Shared Management of Children With Cancer
C. Thomas Kisker, MD;
Carol C. Fethke, PhD;
Raymond Tannous, MD
Arch Pediatr Adolesc Med. 1997;151(10):1008-1013.
Abstract
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Objective
To determine the risks and benefits of university-based pediatric oncologists and community-based primary care physicians sharing the management of children with cancer.
Design
Physicians participating in shared management of children with cancer were surveyed, and the outcomes of the children were measured.
Setting and Participants
One hundred thirty-seven community-based primary care physicians participated in the management of the 226 children with cancer in Iowa and western Illinois during the past 15 years. The survival of the 226 children was compared with that of 240 randomly selected children treated using the identical treatment protocols but treated only by pediatric oncologists.
Intervention
A 7-point Likert scale questionnaire was completed by 97 (71%) of the participating primary care physicians.
Results and Outcome Measures
There were no differences in the survival of children using shared management compared with those treated only by pediatric oncologists. Primary care physicians believed that shared management is of economic and psychosocial benefit to patients, improves the treatment choices available to patients, does not require excessive time, and does not result in loss of practice income. The system strengthens the primary care physicians' relationships with oncologists and results in additional referrals to the university-based pediatric oncologists. It is of educational value, is personally satisfying, and provides relief from the stress associated with caring for these families. Primary care physicians would like to see this system expanded to include other children with special health care needs.
Conclusion
The shared-management approach to care is a viable, attractive option of health care provision for children.
Arch Pediatr Adolesc Med. 1997;151:1008-1013
Author Affiliations
From the Department of Pediatrics, The University of Iowa College of Medicine (Drs Kisker and Tannous), and the Department of Economics (Dr Fethke), College of Business, University of Iowa, Iowa City.
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