cancer care

癌症护理
  • 文章类型: Journal Article
    目的:远程患者监护(RPM)已证明在癌症治疗中具有许多益处,包括提高生活质量,总生存率,减少医疗资源的使用。本研究对护士导航员主导的RPM计划进行了预算影响分析,根据CAPRI的审判,从法国国家健康保险(NHI)的角度来看。该研究旨在评估该计划对医疗资源利用和成本的影响。
    方法:医疗资源利用数据来自医疗管理来源和患者报告问卷。通过将单位成本应用于资源利用并估计每位患者的平均每月成本来计算成本。进行了敏感性分析,以探索不同的观点和不同的资源消耗。
    结果:分析包括559名参与CAPRI项目的癌症患者。从NHI的角度来看,该计划在4.58个月的随访期内平均每位患者节省了377欧元,主要是由于住院人数减少。所有付款人的观点为每位患者节省了504欧元。敏感性分析支持研究结果的稳健性。
    结论:预算影响分析表明,从NHI的角度来看,CAPRIRPM计划与成本节省有关。该计划对减少住院的积极影响超过了与远程监控相关的额外成本。这些发现强调了在癌症护理中实施RPM计划的潜在经济效益。有必要进行进一步的研究,以评估此类程序在现实世界中的长期成本效益和可扩展性。
    OBJECTIVE: Remote patient monitoring (RPM) has demonstrated numerous benefits in cancer care, including improved quality of life, overall survival, and reduced medical resource use. This study presents a budget impact analysis of a nurse navigator-led RPM program, based on the CAPRI trial, from the perspective of the French national health insurance (NHI). The study aimed to assess the impact of the program on medical resource utilization and costs.
    METHODS: Medical resource utilization data were collected from both medico-administrative sources and patient-reported questionnaires. Costs were calculated by applying unit costs to resource utilization and estimating the average monthly cost per patient. Sensitivity analyses were conducted to explore different perspectives and varying resource consumption.
    RESULTS: The analysis included 559 cancer patients participating in the CAPRI program. From the NHI perspective, the program resulted in average savings of €377 per patient over the 4.58-month follow-up period, mainly due to reduced hospitalizations. The all-payers perspective yielded even greater savings of €504 per patient. Sensitivity analyses supported the robustness of the findings.
    CONCLUSIONS: The budget impact analysis demonstrated that the CAPRI RPM program was associated with cost savings from the perspective of the NHI. The program\'s positive impact on reducing hospitalizations outweighed the additional costs associated with remote monitoring. These findings highlight the potential economic benefits of implementing RPM programs in cancer care. Further research is warranted to assess the long-term cost-effectiveness and scalability of such programs in the real-world settings.
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  • 文章类型: Journal Article
    目的:本研究探讨了选择实验性主动监测(而不是标准手术)治疗食管癌的患者及其伴侣或主要护理人员的决策经验。
    方法:17对夫妇参与。对夫妻的共同经历以及他们的个人经历进行了半结构化访谈。使用调整后的对照偏好量表评估治疗决策过程中的首选和感知角色。使用视觉模拟量表测量对治疗决策的感知影响。
    结果:夫妇在决策过程中反映为积极的合作,患者通过做出最终决定来保留他们的自主权,和合作伙伴提供情感支持。夫妇报告了有关不同医院和医疗保健提供者之间治疗方法的大量信息,有时甚至相互矛盾。
    结论:患者经常让他们的伴侣参与决策,他们报告说,这增强了他们应对疾病的能力。决策过程中的数量和有时相互冲突的信息提供了改进的机会。
    结论:夫妇可以从对治疗过程中的期望的概述中受益。如果主动监测在未来成为既定的治疗选择,提供此类概述和一致的信息应该变得更加精简。
    OBJECTIVE: This study explored the decision-making experiences of patients and their partners or primary caregiver who opted for experimental active surveillance (instead of standard surgery) for the treatment of esophageal cancer.
    METHODS: Seventeen couples participated. Semi-structured interviews were conducted on couples\' joint experiences as well as their individual experiences. Preferred and perceived role in the treatment decision-making process was assessed using the adjusted version of the Control Preferences Scale, and perceived influence on the treatment decision was measured using a visual analog scale.
