癌症生存者照护国际经验与构建创新照护模式的建议

近20年来部分发达国家癌症5年生存率大幅提高,而我国与之相比尚存在差距.研究发现,发展癌症生存者照护对于生存率的提升有积极作用,其实践经验和研究成果值得借鉴.全文通过总结其他国家和地区在生存者概念引入、规模估计、生存照护体系建设、照护模式开发等方面的经验与成果,结合中国癌症生存者管理现状及面临的挑战,为构建适于国情的癌...     

The Hospitalist Model and Oncology: Oncologist Opinions About Inpatient Cancer Care Delivery

Hospitalists, rather than oncologists, are increasingly providing inpatient medical care to hospitalized patients with cancer, yet the opinions of oncologists regarding this model of care delivery are unknown. A survey was conducted assessing these opinions and experiences with inpatient cancer care delivery at a tertiary cancer center. Only 30% of oncologists agreed that caring for hospitalized patients with cancer was an efficient use of their time, and most believed a hospitalist service allowed them to pursue other interests. Most had a positive experience with hospitalists, agreeing that hospitalists can diagnose and manage toxicities of cancer therapy, exhibit professionalism, and communicate with them and their patients appropriately. Hematologic malignancy specialists were more likely to value inpatient service time and had less confidence in the ability of hospitalists. Overall, the hospitalist model was generally accepted by oncologists and will continue to be an important part of oncologic care delivery.     

Oral Cancer Knowledge,Attitudes and Practices among Primary Oral Health Care Dentists in Kuwait

Background: Oral cancer signifies a public health concern of international importance. Early detection of oral cancercan improve the prognosis and the 5-year survival rate. Objective: The aim of this study was to assess the level of oralcancer knowledge, opinion, attitudes and practices among dentists working at the primary oral health care centers inKuwait. Methods: In this cross-sectional study, self-reported questionnaire was distributed to the dentists working atthe primary oral health care centers in Kuwait. A total of 289 dentists participated in the present study. The questionnaireincluded 23- questions on oral cancer knowledge, opinion, attitudes and practices. Results: The mean age of the dentistswas 35.2 ± 10.9 years. Approximately, all dentists (99.7%) were aware of the major risk factors that were most likelyassociated with oral cancer. Overall, majority of the participants knew the most common form of oral cancer (80.6%),most common site (80.3%) and the likely lesions associated with oral cancer occurrence (87.9%). A large number ofdental practitioners (81%) would routinely refer a patient with a suspicious lesion to a specialist. Nearly one-third (32%)reviewed their patients’ oral cancer risk factors. Approximately two-thirds (62%) assessed the use of tobacco in theirpractice. Almost, all (92.4%) were interested in attending continuing education courses on oral cancer. Conclusions:Majority of the participants presented good knowledge about various aspects of oral cancer. More continuing educationprograms on risk factors and diagnosis of oral cancer should be organized to train the dentists. Oral cancer screeningshould be a routine procedure for the high risk patients at the primary oral health care centers in Kuwait.     

Nutritional Related Knowledge of Cancer Prevention among Primary Health Care Physicians

Objectives: To explore the cancer prevention-related nutrition knowledge of primary health care physicians towards nutrition and its relation to the development of cancer. Materials and methods: a cross-sectional study was conducted among family physicians in Riyadh, between November 2019 and April 2020. The participants in the current study were surveyed using a self-administered questionnaire. The questionnaire included socio-economic data and data related to the association between nutrition and cancer. Results: The mean correct knowledge score for physicians is good but less than expected (26.5+5.8) 73.6%. Multiple regression revealed that age, position, and nationality to be significantly associated with knowledge of cancer prevention (P<0.05) among physicians. Conclusions:  Primary care physicians have good knowledge about the relation between nutrition and cancer but not sufficient, they should have continuous nutrition educational training programs to ensure safe and sound nutritional advice to patients and for the public about the relation of nutrition and cancer.     

Survivor profiles predict health behavior intent: the Childhood Cancer Survivor Study

Objectives: To determine whether unique groups of adult childhood cancer survivors could be defined on the basis of modifiable cognitive, affective, and motivation indicators. Secondary objectives were to examine to what extent group membership co‐varied with more static variables (e.g. demographics, disease, and treatment) and predicted intent for subsequent medical follow‐up. Methods: Using latent class analysis of data from 978 participants (ages, 18–52 years; mean, 31; and SD, 8) in the Childhood Cancer Survivor Study, we classified survivors according to their worries about health, perceived need for follow‐up care, health motivation, and background variables. Intent to participate in medical follow‐up, as a function of class membership, was tested using equality of proportions. Results: The best‐fitting model (BIC = 18 540.67, BLMRT = <0.001) was characterized by three distinctive survivor classes (worried, 19%; self‐controlling, 26%; and collaborative, 55%) and three significant class covariates (gender, perceptions of health, and severity of late effects). A smaller proportion of survivors in the self‐controlling group (81%) than in the worried (90%) (P = 0.015) and collaborative (88%) (P = 0.015) groups intended to obtain a routine medical checkup. A smaller proportion of survivors in the self‐controlling group (32%) than in the collaborative (65%) (P = <0.001) and worried (86%) (P = <0.001) groups planned a cancer‐related check‐up. A smaller proportion of survivors in the collaborative group (65%) than in the worried group (86%) (P = <0.001) were likely to obtain a cancer‐related check‐up. Conclusions: Childhood cancer survivors can be classified according to the modifiable indicators. The classification is distinctive, predicts intent for future medical follow‐up, and can inform tailored interventions. Copyright © 2011 John Wiley & Sons, Ltd.     

The Effect of Primary Care Physician Knowledge of Lung Cancer Screening Guidelines on Perceptions and Utilization of Low-Dose Computed Tomography

Introduction

Lung cancer screening (LCS) with low-dose computed tomography (LDCT) is recommended by the U.S. Preventive Services Task Force (USPSTF) in high-risk patients, but a minority of eligible people are screened. It is not clear whether knowledge of USPSTF recommendations among primary care physicians (PCP) affects utilization of LDCT.

Knowledge,Attitudes, and Practices Pertaining to Lung Cancer Screening Among Primary Care Physicians in a Public Urban Health Network

IntroductionLung cancer screening (LCS) with annual low-dose computed tomography in high-risk groups decreases the mortality related to lung cancer. Its implementation rate has been low, and knowledge relating to LCS has not been assessed in providers treating underserved populations.Materials and MethodsAn institutional review board-approved anonymous survey was sent to primary care physicians of the Cook County Health system, a safety-net healthcare system. The survey assessed the knowledge pertaining to LCS guidelines, providers’ experience with LCS, and their recommendations for quality improvement using 24 questions. The predictors of LCS within the previous 6 months were identified using logistic regression analysis.ResultsOf the 152 survey responses, 43% were from nontrainees with diverse training backgrounds. Adequate knowledge of LCS was demonstrated by 72% of the respondents, and pretest counseling was the domain most often answered incorrectly in the questionnaire. LCS had been ordered in the previous 6 months by 57% of the respondents. However, 88% estimated that they had screened < 50% of eligible patients. Higher patient volume, more experience, and family medicine training predicted for ordering LCS in the previous 6 months. In addition, 82.2% indicated that prompts in the electronic medical records would increase LCS, and 78.3% reported that receiving statistics about their LCS practice would increase LCS performance.ConclusionsPrimary care physicians in the hospital healthcare system had reasonable knowledge of LCS, but the implementation rate was low. We have identified areas for improvement relating to LCS implementation.