基于医护合作的遗传性肠癌门诊的管理
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摘要
目的 :构建基于医护合作的遗传性肠癌门诊并评价其实践效果,以规范遗传性肠癌患者的管理、改善其亲属肿瘤防治的效果并推动遗传性肿瘤诊疗及研究的规范化发展。方法 :构建基于医护合作的遗传性肠癌门诊,由经过严格选拔并培训的1名结直肠外科主任医师和1名肿瘤专科护士出诊,规范了出诊医生及护士的资质和培训要求,确立接诊对象为有遗传性肠癌风险的患者及亲属。由护士预约、询问患者家族史并绘制家系图、收集患者及家属的诊治资料,主任医师接受就诊对象的遗传咨询。结果 :经过2年半的实践,共接诊502人次,收集并绘制家系图223个,确诊并随访管理遗传性肠癌家系120个;患者亲属中,检出携带高危风险基因52例,肠镜筛查检出肠癌5例,息肉8例。结论 :遗传性肠癌门诊的设立,使遗传性肠癌患者得以确诊,并提高高危亲属的基因检测及肿瘤筛查率,促进高危人群的早期诊断、早期治疗,为遗传性肿瘤门诊的构建提供了实践依据。
Objective: In order to improve the effect of prevention and treatment of cancer in patients with hereditary colorectal cancer and their families, our hospital has established a hereditary colorectal cancer clinic based on physician-nurse collaboration for patients with hereditary colorectal cancer and their families. Methods: A hereditary colorectal cancer clinic based on physician-nurse collaboration was established and operated by a qualified chief physician with perfect training of colorectal surgery department and a clinical nurse specialist of oncology department. Qualification and training requirements of the chief physician and the nurse specialist were normalized and patients with risk of hereditary colorectal cancer and their families were considered as targeted people. The nurse made an appointment, inquired the family history, drew the family diagram, and collected the diagnosis and treatment data of the patients and their families while the director offered genetic counseling. A series of working systems and management methods were developed. Results: During the two and a half years of practice, 502 person times visited the clinic and family diagrams were collected and drew for 223 families. Besides, 120 families with hereditary colorectal carcinoma were diagnosed and offered follow-ups. Among the blood relatives of the 120 hereditary colorectal cancer patients, 52 were found to carry high-risk genes, 5 cases were diagnosed as colorectal cancer by colonoscopy, and 8 cases were polyps. Conclusion: With the help of the clinic, gene detection and tumor screening rate of high-risk relatives has been improved. Furthermore, early detection and early treatment of high-risk groups being promoted provides a practical basis for the construction of the management model of hereditary tumors.
Objective: In order to improve the effect of prevention and treatment of cancer in patients with hereditary colorectal cancer and their families, our hospital has established a hereditary colorectal cancer clinic based on physician-nurse collaboration for patients with hereditary colorectal cancer and their families. Methods: A hereditary colorectal cancer clinic based on physician-nurse collaboration was established and operated by a qualified chief physician with perfect training of colorectal surgery department and a clinical nurse specialist of oncology department. Qualification and training requirements of the chief physician and the nurse specialist were normalized and patients with risk of hereditary colorectal cancer and their families were considered as targeted people. The nurse made an appointment, inquired the family history, drew the family diagram, and collected the diagnosis and treatment data of the patients and their families while the director offered genetic counseling. A series of working systems and management methods were developed. Results: During the two and a half years of practice, 502 person times visited the clinic and family diagrams were collected and drew for 223 families. Besides, 120 families with hereditary colorectal carcinoma were diagnosed and offered follow-ups. Among the blood relatives of the 120 hereditary colorectal cancer patients, 52 were found to carry high-risk genes, 5 cases were diagnosed as colorectal cancer by colonoscopy, and 8 cases were polyps. Conclusion: With the help of the clinic, gene detection and tumor screening rate of high-risk relatives has been improved. Furthermore, early detection and early treatment of high-risk groups being promoted provides a practical basis for the construction of the management model of hereditary tumors.
引文
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[19]Gupta S,Provenzale D,Regenbogen SE,et al.NCCN guidelines insights:genetic/familial highrisk assessment:colorectal,version 3.2017.J Natl Compr Canc Netw,2017,15(12):1465-1475.
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[21]Kessels K,Eisinger JD,Letteboer TG,et al.Sending family history questionnaires to patients before a colonoscopy improves genetic counseling for hereditary colorectal cancer.J Dig Dis,2017,18(6):343-348.
[22]Salemink S,Dekker N,Kets CM,et al.Focusing on patient needs and preferences may improve genetic counseling for colorectal cancer.J Genet Couns,2013,22(1):118-124.
[23]Finkelman A.The clinical nurse specialist:leadership in quality improvement.Clin Nurse Spec,2013,27(1):31-35.
[24]Ares TL.Comparing clinical nurse specialist students'socialization based on magnet employment.Clin Nurse Spec,2016,30(6):332-340.
[2]陈万青,郑荣寿,张思维,等.2012年中国恶性肿瘤发病和死亡分析.中国肿瘤,2016,25(1):1-8.Chen WQ,Zheng RS,Zhang SW,et al.Report of cancer incidence and mortality in China,2012.China Cancer,2016,25(1):1-8.
