循序渐进：癌症复发恐惧分级护理管理的临床路径——与澳大利亚卫生专业人员和研究人员进行三轮在线德尔菲共识过程的结果

Step-by-step: A clinical pathway for stepped care management of fear of cancer recurrence-results of a three-round online delphi consensus process with Australian health professionals and researchers.

作者信息

Smith Allan 'Ben', Girgis Afaf, Taylor Natalie, Pearce Alison, Liu Jia, Shepherd Heather L, Wu Verena S, Garvey Gail, Kirsten Laura, Zakhary Iman, Ee Carolyn, Ewald Daniel, Miller Annie, Shaw Joanne

机构信息

The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia.

South West Sydney Clinical Campuses, UNSW Medicine & Health, UNSW Sydney, Liverpool, NSW, Australia.

出版信息

J Cancer Surviv. 2024 Oct 7. doi: 10.1007/s11764-024-01685-1.

DOI:10.1007/s11764-024-01685-1

PMID:39375279

Abstract

PURPOSE

Fear of cancer recurrence (FCR) is not routinely addressed in clinical practice, meaning many cancer survivors forego effective interventions. We established expert consensus on a clinical pathway to help health professionals identify and manage FCR in early-stage cancer survivors.

METHODS

Australian health professionals and researchers working with adult cancer survivors participated in a three-round Delphi study promoted via oncology professional bodies and social media. The Round 1 online survey presented 38 items regarding FCR screening, triage, assessment, referral, and stepped care, based on a literature review, related pathways/guidelines, and expert input. Participants rated how representative of best-practice items were on a 5-point scale (strongly disagree-strongly agree), with optional qualitative feedback. Consensus was defined as ≥ 80% of participants strongly/agreeing with items. Items not reaching consensus were re-presented to Round 1 participants in two subsequent rounds with new items, derived from content analysis of qualitative feedback.

RESULTS

From 94 participants in Round 1 (89% health professionals), 26/38 (68%) items reached consensus. By round 3, 35/38 (92%) items, including 8 new items, reached consensus. Routine FCR screening and triage conversations and stepped care management (i.e. tailored and staged treatment) were endorsed. However, the timing of FCR screening/triage did not reach consensus.

CONCLUSIONS

This world-first FCR clinical pathway incorporating contemporary evidence and expert opinion recommends routine screening and triage to stepped care management of FCR. Some pathway components, such as screening or triage timing, may need tailoring for different contexts.

IMPLICATIONS FOR CANCER SURVIVORS

Implementation of the pathway could aid routine identification and management of FCR, reducing its burden on cancer survivors and the healthcare system.

摘要

目的

癌症复发恐惧（FCR）在临床实践中未得到常规处理，这意味着许多癌症幸存者放弃了有效的干预措施。我们就一条临床路径达成了专家共识，以帮助卫生专业人员识别和管理早期癌症幸存者的FCR。

方法

与成年癌症幸存者合作的澳大利亚卫生专业人员和研究人员参与了一项三轮德尔菲研究，该研究通过肿瘤学专业机构和社交媒体进行推广。第一轮在线调查基于文献综述、相关路径/指南和专家意见，提出了38项关于FCR筛查、分诊、评估、转诊和分级护理的项目。参与者以5分制（强烈不同意 - 强烈同意）对项目代表最佳实践的程度进行评分，并可提供定性反馈。共识定义为≥80%的参与者强烈同意/同意项目。未达成共识的项目在随后两轮中重新呈现给第一轮参与者，并加入从定性反馈内容分析中得出的新项目。