Managing diabetes during treatment for breast cancer: oncology and primary care providers' views on barriers and facilitators.
Managing diabetes during treatment for breast cancer: oncology and primary care providers' views on barriers and facilitators.
复制标题
DOI：
10.1007/s00520-022-07112-4
复制
发表时间：
2022-08
期刊：
影响因子：
--
通讯作者：
中科院分区：
文献类型：
--
作者：
糖尿病是许多乳腺癌妇女的普遍合并症。在癌症治疗过程中管理糖尿病的角色和责任尚不清楚，因为肿瘤学家缺乏兴趣和临床专业知识，许多患者不再去看他们的初级保健提供者（pcp）。关于谁应该为癌症患者管理糖尿病的不确定性可能导致对幸存者的护理存在差距。我们试图引出提供者的观点关于一种新的糖尿病护理提供干预妇女接受化疗乳腺癌。我们与美国各地的pcp和乳腺肿瘤学家进行了名义上的小组会议。我们引入了一种新的护理模式，其中包括一名在糖尿病方面受过专门培训的执业护士（NP）在肿瘤团队中工作，以管理化疗期间妇女的糖尿病。pcp和肿瘤学家被要求确定干预成功的潜在障碍和促进因素，然后分别投票选出前三个最重要的障碍和促进因素。投票在各届会议期间汇总，并以频率和加权百分比表示。从2020年11月到12月，与pcp进行了两次60分钟的会议，与乳腺肿瘤学家进行了两次60分钟的虚拟会议。共有29名医疗服务提供者参与，其中包括16名pcp和13名乳腺肿瘤学家。在卫生系统层面，确定了两种提供者类型之间最重要的障碍是对以国家规划为主导的干预措施的财政支持。每个护理团队成员明确定义的角色被确定为护理团队级别上最重要的推动者。在患者层面，缺乏针对癌症的糖尿病教育被认为是一个重要的障碍。我们的研究结果强调需要让包括政策制定者、机构领导、护理团队成员和患者在内的各种利益相关者参与进来，以改善对乳腺癌化疗患者的糖尿病护理。因此，多学科干预是必要的，以提高乳腺癌糖尿病患者的意识、参与和自我管理实践。在线版本包含补充材料，可在10.1007/s00520-022-07112-4获得。
Diabetes is a prevalent comorbid condition among many women with breast cancer. The roles and responsibilities of managing diabetes during cancer care are unclear, as oncologists lack interest and clinical expertise and many patients stop seeing their primary care providers (PCPs). Uncertainty around who should manage diabetes for cancer patients can result in gaps in care for survivors. We sought to elicit the perspectives of providers about a novel diabetes care delivery intervention for women undergoing chemotherapy for breast cancer. We conducted nominal group sessions with PCPs and breast oncologists across the USA. We introduced a novel care delivery model, which involved a nurse practitioner (NP) specifically trained in diabetes to work within the oncology team to manage diabetes for women during chemotherapy. PCPs and oncologists were asked to identify potential barriers and facilitators to the intervention’s success and then vote on the top three most important barriers and facilitators, separately. Votes were aggregated across sessions and presented as frequencies and weighted percentages. From November to December 2020, two 60-min sessions with PCPs and two 60-min sessions with breast oncologists were held virtually. In total, 29 providers participated, with 16 PCPs and 13 breast oncologists. At the health system level, financial support for the NP-led intervention was identified as the most important barrier across both provider types. Clearly defined roles for each care team member were identified as the most important facilitator at the care team level. At the patient level, lack of cancer-specific diabetes education was identified as an important barrier. Our findings underscore the need to engage various stakeholders including policy makers, institutional leadership, care team members, and patients to improve diabetes care for patients undergoing chemotherapy for breast cancer. As such, multi-disciplinary interventions are warranted to increase awareness, engagement, and self-management practices among breast cancer patients with diabetes. The online version contains supplementary material available at 10.1007/s00520-022-07112-4.