Cancer Survivorship Care Roles for Primary Care Physicians
Cancer Survivorship Care Roles for Primary Care Physicians
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DOI：
10.1370/afm.2498
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发表时间：
2020-05-01
影响因子：
4.4
通讯作者：
Stange, Kurt C.
中科院分区：
文献类型：
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作者：
Crabtree, Benjamin F.;Miller, William L.;Stange, Kurt C.
尽管癌症幸存者人数迅速增加，肿瘤服务短缺，但缺乏明确的定义和系统的方法来参与癌症幸存者的初级保健。我们试图了解初级保健临床医生如何看待他们在向癌症幸存者提供护理方面的作用。方法：我们对14个初级保健实践的38名临床医生进行了数字记录访谈，这些实践在全国享有劳动力创新者的声誉。访谈是在密集的案例研究数据收集过程中进行的，并探讨了临床医生关于他们在癌症生存护理中的作用的观点。我们分析逐字抄本使用归纳和迭代浸没结晶过程。结果：关于初级保健在癌症幸存者护理中的作用，存在不同的观点，缺乏关于幸存者概念的一致性。一些临床医生认为，急性癌症治疗后的任何后续护理都是肿瘤学的责任；然而，大多数人认为癌症幸存者的护理是他们的职责范围。一些初级保健临床医生认为癌症幸存者是一个独特的人群；其他人则认为癌症幸存者就像其他患有慢性病的病人一样。在进一步的解释分析中，我们发现了一种根深蒂固的全人护理理念，当面临快速变化的专业知识时，这种理念给初级保健临床医生带来了职业认同困境。结论：本研究揭示了初级保健的新身份危机，超越了癌症生存护理。促进全国对话可能有助于专家和初级保健开发知识翻译平台，以支持对需要专业知识的高度复杂问题的患者进行优先排序、整合和个性化的初级保健功能。
PURPOSE Despite a burgeoning population of cancer survivors and pending shortages of oncology services, clear definitions and systematic approaches for engaging primary care in cancer survivorship are lacking. We sought to understand how primary care clinicians perceive their role in delivering care to cancer survivors.METHODS We conducted digitally recorded interviews with 38 clinicians in 14 primary care practices that had national reputations as workforce innovators. Interviews took place during intense case study data collection and explored clinicians' perspectives regarding their role in cancer survivorship care. We analyzed verbatim transcripts using an inductive and iterative immersion-crystallization process.RESULTS Divergent views exist regarding primary care's role in cancer survivor care with a lack of coherence about the concept of survivorship. A few clinicians believed any follow-up care after acute cancer treatment was oncology's responsibility; however, most felt cancer survivor care was within their purview. Some primary care clinicians considered cancer survivors as a distinct population; others felt cancer survivors were like any other patient with a chronic disease. In further interpretative analysis, we discovered a deeply ingrained philosophy of whole-person care that creates a professional identity dilemma for primary care clinicians when faced with rapidly changing specialized knowledge.CONCLUSIONS This study exposes an emerging identity crisis for primary care that goes beyond cancer survivorship care. Facilitated national conversations might help specialists and primary care develop knowledge translation platforms to support the prioritizing, integrating, and personalizing functions of primary care for patients with highly complicated issues requiring specialized knowledge.