    RESULTS: Couples reflected on the decision-making process as a positive collaboration, where patients retain their autonomy by making the final decision, and partners offer emotional support. Couples reported about an overwhelming amount and sometimes conflicting information about treatments among different hospitals and healthcare providers.
    CONCLUSIONS: Patients often involve their partner in decision-making, which they report to have enhanced their ability to cope with the disease. The amount and sometimes conflicting information during the decision-making process provide opportunities for improvement.
    CONCLUSIONS: Couples can benefit from an overview of what they can expect during treatment course. If active surveillance becomes an established treatment option in the future, provision of such overviews and consistent information should become more streamlined.
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  • 文章类型: Journal Article
    向个性化癌症医学(PCM)的转变代表了癌症护理的重大转变,强调基于细胞水平对癌症的遗传理解的定制治疗。这篇综述借鉴了最近的文献,探讨了影响PCM实施的关键因素,突出创新领导力的作用,跨学科合作,以及协调的资金和监管战略。PCM的成功依赖于克服挑战,例如整合不同的医学学科,确保共享基础设施的可持续投资,导航复杂的监管环境。有效的领导对于培养创新和团队合作文化至关重要,对于将复杂的生物学见解转化为个性化治疗策略至关重要。向PCM的过渡不仅需要组织适应,还需要开发新的专业角色和培训计划,强调了多学科方法的必要性以及团队科学在克服传统医学范式局限性方面的重要性。结论强调PCM的成功取决于创建支持创新的协作环境,适应性,以及参与癌症护理的所有利益相关者之间的共同愿景。
    The shift towards personalized cancer medicine (PCM) represents a significant transformation in cancer care, emphasizing tailored treatments based on the genetic understanding of cancer at the cellular level. This review draws on recent literature to explore key factors influencing PCM implementation, highlighting the role of innovative leadership, interdisciplinary collaboration, and coordinated funding and regulatory strategies. Success in PCM relies on overcoming challenges such as integrating diverse medical disciplines, securing sustainable investment for shared infrastructures, and navigating complex regulatory landscapes. Effective leadership is crucial for fostering a culture of innovation and teamwork, essential for translating complex biological insights into personalized treatment strategies. The transition to PCM necessitates not only organizational adaptation but also the development of new professional roles and training programs, underscoring the need for a multidisciplinary approach and the importance of team science in overcoming the limitations of traditional medical paradigms. The conclusion underscores that PCM\'s success hinges on creating collaborative environments that support innovation, adaptability, and shared vision among all stakeholders involved in cancer care.
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  • 文章类型: Journal Article
    加拿大癌症幸存者的癌症护理仍然支离破碎。对加拿大肿瘤科护士为癌症幸存者提供癌症护理的经验知之甚少,他们从急性治疗过渡到初级保健。
    本研究旨在(1)探索肿瘤科护士为癌症幸存者过渡到生存阶段处理零散癌症护理的经验;(2)确定肿瘤科护士对促进或抑制其提供优质癌症护理的观点;(3)获得他们改善癌症护理的建议。
    本研究采用现象学设计,探索肿瘤科护士在向生存过渡期间照顾癌症幸存者的经验,并检查护士参与者如何描述他们的经历。半结构化访谈用于收集数据,并使用解释性现象学分析方法从数据中开发主题。
    三名肿瘤科护士参与了这项研究。出现了以下五个主题:(1)个人转型:护理评估,症状管理,患者教育,提供的资源,拒绝癌症幸存者的标签,促进适应新常态的生活,促进重返工作岗位,并认识到生存的意义;(2)在癌症幸存者的护理过渡下:促进自我护理管理,通信,和身体功能的最大恢复;(3)根据护士的积极经验,促进优质癌症护理的交付:照顾癌症幸存者,经验和知识,并倡导癌症幸存者;(4)在对癌症护理提供产生负面影响的障碍下:低社会经济地位(尤其是低收入),文化和语言障碍,和有限的时间提供护理;(5)建议改善癌症护理:建立新的职位-初级护士,增加医疗保健专业人员的数量,提高知识,技能,和经验。
    肿瘤科护士的知识和经验为高质量的癌症护理奠定了良好的基础,并有助于癌症幸存者的健康和福祉。
    UNASSIGNED: Cancer care for Canadian cancer survivors remains fragmented. Little is known about the experience of Canadian oncology nurses providing cancer care for cancer survivors, as they transition from acute treatment to primary care.