[3]陈万青,郑荣寿,张思维,等.2013年中国恶性肿瘤发病和死亡分析.中国肿瘤,2017,26(1):1-7.Chen WQ,Zheng RS,Zhang SW,et al.Report of cancer incidence and mortality in China,2013.China Cancer,2017,26(1):1-7.
[4]吴晓丹,蔡娟,税敏,等.胃肠道恶性肿瘤家族史结直肠癌患者延诊现状分析.中华肿瘤防治杂志,2018,25(4):221-225.Wu XD,Cai J,Shui M,et al.Analysis of healthseeking delay in colorectal cancer patients with gastrointestinal malignant tumor family history.Chin J Cancer Prev Treat,2018,25(4):221-225.
[5]Hampel H,Frankel WL,Martin E,et al.Feasibility of screening for Lynch syndrome among patients with colorectal cancer.J Clin Oncol,2008,26(35):5783-5788.
[6]Ward RL,Hicks S,Hawkins NJ.Populationbased molecular screening for Lynch syndrome:implications for personalized medicine.J Clin Oncol,2013,31(20):2554-2562.
[7]万德森.大力推广大肠癌筛查.广东医学,2016,37(22):1-2.Wan DS.Promoting colorectal cancer screening.Guangdong Medical Journal,2016,37(22):1-2.
[8]Yurgelun MB.Next-generation strategies for hereditary colorectal cancer risk assessment.JClin Oncol,2015,33(5):388-393.
[9]Vindigni SM,Kaz AM.Universal screening of colorectal cancers for Lynch syndrome:challenges and opportunities.Dig Dis Sci,2016,61(4):969-976.
[10]Wood ME,Kadlubek P,Pham TH,et al.Quality of cancer family history and referral for genetic counseling and testing among oncology practices:a pilot test of quality measures as part of the American Society of Clinical Oncology Quality Oncology Practice Initiative.J Clin Oncol,2014,32(8):824-829.
[11]黄中英,覃惠英.肿瘤专科护士管理的实践与思考.中国护理管理,2011,11(9):20-22.Huang ZY,Qin HY.Practice of establishing oncology nurse specialist system.Chinese Nursing Management,2011,11(9):20-22.
[12]谌永毅,彭翠娥.我院肿瘤专科护士三阶梯培养管理体系建立与实践.中国护理管理,2010,10(5):55-57.Chen YY,Peng CE.The three-step training management system of oncology nurses.Chinese Nursing Management,2010,10(5):55-57.
[13]袁瑛,熊斌,徐烨,等.遗传性结直肠癌临床诊治和家系管理中国专家共识.实用肿瘤杂志,2018,33(1):3-16.Yuan Y,Xiong B,Xu Y,et al.The Chinese expert consensus on clinical diagnosis,treatment and pedigree management of hereditary colorectal cancer.Journal of Practical Oncology,2018,33(1):3-16.
[14]吴晓丹,陈春燕,巢花香,等.结直肠癌患者就诊延误现状及延误时间影响因素分析.中国全科医学,2017,20(33):4109-4114.Wu XD,Chen CY,Chao HX,et al.Status of prehospital delay and influencing factors of delay time in patients with colorectal cancer.Chinese General Practice,2017,20(33):4109-4114.
[15]Cheng TH,Gorman M,Martin L,et al.Common colorectal cancer risk alleles contribute to the multiple colorectal adenoma phenotype,but do not influence colonic polyposis in FAP.Eur JHum Genet,2015,23(2):260-263.
[16]Syngal S,Brand RE,Church JM,et al.ACGclinical guideline:genetic testing and management of hereditary gastrointestinal cancer syndromes.Am J Gastroenterol,2015,110(2):223-263.
[17]Giardiello FM,Allen JI,Axilbund JE,et al.Guidelines on genetic evaluation and management of Lynch syndrome:a consensus statement by the US Multi-society Task Force on colorectal cancer.Am J Gastroenterol,2014,109(8):1159-1179.
[18]Moller P,Seppala T,Bernstein I,et al.Incidence of and survival after subsequent cancers in carriers of pathogenic MMR variants with previous cancer:a report from the prospective Lynch syndrome database.Gut,2017,66(9):1657-1664.
[19]Gupta S,Provenzale D,Regenbogen SE,et al.NCCN guidelines insights:genetic/familial highrisk assessment:colorectal,version 3.2017.J Natl Compr Canc Netw,2017,15(12):1465-1475.
[20]Vasen HF,Blanco I,Aktan-Collan K,et al.Revised guidelines for the clinical management of Lynch syndrome(HNPCC):recommendations by a group of European experts.Gut,2013,62(6):812-823.
[21]Kessels K,Eisinger JD,Letteboer TG,et al.Sending family history questionnaires to patients before a colonoscopy improves genetic counseling for hereditary colorectal cancer.J Dig Dis,2017,18(6):343-348.
[22]Salemink S,Dekker N,Kets CM,et al.Focusing on patient needs and preferences may improve genetic counseling for colorectal cancer.J Genet Couns,2013,22(1):118-124.
[23]Finkelman A.The clinical nurse specialist:leadership in quality improvement.Clin Nurse Spec,2013,27(1):31-35.
[24]Ares TL.Comparing clinical nurse specialist students'socialization based on magnet employment.Clin Nurse Spec,2016,30(6):332-340.