Background: Commissioning of ‘joint care’ across teenage and young adult (TYA) principal treatment centres (PTC) and regional designated hospitals was introduced to enable cancer care closer to home, while providing support through the TYA multidisciplinary team. We aimed to explore the processes being used to enable inter-organisational collaboration under joint care models through rapid ethnography. Methods: Healthcare professionals in TYA PTCs in England and Wales between June 2022 and December 2023 were identified by the TYA lead in each PTC as delivering TYA cancer care. Semi-structured interviews were conducted virtually or by telephone based on the structuration model of collaboration proposed by D’Amour. Data were analysed against the model through framework analysis. Results: Our study highlighted variation across the different dimensions of inter-organisational collaboration. We found that healthcare professionals delivering TYA cancer care were working toward a shared goal but this was not always achieved. Social interaction between professionals was required to develop relationships and trust, but opportunities for social interaction were not regularly available. Processes for sharing information were not streamlined, so there were instances when information could not be shared between organisations. Interventions to achieve coordinated care, such as an outreach team, supported the delivery of joint care but these were not available in every region. While there were some levels of leadership within aspects of services, there were limited examples nationally or across geographical regions, which hindered the development of coordinated care. Conclusions: Coordination of care is mostly developing; however, the shared vision and goals dimension did achieve full active collaboration. The implementation of a service specification will address regional leadership requirements, but resources are required to extend the delivery of interventions to support coordination and collaboration, allowing the commissioned model of care to be delivered safely.
背景：为青少年和年轻成人（TYA）主要治疗中心（PTC）与区域指定医院引入“联合照护”委托机制，旨在实现患者就近接受癌症治疗，同时通过TYA多学科团队提供支持。本研究旨在通过快速民族志方法，探索联合照护模式下促进跨机构协作的实施过程。方法：由各PTC的TYA负责人提名2022年6月至2023年12月期间在英格兰和威尔士TYA PTC中提供TYA癌症照护的医疗专业人员。基于D'Amour提出的协作结构化模型，通过虚拟或电话方式进行半结构化访谈，并运用框架分析法依据该模型对数据进行分析。结果：研究发现跨机构协作在不同维度存在显著差异。提供TYA癌症照护的医疗专业人员虽致力于实现共同目标，但该目标并非总能达成。专业人员需要通过社交互动建立关系与信任，但此类互动机会并不规律。信息共享流程尚未优化，导致机构间存在信息传递障碍。实现协调照护的干预措施（如外展团队）虽能支持联合照护实施，但未在所有区域普及。尽管服务某些层面存在领导机制，但在国家或跨地理区域范围内缺乏系统性的领导范例，这阻碍了协调照护体系的发展。结论：照护协调机制尚处于发展阶段；然而在共同愿景与目标维度已实现充分积极的协作。服务规范的实施将满足区域领导力需求，但需要投入资源扩展支持协调与协作的干预措施，从而确保委托照护模式得以安全实施。
肿瘤(癌症)患者之家