Oncol Nurs Forum. 1997 Jul;24(6):951-3.
The cost-reduction emphasis in healthcare restructuring threatens the delivery of quality cancer care. A primary focus on cost by payors and delivery systems signals an onerous intention to limit access to essential components of cancer care. This is exemplified in recent trends including that Payors restrict access to specialty oncology care. Payors impose limitations on selection of treatment options and access to supportive-care services. Registered nurses are encouraged to generalize rather than specialize in oncology. Experienced oncology registered nurses, including expert advanced practice nurses and senior nurse executives, have lost jobs. Specialized oncology units have dissolved or combined with non-specialty units. Chemotherapy drugs are administered either by nurses lacking oncology knowledge and chemotherapy competencies or lesser-skilled assistive personnel. The oncology registered nurse role in the multidisciplinary team is pivotal in creating an environment conducive to quality patient care. Therefore, it is the position of the Oncology Nursing Society that Quality cancer care is a right of all citizens. Quality cancer care entails timely access to and reimbursement for a coordinated, comprehensive approach to care provided by a multidisciplinary team throughout the cancer trajectory that includes prevention, early detection, treatment, supportive care, long-term follow-up, and end-of-life care. Quality cancer care is culturally competent, ethical, and cost-effective. Quality cancer care incorporates the individual with cancer (and the family) as fully-informed partners and decision-makers. Quality cancer care is coordinated and delivered by competent cancer care providers. Accountability and coordination of quality cancer care is best accomplished by registered nurses who have been educated and certified in the oncology specialty. Oncology advanced practice nurses should be utilized in all cancer care delivery systems. Oncology nursing must be included with equal parity to that of medicine and other disciplines in the planning and implementation of cancer care services.
医疗保健结构调整中对成本降低的强调威胁到了优质癌症护理的提供。支付方和医疗服务提供系统对成本的主要关注表明了一种限制获得癌症护理基本要素的苛刻意图。这在最近的趋势中得到了体现，包括支付方限制获得专科肿瘤护理的机会；支付方对治疗方案的选择和获得支持性护理服务施加限制；鼓励注册护士进行综合护理而非专注于肿瘤学；经验丰富的肿瘤学注册护士，包括专家级高级实践护士和高级护士管理人员，失去了工作；专门的肿瘤科室已经解散或与非专科科室合并；化疗药物由缺乏肿瘤学知识和化疗能力的护士或技能较低的辅助人员进行给药。肿瘤学注册护士在多学科团队中的角色对于营造有利于优质患者护理的环境至关重要。因此，肿瘤护理协会的立场是，优质癌症护理是所有公民的权利。优质癌症护理需要及时获得并报销由多学科团队在整个癌症病程中提供的协调、全面的护理方法，包括预防、早期检测、治疗、支持性护理、长期随访和临终护理。优质癌症护理具有文化适应性、符合伦理且具有成本效益。优质癌症护理将癌症患者（及其家庭）作为充分知情的合作伙伴和决策者纳入其中。优质癌症护理由称职的癌症护理提供者进行协调和提供。优质癌症护理的问责和协调最好由在肿瘤学专科接受过教育并获得认证的注册护士来完成。应在所有癌症护理提供系统中利用肿瘤学高级实践护士。在癌症护理服务的规划和实施中，肿瘤护理必须与医学及其他学科享有同等地位。
