Communicating About Chemotherapy-Induced Nausea and Vomiting: A Comparison of Patient and Provider Perspectives
Communicating About Chemotherapy-Induced Nausea and Vomiting: A Comparison of Patient and Provider Perspectives
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DOI：
10.6004/jnccn.2012.0018
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发表时间：
2012-02-01
影响因子：
13.4
通讯作者：
Cella, David
中科院分区：
文献类型：
--
作者：
Salsman, John M.;Grunberg, Steven M.;Cella, David
尽管最近取得了进展，但化疗引起的恶心和呕吐(CINV)，特别是延迟的CINV，仍然是一个问题。延迟的CINV被低估了，提供者和患者的看法也不同。提供者和患者之间就这种副作用进行沟通可能有助于改善结果。这项研究确定了患者和提供者对管理的看法以及高质量CINV护理的障碍。为了解决潜在的障碍，开发了提供者和患者版本的恶心和呕吐管理障碍问卷。提供者和患者有机会在开放式问题中添加细节。提供者是通过NCCN和肿瘤学护理学会的邮件列表招募的。通过倡导团体联盟招募接受至少2个周期化疗并经历过CINV的患者。提供者(n=141)和患者(n=299)都完成了调查。提供者(41%)和患者(42%)同意药物副作用是一个令人担忧的问题，但更多的患者(63%)比提供者(36%)试图限制药物服用的数量(P<；.0001)。许多提供者(67%)自发地报告了管理CINV的障碍，其中最常见的是财务和患者相关因素。很少有患者(10%)报告说成本是一种障碍，但37%的患者支持“通过不抱怨而变得强大”的愿望。CINV的沟通和高质量护理的障碍在照顾者和患者之间存在差异。解决误解和建立相互一致的目标将导致更有效的整体护理。(JNCCN 2012；10：149-157)
Despite recent progress, chemotherapy-induced nausea and vomiting (CINV), especially delayed CINV, continues to be a problem. Delayed CINV is underestimated and perceived differently by providers and patients. Communication between providers and patients about this side effect may help improve outcomes. This study identifies patients' and providers' perceptions of management and barriers to quality CINV care. Provider and patient versions of a Nausea and Vomiting Management Barriers Questionnaire were developed to address potential barriers. Providers and patients were given opportunities to add detail in open-ended questions. Providers were recruited through the NCCN and the Oncology Nursing Society mailing lists. Patients who received at least 2 cycles of chemotherapy and experienced CINV were recruited through a consortium of advocacy groups. Both providers (n = 141) and patients (n = 299) completed the survey. Providers (41%) and patients (42%) agreed medication side effects were a concern, but more patients (63%) than providers (36%) tried to limit the number of medications taken (P < .0001). Many providers (67%) spontaneously reported barriers to managing CINV, with financial and patient-related factors among the most common. Few patients (10%) reported cost as a barrier, but 37% endorsed the desire "to be strong by not complaining." Barriers to communication and quality care of CINV differ between caregivers and patients. Addressing misconceptions and establishing mutually consistent goals will lead to more effective overall care. (JNCCN 2012;10:149-157)