    UNASSIGNED: This study aimed to (1) explore the experience of oncology nurses dealing with fragmented cancer care for cancer survivors in transition to survivorship; (2) identify oncology nurses\' perspectives about what promotes or inhibits their delivery of quality cancer care; and (3) obtain their suggestions to improve cancer care.
    UNASSIGNED: This study used a phenomenological design to explore the experience of oncology nurses in caring for cancer survivors during transition to survivorship and examine how the nurse participants describe their experience. Semi-structured interviews were used to collect data and an interpretative phenomenological analysis approach was used to develop themes from the data.
    UNASSIGNED: Three oncology nurses participated in this study. The following five themes emerged: (1) Under personal transition: nursing assessment, symptoms management, patient education, resources offered, refusing label of cancer survivors, promoting adjustment to a new normal life, promoting return to work, and recognizing meaning of survivorship; (2) Under cancer survivor\'s care transition: promoting self-care management, communication, and maximal recovery of body functions; (3) Under nurse\'s positive experience promoting delivery of quality cancer care: caring for cancer survivors, experience and knowledge, and advocate for cancer survivors; (4) Under barriers that negatively affected delivery of cancer care: low socioeconomic status (especially low income), cultures and languages barriers, and limited time providing nursing care; and (5) Suggestions to improve cancer care: establishing a new position - primary nurse, increasing the number of healthcare professionals, and improving knowledge, skills, and experience.
    UNASSIGNED: Oncology nurses\' knowledge and experience provide a good foundation for quality cancer care and contribute to the health and wellbeing of cancer survivors.
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  • 文章类型: Editorial
    暂无摘要。
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  • 文章类型: Journal Article
    越来越多的证据表明身体活动如何改善癌症护理。不幸的是,运动仍未广泛用于肿瘤患者,尽管它带来了好处。为了发生这种情况,有必要采用涉及不同类型医疗保健专业人员的多学科方法,考虑到每种治疗都是针对每种情况量身定制的。除了纳入适当的基础设施和转诊途径,我们需要将锻炼融入医疗实践,改善患者的生活质量和治疗副作用。来自西班牙医学肿瘤学会(SEOM),并通过运动和癌症工作组,我们指出了注意事项,分析患者护理方案,并提出了一种运动处方的转诊路径算法,考虑到病人的需要。在本文的后面部分,我们描述了如何实现这个算法,以及如何建立锻炼计划,包括身体活动内容,设置,和交付模式。我们得出结论,专业人士,基础设施,和组织应该在每一个援助水平上创建计划,为癌症患者提供足够的运动训练。
    There is growing evidence about how physical activity can improve cancer care. Unfortunately, exercise is still not widely prescribed to oncology patients, despite the benefit it brings. For this to occur, it is necessary for a multidisciplinary approach involving different types of healthcare professionals, given that each treatment be tailored for each single case. Besides incorporating appropriate infrastructures and referral pathways, we need to integrate exercise into healthcare practice, which ameliorates patients\' quality of life and treatment side effects. From the Spanish Society of Medical Oncology (SEOM), and through the Exercise and Cancer Working Group, we indicate considerations, analyze patient care scenarios, and propose a referral pathway algorithm for exercise prescription, taking in account the patient\'s needs. In later sections of this paper, we describe how this algorithm could be implemented, and how the exercise programs should be built, including the physical activity contents, the settings, and the delivery mode. We conclude that professionals, infrastructures, and organizations should be available at every assistance level to create programs providing adequate exercise training for cancer patients.
