儿童癌症幸存者多发慢性病的连续性与协调性护理：儿童癌症幸存者研究的结果

Continuity and coordination of care for childhood cancer survivors with multiple chronic conditions: Results from the Childhood Cancer Survivor Study

CANCER

影响因子:5.1

分区:医学1区 Top / 肿瘤学2区

发表日期:2024 Dec 15

作者: Claire Snyder, Katherine C Smith, Wendy M Leisenring, Kayla L Stratton, Cynthia M Boyd, Youngjee Choi, Lorraine T Dean, Melissa M Hudson, Eric J Chow, Kevin C Oeffinger, Elyse R Park, Aaron J McDonald, Gregory T Armstrong, Paul C Nathan

DOI: 10.1002/cncr.35522

摘要

儿童癌症幸存者多发慢性病的连续性和协调性护理研究不足，但对其后续护理至关重要。2022年4月至6月，使用“多学科临床医生的患者感知连续性护理”问卷，通过电子邮件向800名患有两种及以上慢性病（其中一种或多种为严重/危及生命/致残）的儿童癌症幸存者参与者发送。问卷内容包括主要（负责大部分医疗）和协调（确保随访）提供者，生成三个护理协调总结得分（主要提供者、跨多提供者、患者-提供者合作关系），并包括六个不连续指标（如需自己组织护理）。定义不连续为在一项或多项指标表现不佳。采用卡方检验分析不连续性与社会人口学特征的关系。利用修正的Poisson回归模型估算与主提供者和协调提供者的就诊年数以及护理协调得分相关的不连续风险比（PR）。调整非参与调查的逆概率权重。共收到377份回复（占47%，平均年龄48岁，女性68%，非西班牙裔白人89%，私人保险78%，本科及以上74%）；其中39%报告存在不连续。年轻幸存者更可能报告不连续（p=0.02）。与主提供者就诊≤3年相关的不连续发生率较高（PR，1.17；95% CI，1.02-1.34，≥10年为对照）。由肿瘤专业医生担任主要提供者与较少不连续相关（PR，0.81；95% CI，0.66-0.99），而所有三项护理协调得分较好者均与较低不连续风险相关：主要提供者（PR，0.73；95% CI，0.64-0.83）、跨多提供者（PR，0.81；95% CI，0.78-0.83）以及患者-提供者合作（PR，0.85；95% CI，0.80-0.89）。儿童癌症幸存者中的护理不连续性普遍存在，亟需干预。

Abstract

Continuity and coordination-of-care for childhood cancer survivors with multiple chronic conditions are understudied but critical for appropriate follow-up care.From April through June 2022, 800 Childhood Cancer Survivor Study participants with two or more chronic conditions (one or more severe/life-threatening/disabling) were emailed the "Patient Perceived Continuity-of-Care from Multiple Clinicians" survey. The survey asked about survivors' main (takes care of most health care) and coordinating (ensures follow-up) provider, produced three care-coordination summary scores (main provider, across multiple providers, patient-provider partnership), and included six discontinuity indicators (e.g., having to organize own care). Discontinuity (yes/no) was defined as poor care on one or more discontinuity item. Chi-square tests assessed associations between discontinuity and sociodemographics. Modified Poisson regression models estimated prevalence ratios (PRs) for discontinuity risk associated with the specialty and number of years seeing the main and coordinating provider, and PRs associated with better scores on the three care-coordination summary measures. Inverse probability weights adjusted for survey non-participation.A total of 377 (47%) survivors responded (mean age 48 years, 68% female, 89% non-Hispanic White, 78% privately insured, 74% ≥college graduate); 147/373 (39%) reported discontinuity. Younger survivors were more likely to report discontinuity (chi-square p = .02). Seeing the main provider ≤3 years was associated with more prevalent discontinuity (PR; 95%CI) (1.17; 1.02-1.34 vs ≥ 10 years). Cancer specialist main providers were associated with less prevalent discontinuity (0.81; 0.66-0.99 vs. primary care). Better scores on all three care-coordination summary measures were associated with less prevalent discontinuity: main provider (0.73; 0.64-0.83), across multiple providers (0.81; 0.78-0.83), patient-provider partnership (0.85; 0.80-0.89).Care discontinuity among childhood cancer survivors is prevalent and requires intervention.