Breast cancer follow-up: could primary care be the right venue?
Breast cancer follow-up: could primary care be the right venue?
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DOI：
10.1185/030079906x96407
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发表时间：
2006-04-01
影响因子：
2.3
通讯作者：
Reed, Malcolm
中科院分区：
文献类型：
--
作者：
Jiwa, Moyez;Thompson, Joanne;Reed, Malcolm
目的：参考英国一个地区的主要利益相关者，确定初级保健中乳腺癌患者随访方案的要素。方法：第一阶段：对100例与接受乳腺癌治疗的患者相关的连续医院记录进行调查。确定了在后续行动中管理的最常见问题以及所使用资源的类型和频率。阶段2：与利益相关者组成焦点小组，确定乳腺癌患者在成功治疗后在初级保健中进行随访的潜在障碍。阶段3：一个名义上的小组概述了初级护理的随访方案的要素。结果：在702个患者年的随访中，最常见的问题是焦虑、无关的医疗问题和关节疼痛。焦虑和抑郁往往出现得相对较快，而且往往是持久的，而伴随而来的医疗问题也会在以后出现。卫生保健专业人员认为患者很难管理，因为复发症状需要进行调查，以绝对保证有症状的患者。然而，除了乳房X光检查之外，很少有必要进行其他调查。结论：一个多学科小组认为，关注乳腺癌的心理社会后遗症是随访的一个重要方面。专利及其合作伙伴正全神贯注于对复发的恐惧。这可能会以各种形式表现出来，包括精神健康问题。这些问题可以在初级保健中得到解决，特别是在辅导员的支持下，以及团队合作和商定的转介方案，以便在需要时转回专家那里。
Aims: To identify the elements of a follow-up protocol for treated breast cancer patients in primary care with reference to key stakeholders in one region of the UK.Methods: Stage 1: a survey of 100 consecutive hospital records relating to patients treated for primary breast cancer. The most common problems managed at follow-up and the type and frequency of resources used were identified. Stage 2: focus groups with stakeholders identifying potential barriers to follow-up of breast cancer patients in primary care after successful therapy. Stage 3: a nominal group outlined the elements of a follow-up protocol in primary care.Results: The most frequently recorded problems in 702 patient years of follow-up were anxiety, unrelated medical problems and joint pain. Anxiety and depression tend to present relatively soon and are often enduring whereas concomitant medical problems also present later. Health care professionals considered patients difficult to manage because symptoms of recurrence require investigation for absolute reassurance of the symptomatic patient. However, investigations other than mammograms were seldom necessary.Conclusions: A multidisciplinary panel identified attention to the psychosocial sequelea of breast cancer as a vital aspect of follow-up. Patents and their partners are preoccupied with a fear of recurrence. This may manifest in a variety of guises including mental health problems. These can be addressed in primary care especially with the support of counsellors, with teamwork and agreed protocols for referral back to specialists when indicated.