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  • 文章类型: Journal Article
    癌症的发病率正在增加,癌症幸存者也呈指数级增长。癌症被定义为一种新的慢性疾病。然而,在中国,以慢性病为形式的癌症的管理仍处于起步阶段,没有标准化的护理模式。
    本研究旨在从患者的角度探讨癌症护理管理的现状。
    这项横断面研究是对被诊断患有癌症的患者的问卷调查,包括日常医疗咨询的现状信息,合并症的状况,以及未来寻求癌症治疗的期望。采用卡方检验和logistic回归分析探讨影响患者选择肿瘤管理模式的因素。
    总共200名癌症患者被纳入研究。大多数(n=150)癌症患者选择了三级医院的肿瘤学家进行癌症护理。注册困难(45%),耗时(34.5%),重复检查(34.5%)和不同的治疗意见(12.0%)是他们目前在三级医院就诊中遇到的主要困难。在社区医院,对全科医生缺乏信任(n=33)和社区医院必要的药物或检测项目(n=47)是他们就诊期间的主要困难。Logistic回归分析显示,男性(OR=2.737,95%CI,1.332~5.627,p=0.006)和老年患者(OR=3.186,95%CI,1.172~8.661,p=0.023)更倾向于选择社区医院全科医生。29名(14.5%)患者希望在全科医生的积极参与下,在三级和社区医院进行综合多学科管理。
    提高药物利用率,设备和优质的癌症护理服务有助于提高癌症患者对社区医院的认可度。此外,由全科医生参与的三级医院和社区的多学科综合管理是一种值得探索的改善癌症护理管理的模式。
    UNASSIGNED: The incidence of cancer is increasing, and cancer survivors are also growing exponentially. Cancer is defined as a new chronic disease. Nevertheless, the management of cancer in the form of chronic diseases in China is still in its infancy, without a standardized care model.
    UNASSIGNED: This study aimed to explore the current status of management of cancer care from the patient\'s perspective.
    UNASSIGNED: This cross-sectional study was a questionnaire survey of patients diagnosed with cancer, including information of the current situation of daily medical consultation, status of comorbidity, and expectations of seeking cancer care in future. Chi-square test and logistic regression analysis were used to explore the factors influencing patients\' choice of cancer management mode.
    UNASSIGNED: A total of 200 cancer patients were included in the study. The majority (n = 150) of cancer patients chose an oncologist in a tertiary hospital for cancer care. Difficulty in registration (45%), time-consuming (34.5%), repeated examinations (34.5%) and different treatment opinions (12.0%) were the main difficulties they encountered currently during tertiary hospital visits. In community hospital, lack of trust in general practitioners (n = 33) and the necessary drugs or testing items in community hospitals (n = 47) were the main difficulties during their visits. Logistic regression analysis showed that male (OR = 2.737, 95% CI, 1.332-5.627, p = 0.006) and elderly patients (OR = 3.186, 95% CI, 1.172-8.661, p = 0.023) were more likely to choose general practitioners (GPs) in community hospitals. Twenty-nine (14.5%) patients hope to have an integrated multidisciplinary management in tertiary and community hospitals with the active participation of GPs for cancer care.
    UNASSIGNED: Improving drug availability, equipment and quality of cancer care services can help to increase cancer patients\' recognition of community hospital. In addition, the multidisciplinary management integrated tertiary hospitals and communities with the participation of GPs is a worth exploring mode that improves the management of cancer care.
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  • 文章类型: Journal Article
    背景:癌症被认为是世界范围内的主要负担。患者的痛苦与疾病进展有关。研究表明,参与策略会影响临床决策和患者预后。最佳的参与方法是将患者的专业知识整合到医疗保健系统的全面共同设计中的合作伙伴关系。
    目的:这是第一项调查癌症患者作为伴侣的经历及其对痛苦水平的影响的研究,决策和自我管理。
    方法:这是一项定量和准实验研究,在黎巴嫩一家医院采用了伙伴关系委员会。采用分层随机抽样的方法,并通过自编问卷收集数据。我们使用了标准化的遇险温度计和PPEET。
    结果:我们招募了100名患者伙伴。癌症患者作为合作伙伴在QI项目中具有最佳的参与体验(平均值=4;SD=0.4)。伙伴关系的主要益处是改善住院体验(49%)。几乎一半的PP报告没有面临挑战(49%)。改进建议是培训(19%),团队动态管理(12%)和适当的时间分配(7%)。伙伴关系后的痛苦水平显着降低(t=12.57,p<0.0001)。本研究强调了伙伴关系的重要性及其影响共同决策偏好的能力[χ2(2)=13.81,p=0.025]和自我管理实践[F(3,11.87)=7.294,p=0.005]。
    结论:研究结果表明,来自弱势群体的伴侣可以拥有最佳的伴侣经验。护理的伙伴关系模式可以将医疗保健系统塑造成以人为本的文化。需要进一步的研究来探索不同的PP参与方法及其对组织发展的影响。
    患者和家庭成员参与了研究方法的共同设计,特别是研究仪器的修改。有生活经验的患者伙伴作为核心成员参与患者伙伴关系委员会,以改善医疗保健系统的设计和评估。
    BACKGROUND: Cancer is regarded as a major worldwide burden. Patient distress has been linked to disease progression. Studies show that engagement strategies affect clinical decision-making and patient outcomes. The optimal engagement method is a partnership that integrates the patient\'s expertise into the comprehensive co-design of the healthcare system.
