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首页> 外文期刊>BMC Medical Informatics and Decision Making >Challenges in multidisciplinary cancer care among general surgeons in Canada
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Challenges in multidisciplinary cancer care among general surgeons in Canada

机译：加拿大全科医生对多学科癌症护理的挑战

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Background While many factors can influence the way that cancer care is delivered, including the way that evidence is packaged and disseminated, little research has evaluated how health care professionals who manage cancer patients seek and use this information to identify whether and how this could be supported. Through interviews we identified that general surgeons experience challenges in coordinating care for complex cancer patients whose management is not easily addressed by guidelines, and conducted a population-based survey of general surgeon information needs and information seeking practices to extend these findings. Methods General surgeons with privileges at acute care hospitals in Ontario, Canada were mailed a questionnaire to solicit information needs (task, importance), information seeking (source, frequency of and reasons for use), key challenges and suggested solutions. Non-responders received up to three reminder packages. Significant differences among sub-groups (age, setting) were examined statistically (Kruskal Wallis, Mann Whitney, Chi Square). Standard qualitative methods were used to thematically analyze open-ended responses. Results The response rate was 44.2% (170/385) representing all 14 health regions. System resource constraints (60.4%), comorbidities (56.4%) and physiologic factors (51.8%) were top-ranked issues creating information needs. Local surgical colleagues (84.6%), other local colleagues (82.2%) and the Internet (81.1%) were top-ranked sources of information, primarily due to familiarity and speed of access. No resources were considered to be highly applicable to patient care. Challenges were related to limitations in diagnostics and staging, operative resources, and systems to support multidisciplinary care, together accounting for 76.0% of all reported issues. Findings did not differ significantly by surgeon age or setting of care. Conclusion General surgeons appear to use a wide range of information resources but they may not address the complex needs of many cancer patients. Decision-making is challenged by informational and logistical issues related to the coordination of multidisciplinary care. This suggests that limitations in system capacity may, in part, contribute to variable guideline compliance. Further research is required to evaluate the appropriateness of information seeking, and both concurrent and consecutive mechanisms by which to achieve multidisciplinary care.
机译：背景信息虽然许多因素都可能影响癌症护理的提供方式，包括证据的包装和传播方式，但很少有研究评估管理癌症患者的医疗保健专业人员如何寻找和使用此信息来确定是否以及如何支持该信息。 。通过访谈，我们发现普通医师在协调指南难以解决的复杂癌症患者的护理方面遇到了挑战，并且对普通医师的信息需求和信息寻求实践进行了基于人群的调查，以扩展这些发现。方法向加拿大安大略省急诊医院的普通外科医师发送了问卷，以征询其信息需求（任务，重要性），信息搜索（来源，使用频率和使用原因），主要挑战和建议的解决方案。无响应者最多收到三个提醒包。统计检查亚组（年龄，环境）之间的显着差异（Kruskal Wallis，Mann Whitney，卡方）。标准定性方法用于主题分析开放式响应。结果代表所有14个健康地区的缓解率为44.2％（170/385）。系统资源限制（60.4％），合并症（56.4％）和生理因素（51.8％）是产生信息需求的头号问题。本地外科同事（84.6％），其他本地同事（82.2％）和互联网（81.1％）是信息来源排名最高的信息来源，主要是由于熟悉程度和访问速度。没有资源被认为高度适用于患者护理。挑战涉及诊断和分期的局限性，手术资源和支持多学科护理的系统，这些问题合计占所有报告问题的76.0％。根据外科医生的年龄或所接受的护理，发现没有显着差异。结论普通外科医师似乎使用广泛的信息资源，但它们可能无法满足许多癌症患者的复杂需求。决策受到与多学科护理协调相关的信息和后勤问题的挑战。这表明系统容量的局限性可能部分地导致了对准则遵循的变化。需要进一步的研究来评估信息寻找的适当性，以及实现多学科护理的并行和连续机制。

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