Venchiarutti Rebecca L, Dhillon Haryana, Ee Carolyn, Hart Nicolas H, Jefford Michael, Koczwara Bogda
Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Missenden Road, PO Box M5, Camperdown, NSW, 2050, Australia.
Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.
J Cancer Surviv. 2024 Oct 2. doi: 10.1007/s11764-024-01686-0.
Multimorbidity is common in people with cancer and associated with increased complexity of care, symptoms, mortality, and costs. This study aimed to identify priorities for care and research for cancer survivors with multimorbidity.
A Delphi consensus process was conducted. Elements of care and research were based on Australia's National Strategic Framework for Chronic Conditions, a literature review, and expert input. In Round 1, health professionals, cancer survivors, and researchers rated the importance of 18 principles, 9 enablers, and 4 objectives. In Round 2, new elements were rated and all elements were ranked.
In Round 1, all elements reached consensus for care delivery; three principles and one enabler did not reach consensus for research and were eliminated. One principle and two enablers were added, reaching consensus. In the final list, 19 principles, 10 enablers, and 4 objectives were included under care delivery; 14 principles, 9 enablers, and 4 objectives were included under research. For care delivery, principles of 'survivorship' and 'self-management' were ranked highest, and 'peer support' and 'technology' were the most important enablers. For research, 'survivorship' and 'coordinated care' were the highest-ranked principles, with 'peer support' and 'education' the most important enablers.
Most elements apply to the general population and cancer survivors; however, additional elements relevant to survivorship need consideration when managing multimorbidity in cancer survivors.
Chronic disease frameworks should be more inclusive of issues prioritised by people with, managing, or researching cancer through interdisciplinary approaches including acute and primary care.
多种疾病并存的情况在癌症患者中很常见，并且与护理的复杂性增加、症状、死亡率和成本相关。本研究旨在确定患有多种疾病的癌症幸存者的护理和研究重点。
进行了德尔菲共识程序。护理和研究的要素基于澳大利亚慢性病国家战略框架、文献综述和专家意见。在第一轮中，卫生专业人员、癌症幸存者和研究人员对18项原则、9项促进因素和4项目标进行了重要性评级。在第二轮中，对新要素进行了评级，并对所有要素进行了排序。
在第一轮中，所有要素在护理提供方面达成了共识；三项原则和一项促进因素在研究方面未达成共识并被淘汰。增加了一项原则和两项促进因素，达成了共识。在最终列表中，护理提供下包括19项原则、10项促进因素和4项目标；研究下包括14项原则、9项促进因素和4项目标。对于护理提供，“生存”和“自我管理”原则排名最高，“同伴支持”和“技术”是最重要的促进因素。对于研究，“生存”和“协调护理”是排名最高的原则，“同伴支持”和“教育”是最重要的促进因素。
大多数要素适用于一般人群和癌症幸存者；然而，在管理癌症幸存者的多种疾病时，需要考虑与生存相关的其他要素。
慢性病框架应通过包括急性和初级护理在内的跨学科方法，更全面地纳入癌症患者、护理人员或研究人员优先考虑的问题。
