初级保健提供者和肿瘤学家在癌症和合并症患者积极治疗过程中对护理沟通和协调的看法差异

Julia P Brockway, Keerti Murari, Alexandra Rosenberg, Orit Saigh, M. Press, Jenny J. Lin
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引用次数: 2

摘要

癌症患者合并症的管理往往不明确。我们研究的目的是确定初级保健提供者和肿瘤学家在接受积极癌症治疗的患者的护理协调和合并症管理方面的知识、态度和信念的异同。方法:2014年3月至12月,我们对纽约市三家学术医院(西奈山医院、贝斯以色列西奈山医院和威尔康奈尔医院)约600名门诊和住院的初级保健和肿瘤内科医生进行了一项匿名自我调查,并进行了横断面研究。我们的调查工具评估医生的知识,态度和信念使用临床小插曲的癌症患者接受积极治疗。描述性统计用于总结调查反应的人口学和实践细节,单变量分析用于评估初级保健提供者和肿瘤学家之间反应的差异。结果共有203名医护人员完成调查,其中初级保健人员127名(62.5%),肿瘤内科医师32名(15.8%),姑息治疗医师11名(5.4%),执业护士或医师助理33名(16.3%)。肿瘤学家承认,与初级保健提供者相比,谁应该管理预防保健更不确定(34.4%对16.5%,p = 0.02),而初级保健提供者更关心重复护理(22.8%对6.3%,p = 0.03)。初级保健提供者和医学肿瘤学家都同意在癌症治疗期间应积极管理糖尿病。更多的初级保健提供者认为允许不那么严格的血糖控制(56.8%对37.5%,p = 0.05),并且允许患者错过一些与糖尿病相关的就诊(80.6%对56.3%,p = 0.01)。初级保健提供者和医学肿瘤学家在接受癌症治疗的患者的合并症的护理和管理的协调方面的知识、态度和信念不同。这些差异反映了向癌症患者提供护理的系统性挑战以及对护理协调模式的需求。
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Differences in primary care providers’ and oncologists’ views on communication and coordination of care during active treatment of patients with cancer and comorbidities
Introduction Management of comorbid diseases in patients with cancer is often unclear. The purpose of our study was to identify differences and similarities between primary care providers and oncologists’ knowledge, attitudes, and beliefs regarding coordination of care and comorbid disease management for patients undergoing active cancer treatment. Methods We conducted a cross-sectional study using an anonymous self-administered survey which was available to approximately 600 providers in primary care and medical oncology practicing in both outpatient and inpatient settings from March to December 2014 at three academic hospitals in New York City (Mount Sinai Hospital, Mount Sinai Beth Israel, and Weill Cornell). Our survey instrument assessed physician knowledge, attitudes, and beliefs using a clinical vignette of a cancer patient undergoing active treatment. Descriptive statistics were used to summarize the demographic and practice details of survey responses, and univariate analyses were used to assess differences in responses between primary care providers and oncologists. Results The survey was completed by 203 providers, including 127 primary care providers (62.5%), 32 medical oncologists (15.8%), 11 palliative care physicians (5.4%), and 33 nurse practitioners or physician assistants (16.3%). Medical oncologists admitted more uncertainty regarding who should manage preventive care as compared to primary care providers (34.4% vs. 16.5%, p = 0.02), whereas primary care providers were more concerned about duplicated care (22.8% vs. 6.3%, p = 0.03). Both primary care providers and medical oncologists agreed that diabetes should be actively managed during cancer treatment. More primary care providers felt less strict glycemic control was allowable (56.8% vs. 37.5%, p = 0.05) and that it is allowable for patients to miss some diabetes-related visits (80.6% vs. 56.3%, p = 0.01). Discussion Primary care providers and medical oncologists differ in their knowledge, attitudes, and beliefs regarding coordination of care and management of comorbid conditions in patients undergoing cancer treatment. These differences reflect systemic challenges to provision of care to cancer patients and the need for a model of care coordination.
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来源期刊
CiteScore
3.10
自引率
14.30%
发文量
15
期刊介绍: The International Journal of Care Coordination (formerly published as the International Journal of Care Pathways) provides an international forum for the latest scientific research in care coordination. The Journal publishes peer-reviewed original articles which describe basic research to a multidisciplinary field as well as other broader approaches and strategies hypothesized to improve care coordination. The Journal offers insightful overviews and reflections on innovation, underlying issues, and thought provoking opinion pieces in related fields. Articles from multidisciplinary fields are welcomed from leading health care academics and policy-makers. Published articles types include original research, reviews, guidelines papers, book reviews, and news items.
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