Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
O'Brien Institute of Public Health, University of Calgary, Calgary, AB, Canada.
BMC Cancer. 2024 Sep 5;24(1):1108. doi: 10.1186/s12885-024-12862-x.
Patients with head and neck cancers (HNC) experience many transitions in care (TiC), occurring when patients are transferred between healthcare providers and/or settings. TiC can compromise patient safety, decrease patient satisfaction, and increase healthcare costs. The evidence around TiC among patients with HNC is sparse. The objective of this study was to improve our understanding of TiC among patients with HNC to identify ways to improve care.
This multimethod study consisted of two phases: Phase I (retrospective population-based cohort study) characterized the number and type of TiC that patients with HNC experienced using deterministically linked, population-based administrative health data in Alberta, Canada (January 1, 2012, to September 1, 2020), and Phase II (qualitative descriptive study) used semi-structured interviews to explore the lived experiences of patients with HNC and their healthcare providers during TiC.
There were 3,752 patients with HNC; most were male (70.8%) with a mean age at diagnosis of 63.3 years (SD 13.1). Patients underwent an average of 1.6 (SD 0.7) treatments, commonly transitioning from surgery to radiotherapy (21.2%). Many patients with HNC were admitted to the hospital during the study period, averaging 3.3 (SD 3.0) hospital admissions and 7.8 (SD 12.6) emergency department visits per patient over the study period. Visits to healthcare providers were also frequent, with the highest number of physician visits being to general practitioners (average = 70.51 per patient). Analysis of sixteen semi-structured interviews (ten patients with HNC and six healthcare providers) revealed three themes: (1) Navigating the healthcare system including challenges with the complexity of HNC care amongst healthcare system pressures, (2) Relational head and neck cancer care which encompasses patient expectations and relationships, and (3) System and individual impact of transitions in care.
This study identified challenges faced by both patients with HNC and their healthcare providers amidst the frequent TiC within cancer care, which was perceived to have an impact on quality of care. These findings provide crucial insights that can inform and guide future research or the development of health interventions aiming to improve the quality of TiC within this patient population.
头颈部癌症（HNC）患者在医疗保健提供者和/或环境之间转移时，会经历许多治疗转换（TiC）。TiC 可能会危及患者安全，降低患者满意度，并增加医疗保健成本。有关 HNC 患者 TiC 的证据很少。本研究的目的是提高我们对头颈部癌症患者 TiC 的认识，以找到改善护理的方法。
这项多方法研究包括两个阶段：第一阶段（回顾性基于人群的队列研究）使用确定性链接的基于人群的行政健康数据，在加拿大艾伯塔省（2012 年 1 月 1 日至 2020 年 9 月 1 日）描述 HNC 患者经历的 TiC 的数量和类型，第二阶段（定性描述性研究）使用半结构化访谈来探索 HNC 患者及其医疗保健提供者在 TiC 期间的生活经历。
有 3752 名 HNC 患者；大多数是男性（70.8%），诊断时的平均年龄为 63.3 岁（SD 13.1）。患者平均接受 1.6 次（SD 0.7）治疗，常见的是从手术转为放疗（21.2%）。许多 HNC 患者在研究期间住院，平均每位患者在研究期间住院 3.3 次（SD 3.0），急诊就诊 7.8 次（SD 12.6）。患者与医疗保健提供者的就诊也很频繁，就诊最多的医生是全科医生（平均每位患者 70.51 次）。对 16 次半结构化访谈（10 名 HNC 患者和 6 名医疗保健提供者）的分析揭示了三个主题：（1）在医疗保健系统中导航，包括医疗保健系统压力下 HNC 护理的复杂性带来的挑战，（2）头颈部癌症的关系护理，包括患者的期望和关系，以及（3）治疗转换对系统和个人的影响。
本研究确定了 HNC 患者及其医疗保健提供者在癌症护理中经常面临的挑战，这些挑战被认为会对护理质量产生影响。这些发现提供了至关重要的见解，可以为未来旨在改善该患者群体 TiC 质量的研究或健康干预措施提供信息和指导。
