Evaluating potential overuse of surveillance care in cancer survivors.
Evaluating potential overuse of surveillance care in cancer survivors.
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生存护理计划（SCPs）将癌症相关信息从肿瘤学提供者传递给患者和初级保健提供者。scp可以通过指定必要的后续护理来限制过度使用测试。从一项随机对照试验中，我们检查了在SCP接收后进行的未在SCP中指定的癌症相关测试是否合适或是否与过度使用一致。在城市-学术或农村-社区卫生系统接受治疗的乳腺癌、结直肠癌或前列腺癌幸存者被随机分配到三种SCP递送组中的一种。如果收到SCP后18个月内的测试(1)不包含在SCP中，(2)在基于指南的预先确定的“不推荐监视”列表中，则将其归类为与过度使用一致。在病历抽象化后，医生对潜在的过度用药进行审查和判定。对与过度使用相符的试验进行了描述性分析。负二项回归模型确定了在不同的研究组中是否与过度用药一致。在316例患者中（137例乳腺，67例结肠直肠，112例前列腺），140例个体检查被确定为潜在的过度使用。经审查，98项被认为与过度使用一致：78项肿瘤标志物和20项影像学检查。大多数过度使用检测与乳腺癌相关（95%）。在各个站点，27例患者（9%）接受了与过度用药一致的≥1次试验；大多数是乳腺癌患者（22/27）。两组间过度使用测试频率的探索性分析显示差异无统计学意义。该分析确定了与过度使用监测测试相一致的实践模式，可以为改进指南-一致性护理的努力提供信息。未来的干预措施可能包括个人实践模式和提供者教育。学术和社区癌症中心的癌症幸存者都经历了过度使用监测测试。该分析确定了与过度使用监测模式相一致的实践模式，可以为改进指南-一致性护理的努力提供信息。
Survivorship care plans (SCPs) communicate cancer‐related information from oncology providers to patients and primary care providers. SCPs may limit overuse testing by specifying necessary follow‐up care. From a randomized, controlled trial of SCP delivery, we examined whether cancer‐related tests not specified in SCPs, but conducted after SCP receipt, were appropriate or consistent with overuse. Survivors of breast, colorectal, or prostate cancer treated at urban‐academic or rural‐community health systems were randomized to one of three SCP delivery arms. Tests during 18 months after SCP receipt were classified as consistent with overuse if they were (1) not included in SCPs and (2) on a guideline‐based predetermined list of “not recommended surveillance.” After chart abstraction, physicians performed review and adjudication of potential overuse. Descriptive analyses were conducted of tests consistent with overuse. Negative binomial regression models determined if testing consistent with overuse differed across study arms. Among 316 patients (137 breast, 67 colorectal, 112 prostate), 140 individual tests were identified as potential overuse. Upon review, 98 were deemed to be consistent with overuse: 78 tumor markers and 20 imaging tests. The majority of overuse testing was breast cancer‐related (95%). Across sites, 27 patients (9%) received ≥1 test consistent with overuse; most were breast cancer patients (22/27). Exploratory analyses of overuse test frequency by study arm showed no significant difference. This analysis identified practice patterns consistent with overuse of surveillance testing and can inform efforts to improve guideline‐concordant care. Future interventions may include individual practice patterns and provider education. Cancer survivors at both academic and community cancer centers experienced overuse of surveillance testing. This analysis identified practice patterns consistent with overuse of surveillance patterns and can inform efforts to improve guideline‐concordant care.
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DOI：
10.1007/s11764-013-0290-x
发表时间：
2013-09
期刊：
Journal of cancer survivorship : research and practice
影响因子：
--
作者：
Carpentier MY;Vernon SW;Bartholomew LK;Murphy CC;Bluethmann SM
通讯作者：
Bluethmann SM
影响因子：
2.8
作者：
Choi, Youngjee;Smith, Katherine C.;Snyder, Claire F.
通讯作者：
Snyder, Claire F.
影响因子：
39
作者：
Merkow RP;Korenstein D;Yeahia R;Bach PB;Baxi SS
通讯作者：
Baxi SS
影响因子：
4.5
作者：
Monticciolo, Debra L.;Newell, Mary S.;Sickles, Edward A.
通讯作者：
Sickles, Edward A.
影响因子：
--
作者：
Grunfeld, Eva;Hodgson, David C.;Moineddin, Rahim
通讯作者：
Moineddin, Rahim