症诊断途径中患者体验和需求的范围综述。

Symptomatic presentation of cancer in primary care: a scoping review of patients' experiences and needs during the cancer diagnostic pathway.

机构信息

Brighton & Sussex Medical School, University of Sussex, Brighton, UK.

Department of Health Care Management & Policy, University of Surrey, Guildford, Surrey, UK.

出版信息

BMJ Open. 2024 Mar 20;14(3):e076527. doi: 10.1136/bmjopen-2023-076527.

Abstract

OBJECTIVES

The objective was to map the experiences and needs of patients presenting with symptoms of suspected cancer in the primary care interval (from when they first present to primary care to their first appointment or referral to a secondary or tertiary level healthcare facility).

DESIGN

This was a scoping review.

INCLUSION CRITERIA

Studies or reports written in English which included primary data on the primary care interval experiences and/or needs of adult patients presenting with new symptoms of suspected cancer were eligible. Studies which only included patients with secondary or recurring cancer, conference abstracts and reviews were excluded. No date limits were applied.

METHODS

The Joanna Briggs Institute method for Scoping Reviews guided screening, report selection and data extraction. At least two independent reviewers contributed to each stage. Medline, CINAHL, PsychInfo, Embase and Web of Science were searched and several grey literature resources. Relevant quantitative findings were qualitised and integrated with qualitative findings. A thematic analysis was carried out.

RESULTS

Of the 4855 records identified in the database search, 18 were included in the review, along with 13 identified from other sources. The 31 included studies were published between 2002 and 2023 and most (n=17) were conducted in the UK. Twenty subthemes across four themes (patient experience, interpersonal, healthcare professional (HCP) skills, organisational) were identified. No studies included patient-reported outcome measures. Patients wanted (1) to feel heard and understood by HCPs, (2) a plan to establish what was causing their symptoms, and (3) information about the next stages of the diagnostic process.

CONCLUSIONS

Scoping review findings can contribute to service planning as the cancer diagnostic pathway for symptomatic presentation of cancer evolves. The effectiveness of this pathway should be evaluated not only in terms of clinical outcomes, but also patient-reported outcomes and experience, along with the perspectives of primary care HCPs.

摘要

目的

本研究旨在绘制在初级保健间隔期(从首次就诊于初级保健到首次预约或转诊至二级或三级医疗机构)出现疑似癌症症状的患者的体验和需求图谱。

设计

这是一项范围性综述。

纳入标准

纳入的研究或报告必须使用英文撰写,并包含关于出现新疑似癌症症状的成年患者在初级保健间隔期的体验和/或需求的原始数据。仅纳入二级或复发性癌症患者、会议摘要和综述的研究被排除在外。未设定日期限制。

方法

本研究采用乔安娜·布里格斯研究所(Joanna Briggs Institute)的范围性综述方法来指导筛选、报告选择和数据提取。每个阶段至少有两名独立审查员参与。检索了 Medline、CINAHL、PsychInfo、Embase 和 Web of Science 数据库,并查阅了一些灰色文献资源。对相关的定量发现进行了定性分析,并与定性发现进行了整合。采用主题分析法进行分析。

结果

在数据库搜索中确定了 4855 条记录,其中 18 条被纳入综述,另有 13 条是从其他来源确定的。纳入的 31 项研究发表于 2002 年至 2023 年期间,其中大多数(n=17)在英国进行。确定了四个主题下的 20 个子主题(患者体验、人际关系、医疗保健专业人员技能、组织)。没有研究纳入患者报告的结果测量指标。患者希望(1)能被医疗保健专业人员倾听和理解,(2)制定一个确定导致其症状原因的计划,以及(3)了解诊断过程的下一个阶段的信息。

结论

随着癌症诊断途径因癌症症状就诊而不断发展,范围性综述结果可有助于服务规划。不仅应从临床结果的角度,还应从患者报告的结果和体验以及初级保健医疗保健专业人员的角度评估该途径的有效性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c3f1/10961516/96d17f5af10e/bmjopen-2023-076527f01.jpg

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