Aleshchenko Ekaterina, Langer Thorsten, Calaminus Gabriele, Gebauer Judith, Swart Enno, Baust Katja
Faculty of Medicine, Institute of Social Medicine and Health Systems Research, Otto von Guericke University, Magdeburg, Germany.
University Hospital of Schleswig-Holstein, Lübeck, Germany.
Front Public Health. 2025 Mar 3;13:1524310. doi: 10.3389/fpubh.2025.1524310. eCollection 2025.
This study examines the organization of long-term follow-up care for pediatric cancer survivors through the lens of Bronfenbrenners' Ecological Systems Theory (EST). Using focus group discussions with survivors and healthcare professionals across Germany, we aimed to identify challenges and facilitators in care provision. Data were gathered during four focus groups, each consisting of 5-9 participants. A multimethods approach was used, employing both inductive and deductive thematic analysis. Results indicated key challenges such as fragmented care during transitions and insufficient offer of psychological support. The application of EST revealed the importance of coordinating care across multiple system levels: microsystem (direct care), mesosystem (coordination between care settings), exosystem (healthcare policies), and macrosystem (cultural attitudes). The study proposes strategies to improve care, such as implementing case managers and introducing culturally sensible long-term follow-up protocols. These findings highlight the complexity of survivorship care and the need for a more integrated approach to meet the evolving needs of survivors after childhood and adolescent cancer.
本研究通过布朗芬布伦纳的生态系统理论（EST）视角，审视了儿童癌症幸存者的长期后续护理组织情况。通过与德国各地的幸存者和医疗保健专业人员进行焦点小组讨论，我们旨在确定护理提供过程中的挑战和促进因素。在四个焦点小组中收集了数据，每个小组由5至9名参与者组成。采用了多方法途径，运用归纳和演绎主题分析。结果表明了关键挑战，如过渡期间护理分散以及心理支持提供不足。EST的应用揭示了跨多个系统层面协调护理的重要性：微观系统（直接护理）、中观系统（护理环境之间的协调）、外部系统（医疗保健政策）和宏观系统（文化态度）。该研究提出了改善护理的策略，如实施个案管理师和引入具有文化敏感性的长期随访方案。这些发现凸显了幸存者护理的复杂性，以及需要一种更综合的方法来满足儿童和青少年癌症幸存者不断变化的需求。