    OBJECTIVE: This is the first study to investigate cancer patient-as-partner experience and its impact on distress levels, decision-making and self-management.
    METHODS: It is a quantitative and quasi-experimental study that adopted a partnership committee at a Lebanese hospital. A stratified random sampling approach was used, and data were collected by self-administered questionnaires. We utilized the standardized distress thermometer and PPEET.
    RESULTS: We recruited 100 patient partners. Cancer patients-as-partners had optimal engagement experience in QI projects (mean = 4; SD = 0.4). The main partnership benefit was improved hospitalization experience (49%). Almost half of PP reported no challenges faced (49%). Recommendations for improvement were training (19%), team dynamics management (12%) and proper time allocation (7%). The distress level post-partnership was significantly reduced (t = 12.57, p < 0.0001). This study highlights the importance of partnership and ‎its ability to influence shared decision-making preference [χ2(2) = 13.81, p = 0.025] and self-management practices [F(3, 11.87) = 7.294, p = 0.005].
    CONCLUSIONS: Research findings suggest that partners from disadvantaged groups can have optimal partnership experience. A partnership model of care can shape the healthcare system into a people-oriented culture. Further research is needed to explore diverse PP engagement methodologies and their effect on organizational development.
    UNASSIGNED: Patients and family members were engaged in the co-design of the study methodology, especially the modification of a research instrument. Patient partners with lived experience were involved in the patient partnership committee as core members to improve healthcare system design and evaluation.
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  • 文章类型: Journal Article
    背景:癌症患者的生活质量(QoL)显著影响治疗反应和死亡率。了解癌症患者的QoL域及其影响因素有助于创建改善QoL和缓解患者体验的干预措施。本研究测量癌症患者的OoL及其影响因素。
    方法:一项基于前瞻性横断面问卷的研究包括目前正在接受治疗的年龄>18岁的癌症患者。问卷收集了社会和经济数据,随后是经过验证的阿拉伯文版本的欧洲癌症研究和治疗组织生活质量问卷(EORTC-QLQ-C30)。所描述的数值变量的平均值和标准偏差以及所描述的分类变量的频率和百分比。方差分析,F-tests,并报告P值。
    结果:在182名癌症患者中,60%是女性。年轻患者在身体和角色功能方面表现出更高的QoL(P=.016和.03),并且经历了更显着的财务影响(P=.0144)。女性报告了更多癌症症状的不良反应,包括疲劳,恶心,呕吐,和疼痛(36.7%vs25.5%,P=0.005;20.6%对11.5%,P=.0186;34.7%对25.1%,P=.0281)。与其他患者相比,单身患者的身体功能QoL优于其他患者(P=0.0127)。长途旅行的患者更有可能面临不利的经济后果(P=.007)。哮喘患者在身体上表现出较低的QoL,角色,和认知功能(72.3vs37.8,P=.0147;76.4vs22.2,P=.0024;84.7vs44.4,P=.0038),并报告呼吸困难和食欲减退增加(16vs55.6和26.1vs66.7,均P<.05)。
    结论:影响沙特癌症患者QoL的因素包括年龄,婚姻状况,性别,医院距离,和慢性病。因此强调个性化护理策略的必要性,以提高预后并减轻癌症护理的总体负担。
    BACKGROUND: Cancer patients\' quality of life (QoL) significantly influences treatment response and mortality rates. Understanding QoL domains among patients with cancer and what affects it can help create interventions that improve QoL and ease patients\' experience. This study measures the OoL among patients with cancer and influencing factors.
