Valentini Jan, Froehlich Daniela, Roesel Inka, Stolz Regina, Mahler Cornelia, Martus Peter, Klafke Nadja, Horneber Markus, Witte Claudia, Kramer Klaus, Greil Christine, Gruen Barbara, Tomaschko-Ubelaender Katrin, Joos Stefanie
Institute for General Practice and Interprofessional Care, University Hospital and Faculty of Medicine Tuebingen, Tuebingen, Germany.
Institute for Clinical Epidemiology and Applied Biostatistics, University Hospital and Faculty of Medicine Tuebingen, Tuebingen, Germany.
Front Med. 2024 Dec;18(6):1013-1025. doi: 10.1007/s11684-024-1097-z. Epub 2024 Nov 14.
Complementary and integrative healthcare (CIH) is increasingly recognized as a valuable approach to empowering and activating cancer patients. Studies have shown that higher patient activation is positively associated with improved health outcomes and reduced healthcare costs. The CCC-Integrativ study aimed to assess the implementation of an evidence-based counseling service on CIH at four Comprehensive Cancer Centers (CCC) in Germany. In this controlled implementation study, the patient-level intervention included three CIH consultations within a 3-month period delivered by interprofessional teams of physicians and nurses. The primary endpoint was patient activation using the PAM-13 at baseline (T1) and post-intervention (T2), and compared between control (CO, receiving routine care) and the intervention group (IG) using an analysis of covariance. Missing data were handled with multiple imputations. Maintenance effects at 6-month follow-up (T3) were investigated using a linear mixed model. A total of n = 1128 oncology patients (CO = 443, IG = 685) with diverse tumor entities and cancer stages were included in the study. The overall mean baseline PAM-13 score was 69.74 (SD = 14.24) (n = 959 (85.0%)). A statistically significant between-group difference in post-intervention PAM-13 scores was observed (F(1, 1866.82) = 8.634, P = 0.003), with an adjusted mean difference of 2.22 PAM-points. Age, gender, tumor entity, disease stage, or CCC study site did not significantly predict post-treatment PAM-13 scores. The maintenance effect of the intervention was not statistically significant (F(1, 3316.04) = 2.337, P = 0.096). Individually tailored counseling on CIH, offered by specifically trained, interprofessional teams, significantly improved patient activation. Given the established positive effects of higher patient activation, the implementation of such a program at cancer centers may yield beneficial outcomes for both patients and the healthcare system.
补充与整合医疗保健（CIH）越来越被认为是增强和激活癌症患者能力的一种有价值的方法。研究表明，患者激活程度越高，与改善的健康结果和降低的医疗成本呈正相关。CCC-Integrativ研究旨在评估在德国四个综合癌症中心（CCC）实施基于证据的CIH咨询服务的情况。在这项对照实施研究中，患者层面的干预包括在3个月内由医生和护士的跨专业团队提供三次CIH咨询。主要终点是在基线（T1）和干预后（T2）使用PAM-13评估患者激活情况，并使用协方差分析在对照组（CO，接受常规护理）和干预组（IG）之间进行比较。缺失数据采用多重插补法处理。使用线性混合模型研究6个月随访（T3）时的维持效果。该研究共纳入了n = 1128名患有不同肿瘤类型和癌症阶段的肿瘤患者（CO = 443，IG = 685）。总体平均基线PAM-13评分为69.74（标准差 = 14.24）（n = 959（85.0%））。干预后PAM-13评分在组间存在统计学显著差异（F(1, 1866.82) = 8.634，P = 0.003），调整后的平均差异为2.22个PAM点。年龄、性别（此处原文可能有误，推测为性别，根据语境调整）、肿瘤类型、疾病阶段或CCC研究地点均未显著预测治疗后PAM-13评分。干预的维持效果无统计学显著性（F(1, 3316.04) = 2.337，P = 0.096）。由经过专门培训的跨专业团队提供的针对CIH的个性化咨询显著提高了患者激活程度。鉴于较高的患者激活程度已确立的积极效果，在癌症中心实施这样的项目可能会给患者和医疗系统都带来有益的结果。
