Systematic Review of the Impact of Cancer Survivorship Care Plans on Health Outcomes and Health Care Delivery
Systematic Review of the Impact of Cancer Survivorship Care Plans on Health Outcomes and Health Care Delivery
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DOI：
10.1200/jco.2018.77.7482
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发表时间：
2018-07-10
影响因子：
45.3
通讯作者：
Rowland, Julia H.
中科院分区：
文献类型：
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作者：
Jacobsen, Paul B.;DeRosa, Antonio P.;Rowland, Julia H.
许多组织建议癌症患者接受生存护理计划（SCP），包括治疗总结和随访护理计划。目前实施的障碍之一是供应商对SCP改善结果的证据强度的担忧。本系统评价是否提供SCP的健康结果和医疗保健交付癌症survivor.MethodsRandomized和nonrandomized研究评估患者报告的结果，医疗保健的使用，并交付SCP后的疾病结果确定搜索MEDLINE，Embase，Psyc-INFO，累积索引护理和相关健康文献，和科克伦图书馆。由独立评分者提取的数据进行了总结的基础上，定性synthes.Results11 nonrandomized和13随机研究符合纳入标准。在癌症类型、SCP交付时间和方法、SCP接受者和内容、SCP相关咨询和评估结果的研究中，变异性是明显的。非随机研究结果产生了关于护理满意度和SCP反应的描述性信息。随机研究结果一般是负面的最常见的评估结果（即，身体，功能和心理健康）;结果是积极的其他结果，包括收到的信息量，满意度与护理，和医生实施的建议care.ConclusionExisting研究提供的证据表明，SCP改善健康状况和医疗保健服务。可能的解释包括研究设计的异质性和单独SCP输送影响远端结局的可能性较低。调查结果是有限的，但更积极的近端结果（例如，收到的信息）和护理提供，特别是当SCP伴随着辅导，以准备幸存者为未来的临床遭遇。对未来研究的建议包括在更大程度上侧重于评估如何确保SCP建议随后作为持续护理的一部分采取行动。
PurposeNumerous organizations recommend that patients with cancer receive a survivorship care plan (SCP) comprising a treatment summary and follow-up care plans. Among current barriers to implementation are providers' concerns about the strength of evidence that SCPs improve outcomes. This systematic review evaluates whether delivery of SCPs has a positive impact on health outcomes and health care delivery for cancer survivors.MethodsRandomized and nonrandomized studies evaluating patient-reported outcomes, health care use, and disease outcomes after delivery of SCPs were identified by searching MEDLINE, Embase, Psyc-INFO, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library. Data extracted by independent raters were summarized on the basis of qualitative synthesis.ResultsEleven nonrandomized and 13 randomized studies met inclusion criteria. Variability was evident across studies in cancer types, SCP delivery timing and method, SCP recipients and content, SCP-related counseling, and outcomes assessed. Nonrandomized study findings yielded descriptive information on satisfaction with care and reactions to SCPs. Randomized study findings were generally negative for the most commonly assessed outcomes (ie, physical, functional, and psychological well-being); findings were positive in single studies for other outcomes, including amount of information received, satisfaction with care, and physician implementation of recommended care.ConclusionExisting research provides little evidence that SCPs improve health outcomes and health care delivery. Possible explanations include heterogeneity in study designs and the low likelihood that SCP delivery alone would influence distal outcomes. Findings are limited but more positive for proximal outcomes (eg, information received) and for care delivery, particularly when SCPs are accompanied by counseling to prepare survivors for future clinical encounters. Recommendations for future research include focusing to a greater extent on evaluating ways to ensure SCP recommendations are subsequently acted on as part of ongoing care.