    METHODS: A prospective cross-sectional questionnaire-based study included cancer patients aged >18 currently receiving treatment. The questionnaire collected social and economic data, followed by the validated Arabic version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30). Means and standard deviations for described numeric variables and frequencies and percentages described categorical variables. Analysis of variance, F-tests, and P-values were reported.
    RESULTS: Among 182 cancer patients, 60% were female. Younger patients exhibited higher QoL in physical and role functioning (P = .016 and .03) and experienced more significant financial impact (P = .0144). Females reported more adverse effects from cancer symptoms, including fatigue, nausea, vomiting, and pain (36.7% vs 25.5%, P = .005; 20.6% vs 11.5%, P = .0186; 34.7% vs 25.1%, P = .0281). Single patients had superior QoL in physical functioning compared to others (P = .0127). Patients traveling long distances were more likely to face adverse financial consequences (P = .007). Asthmatic patients exhibited lower QoL in physical, role, and cognitive functioning (72.3 vs 37.8, P = .0147; 76.4 vs 22.2, P = .0024; 84.7 vs 44.4, P = .0038) and reported increased dyspnea and appetite loss (16 vs 55.6 and 26.1 vs 66.7, both P < .05).
    CONCLUSIONS: Factors influencing QoL in Saudi cancer patients include age, marital status, gender, hospital distance, and chronic conditions. Thus emphasizing the necessity for personalized care strategies to enhance outcomes and alleviate the overall burden of cancer care.
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  • 文章类型: Journal Article
    背景:指导对于学术医学的职业发展至关重要,沟通是指导关系的所有方面的基础。尽管培训研究导师已被证明是有效的,很少有学术医学院接受过如何指导的培训。研究人员开发了一种新颖的干预措施,肿瘤学学院导师沟通技巧培训(“Comskil导师培训”),并检查了可行性和初步疗效。
    方法:本研究采用单臂干预前后设计。干预(ComskilMentorTraining)是在一个虚拟的3小时课程中提供的,其中包括一个带有示范性技能演示视频的说教讲座,主持人领导的小团体角色扮演与训练有素的演员,和评价。来自12个部门的19名教师参加了培训。
    结果:所有参与者都完成了培训。总的来说,培训得到了好评,超过80%的参与者表示他们“同意”或“强烈同意”培训评估。从培训前到培训后,参与者与受训者沟通的整体自我效能感有了显著改善,以及参与者全面使用沟通技巧和指导特定语言。
    结论:我们的研究结果支持为肿瘤学多学科临床和研究教师提供的经验性导师沟通技能培训计划的可行性和初步有效性。
    BACKGROUND: Mentoring is vital to career development in academic medicine, and communication underlies all aspects of the mentoring relationship. Although training research mentors has been shown to be effective, few academic medicine faculties have received training in how to mentor. The investigators developed a novel intervention, the Mentor Communication Skills Training for Oncology Faculty (\"Comskil Mentor Training\") and examined feasibility and preliminary efficacy.
    METHODS: The study was a single arm pre-post intervention design. The intervention (Comskil Mentor Training) was offered in one virtual 3-hour session and included a didactic lecture with exemplary skill demonstration videos, facilitator-led small group role plays with trained actors, and evaluation. 19 faculty members from 12 departments participated in the training.
    RESULTS: All participants completed the training. Overall, the training was rated favorably, with more than 80% of participants indicating that they \"agreed\" or \"strongly agreed\" with training evaluation. From pre- to post-training, significant improvement was seen in participants\' overall self-efficacy to communicate with mentees, as well as participants\' overall use of communication skills and mentoring-specific language.
    CONCLUSIONS: Our findings support the feasibility and preliminary efficacy of a virtually delivered experiential mentor communication skills training program for multidisciplinary clinical and research faculty in oncology.
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