与癌症生存者社会风险因素筛查和转介实施相关的背景因素：一项定性研究。
Contextual Factors Relevant to Implementing Social Risk Factor Screening and Referrals in Cancer Survivorship: A Qualitative Study.
机构信息
The George Washington Cancer Center, The George Washington School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia.
Healthcare Delivery Research, MedStar Health Research Institute, Washington, District of Columbia.
出版信息
Prev Chronic Dis. 2024 Apr 4;21:E22. doi: 10.5888/pcd21.230352.
INTRODUCTION
Social risk factors such as food insecurity and lack of transportation can negatively affect health outcomes, yet implementation of screening and referral for social risk factors is limited in medical settings, particularly in cancer survivorship.
METHODS
We conducted 18 qualitative, semistructured interviews among oncology teams in 3 health systems in Washington, DC, during February and March 2022. We applied the Exploration, Preparation, Implementation, Sustainment Framework to develop a deductive codebook, performed thematic analysis on the interview transcripts, and summarized our results descriptively.
RESULTS
Health systems varied in clinical and support staff roles and capacity. None of the participating clinics had an electronic health record (EHR)-based process for identifying patients who completed their cancer treatment ("survivors") or a standardized cancer survivorship program. Their capacities also differed for documenting social risk factors and referrals in the EHR. Interviewees expressed awareness of the prevalence and effect of social risk factors on cancer survivors, but none employed a systematic process for identifying and addressing social risk factors. Recommendations for increasing screening for social risk factors included designating a person to fulfill this role, improving data tracking tools in the EHR, and creating systems to maintain up-to-date information and contacts for community-based organizations.
CONCLUSION
The complexity of cancer care workflows and lack of reimbursement results in a limited ability for clinic staff members to screen and make referrals for social risk factors. Creating clinical workflows that are flexible and tailored to staffing realities may contribute to successful implementation of a screening and referral program. Improving ongoing communication with community-based organizations to address needs was deemed important by interviewees.
简介
社会风险因素，如食物无保障和缺乏交通工具，可能对健康结果产生负面影响，但在医疗环境中，特别是在癌症生存者中，对社会风险因素进行筛查和转介的实施受到限制。
方法
我们在 2022 年 2 月至 3 月期间，在华盛顿特区的 3 个卫生系统中对肿瘤团队进行了 18 次定性、半结构化访谈。我们应用探索、准备、实施、维持框架来开发一个演绎式代码簿，对访谈记录进行主题分析，并以描述性方式总结我们的结果。
结果
卫生系统在临床和支持人员的角色和能力方面存在差异。没有一家参与的诊所拥有基于电子健康记录（EHR）的流程来识别完成癌症治疗的患者（“幸存者”）或标准化的癌症生存者计划。他们在 EHR 中记录社会风险因素和转介的能力也存在差异。受访者表示意识到社会风险因素对癌症幸存者的普遍性和影响，但没有人采用系统的方法来识别和解决社会风险因素。增加社会风险因素筛查的建议包括指定一个人来履行这一角色，改进 EHR 中的数据跟踪工具，以及创建系统来维护社区组织的最新信息和联系人。
结论
癌症护理工作流程的复杂性和缺乏报销导致诊所工作人员筛查和转介社会风险因素的能力有限。创建灵活且符合人员配备实际情况的临床工作流程可能有助于成功实施筛查和转介计划。改善与社区组织的持续沟通以满足需求被受访者认为是重要的。
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