肿瘤个案管理临床实践

Reflection on the clinical practice of cancer case management

为进一步改善肿瘤患者疾病治疗及身心康复结局,并深化肿瘤专科化发展,本研究对肿瘤个案管理师的培养、岗位设置、肿瘤个案管理模式进行了探索,并在结直肠癌和乳腺癌患者中进行临床实践。经过1年半的实践,收案达817例,实现了肿瘤患者的全程无缝隙管理,提高了患者的治疗依从性、满意度、生活质量和医疗资源的利用率,降低了医患、护患纠纷的发生率。依托多学科团队的肿瘤个案管理模式能对患者进行有效的全程管理、满足患者需求。为其他单病种肿瘤和其他医院进行个案管理实践提供了借鉴依据。

The aims of our project were to improve the treatment as well as the physical and mental rehabilitation outcomes of cancer patients, and enhance the development of oncology nursing. After more than one year of preparation and clinical practice of case management in 817 colorectal cancer patients and breast cancer patients, we achieved seamless management of cancer patients, improved patient retention rate, treatment compliance, quality of life, patient satisfaction and hospital resource utilization rate, and reduced the incidence of medical and nursing disputes. Based on the support of a multidisciplinary team, the case management model is an effective way to realize whole course management of cancer patients and fulfill their demands. It can be used as a reference for case management of other cancer patients and in other hospitals.