Background/Objectives:Cancer is a leading cause of death for Aboriginal and Torres Strait Islander people, with remoteness increasing the risk for poorer outcomes. Primary health care (PHC) clinics have an important role in cancer screening, diagnosis, and post-discharge cancer care, particularly in remote communities, so accurate, timely communication between hospitals, specialists and PHC clinics is vital. This paper analyses the perspectives of Northern Territory health care professionals on communication between PHC and hospital services related to providing care for Aboriginal people with cancer and recommends strategies for improving communication between services.Methods:A qualitative study was undertaken in which semi-structured interviews were conducted with fifty staff from 15 health services (8 regional, remote, and very remote PHC clinics; 3 hospitals; one cancer centre and 3 cancer support services) between 2016 and 2019. Transcripts were thematically analysed, with findings categorized into barriers and enablers to communication.Results:Deficiencies in communication impeded patient care and support. A major barrier was fragmented, inefficient information systems; IT systems across health services were unable to interface, resulting in delayed/missing patient information that impacted discharge and follow up. Other barriers included PHC staff with limited knowledge of cancer, high turnover of PHC staff and tertiary hospital staff with limited understanding of remote health care challenges. Individuals used workarounds to overcome system failures and made substantial efforts around individual patients to improve communication. Specific roles and the use of telehealth between services and centralised cancer care services supported better between-service communication.Conclusions:Communication between hospital services and remote PHC clinics is essential to care for Aboriginal cancer patients; our research identified communication as inadequate in terms of consistency and timeliness. Commitment to more timely communication, health care IT systems that facilitate sharing information, designated staff in PHC clinics to support patients with cancer, dedicated Aboriginal cancer roles and additional resourcing to coordinate telehealth appointments could improve communication and sharing of patient information between services.
背景/目的：癌症是澳大利亚原住民和托雷斯海峡岛民的主要死因，偏远地区居民面临更差的健康结局风险。初级卫生保健诊所在癌症筛查、诊断及出院后癌症护理中发挥着重要作用，在偏远社区尤为关键，因此医院、专科医生与初级卫生保健诊所之间准确及时的信息沟通至关重要。本研究分析了北领地医疗专业人员对初级卫生保健与医院服务之间为原住民癌症患者提供护理时沟通现状的看法，并提出改善跨机构沟通的策略建议。 方法：本研究于2016年至2019年间开展质性研究，对来自15家医疗机构（包括8家区域、偏远及极偏远初级卫生保健诊所、3家医院、1家癌症中心和3家癌症支持服务机构）的50名工作人员进行半结构化访谈。访谈记录采用主题分析法，研究结果归纳为沟通障碍与促进因素两大类。 结果：沟通缺陷阻碍了患者护理与支持。主要障碍是碎片化、低效的信息系统：各医疗机构间的信息技术系统无法对接，导致患者信息延迟或缺失，影响出院与随访。其他障碍包括初级卫生保健人员癌症知识有限、人员流动率高，以及三级医院工作人员对偏远地区医疗挑战认识不足。工作人员通过变通方法克服系统缺陷，并为改善个体患者沟通付出巨大努力。特定岗位的设置、跨机构远程医疗应用以及集中式癌症护理服务有助于促进机构间沟通。 结论：医院服务与偏远地区初级卫生保健诊所之间的沟通对原住民癌症患者护理至关重要；本研究发现当前沟通在持续性和及时性方面存在不足。通过以下措施可改善机构间沟通与患者信息共享：建立更及时的沟通机制、开发便于信息共享的医疗信息系统、在初级卫生保健诊所设立癌症患者支持专岗、设置原住民癌症护理专职岗位，以及增加协调远程医疗预约的资源配置。
肿瘤(癌症)患者之家