RE: How the Coronavirus Disease-2019 May Improve Care: Rethinking Cervical Cancer Prevention.
RE: How the Coronavirus Disease-2019 May Improve Care: Rethinking Cervical Cancer Prevention.
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DOI：
10.1093/jnci/djaa152
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发表时间：
2021-01-04
期刊：
影响因子：
--
通讯作者：
Battaglia TA
中科院分区：
文献类型：
--
作者：
Clark CR;Haas JS;Lemon SC;Freund KM;Burns White K;Marotta C;Wint AJ;LeClair AM;Lloyd-Travaglini C;Xiao V;Casanova N;Battaglia TA
在《华尔街日报》最近的一篇文章中，费尔德曼和哈斯及时撰写了一篇关于在2019冠状病毒病（COVID-19）时代加强癌症预防和癌症护理提供的潜力的文章（1）。该评论以宫颈癌预防为用例，描述了通过虚拟平台和非传统环境（如患者家中）提供的临床护理，这些领域需要创造性的方法来确保安全有效地提供护理。当我们考虑与COVID-19后提供有效的癌症预防和癌症护理相关的因素时，我们建议将解决健康的社会决定因素（生活经验中经常被遗忘的维度）作为优先考虑的战略，以提高护理提供的公平性（2）。健康的社会决定因素，包括食物和住房不安全，已被证明通过包括延迟和不完整护理在内的多种机制影响癌症患者的结果（3）。作为癌症护理和预防的一部分，存在解决健康社会决定因素的成功方法（3）。例如，通过将研究转化为实践研究，我们正在与肿瘤学实践合作，在新诊断为乳腺癌的种族和民族多样化和低收入患者中实施患者导航的最佳实践模式，其中包括筛查患者的社会需求，并将他们与服务联系起来，以促进及时的乳腺癌护理（4）。自2018年该项目启动以来，我们观察到乳腺癌患者的社会需求是深刻而普遍的：43%的患者在诊断时至少有一种社会需求（表1）。最常见的是病人需要帮助寻找食物（26%）和支付水电费（23%）以及失业困难（24%）。保障住房、支付治疗费用和获得法律的援助也被确定为共同关注的问题。解决基本的社会需求对于提供公平的护理至关重要，这样所有患者都可以在虚拟或传统环境中接受护理。重新制定癌症预防和护理服务以解决健康的社会决定因素具有政策意义，包括对护理支付模式的影响（5）。在医疗保险和医疗补助中心扩大远程医疗和其他虚拟护理报销的方式中，有必要考虑支付模式和策略，以更好地为导航员提供资金，作为解决健康社会决定因素的关键资源，这些决定因素将越来越多地成为COVID-19时代接受护理的障碍和促进因素（5）。当我们实施将研究转化为实践的导航模型时，我们观察到，尽管该模型已整合到肿瘤学项目中，但我们合格人群中有24%的患者没有接受社会需求筛查。进行筛查需要大量时间，需要适当的人员配备和培训。分配适当的资源来实施社会护理工作流程是识别和解决社会需求的导航的关键部分（6）。因此，除了Feldman和哈斯提出的考虑因素外，我们还建议癌症护理指南应扩展到包括以下方面的正式建议：
In a recent article in the Journal, Feldman and Haas wrote a timely piece on the potential to enhance cancer prevention and cancer care delivery in the coronavirus disease 2019 (COVID-19) era (1). Using cervical cancer prevention as a use case, the commentary described clinical care provided via virtual platforms and in nontraditional settings, such as the patient’s home, as areas needing creative approaches to ensure care is provided safely and efficiently. As we consider factors that are relevant to delivering effective cancer prevention and cancer care post-COVID-19, we suggest that addressing social determinants of health, an often-forgotten dimension of lived experience, should be prioritized as a strategy to enhance the equity of care provision (2). Social determinants of health, including food and housing insecurity, have been shown to impact outcomes of patients with cancer through a number of mechanisms including delays and incomplete care (3). Successful approaches exist for addressing social determinants of health as a part of cancer care and prevention (3). As an example, through the Translating Research into Practice study, we are working with oncology practices to implement a best-practice model of patient navigation among racially and ethnically diverse and low-income patients newly diagnosed with breast cancer, which includes screening patients for social needs and connecting them with services to promote timely breast cancer care (4). Since the program began in 2018, we have observed that social needs in our breast cancer patients are profound and common: 43% of our patients have at least one social need at the time of diagnosis (Table 1). Patients’ needs for assistance finding food (26%) and paying for utilities (23%) and difficulties with unemployment (24%) were the most frequently identified. Securing housing, paying for treatment, and obtaining legal assistance were also identified as common concerns. Addressing foundational social needs is essential to providing equitable care so that all patients can receive care, in virtual or traditional settings.Reframing cancer prevention and care delivery to address social determinants of health has policy implications, including implications for care payment models (5). In the ways that the Centers for Medicare and Medicaid has broadened reimbursement for telemedicine and other virtual care, it is necessary to consider payment models and strategies to better fund navigators as critical resources to address social determinants of health that will increasingly become barriers and facilitators to receiving care in the COVID-19 era (5). As we implement the Translating Research into Practice navigation model, we have observed that 24% of patients in our eligible population have not received social needs screening, despite integration of the model within oncology programs. Performing screening is timeintensive and requires appropriate staffing and training. Allocating appropriate resources for implementing workflows for social care is a critical part of navigation to identify and address social needs (6). Therefore, in addition to considerations raised by Feldman and Haas, we also suggest cancer care guidelines be expanded to include formal recommendations for
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将研究转化为实践：社区参与的阶梯式楔形随机试验方案，旨在通过区域患者导航协作减少乳腺癌治疗的差异。
影响因子：
2.2
作者：
Battaglia TA;Freund KM;Haas JS;Casanova N;Bak S;Cabral H;Freedman RA;White KB;Lemon SC;TRIP Consortium
通讯作者：
TRIP Consortium
影响因子：
254.7
作者：
Alcaraz, Kassandra, I;Wiedt, Tracy L.;Wender, Richard C.
通讯作者：
Wender, Richard C.
影响因子：
6.2
作者：
Rodday AM;Parsons SK;Snyder F;Simon MA;Llanos AA;Warren-Mears V;Dudley D;Lee JH;Patierno SR;Markossian TW;Sanders M;Whitley EM;Freund KM
通讯作者：
Freund KM
影响因子：
10.3
作者：
Feldman, Sarah;Haas, Jennifer S.
通讯作者：
Haas, Jennifer S.
影响因子：
3.5
作者：
Clark, Cheryl R.;Baril, Nashira;Bigby, JudyAnn
通讯作者：
Bigby, JudyAnn