Johnson Timothy V, Goodman Michael, Master Viraj A
Department of Urology, Emory University, Atlanta, Georgia 30322, USA.
J Urol. 2007 Aug;178(2):623-9; discussion 629. doi: 10.1016/j.juro.2007.03.118. Epub 2007 Jun 13.
Appropriate patient treatment necessitates patient literacy due to the increasing use of written screening tools in medicine. We evaluated the frequency, predictors and impact of poor understanding of the American Urological Association symptom index on patient care.
This prospective cohort study included 300 male patients older than 40 years who completed the American Urological Association symptom index twice, as self-administered and then as interviewer administered. These 2 responses were compared by calculating correlation coefficients and weighted kappa statistics to assess patient understanding of the American Urological Association symptom index. Multivariate logistic regression analyses examined the association between patient characteristics and poor understanding of the symptom index, defined as understanding fewer than 4 questions, by calculating the OR and corresponding 95% CI.
Of the 7 symptom index questions 16% of patients understood all, 38% understood more than half, 18% understood fewer than half and 28% understood none. The agreement between self-administered and interviewer administered responses decreased with decreasing education level. Compared to patients with at least some college education those with fewer than 9 years of education were more likely to have a poor understanding of the American Urological Association symptom index (OR 102.16, 95% CI 23.93-436.10), resulting in a 2-fold increase in the risk of symptom misclassification (p trend <0.01). After controlling for education associations for age, income, employment and race were not significantly different from null.
A significant number of patients with lower education and literacy levels incorrectly self-administer the American Urological Association symptom index, resulting in the misclassification of their symptoms, which may severely limit their access to appropriate care.
由于医学中书面筛查工具的使用日益增加，恰当的患者治疗需要患者具备一定的读写能力。我们评估了对美国泌尿外科学会症状指数理解不佳的频率、预测因素及其对患者护理的影响。
这项前瞻性队列研究纳入了300名40岁以上的男性患者，他们两次完成美国泌尿外科学会症状指数的填写，一次是自行填写，另一次是由访谈者协助填写。通过计算相关系数和加权kappa统计量来比较这两种回答，以评估患者对美国泌尿外科学会症状指数的理解。多因素逻辑回归分析通过计算比值比（OR）和相应的95%置信区间（CI），研究患者特征与对症状指数理解不佳（定义为理解少于4个问题）之间的关联。
在症状指数的7个问题中，16%的患者全部理解，38%的患者理解超过一半，18%的患者理解少于一半，28%的患者一个都不理解。自行填写和访谈者协助填写的回答之间的一致性随着教育水平的降低而下降。与至少接受过一些大学教育的患者相比，教育年限少于9年的患者更有可能对美国泌尿外科学会症状指数理解不佳（OR 102.16，95% CI 23.93 - 436.10），导致症状错误分类的风险增加两倍（p趋势<0.01）。在控制教育因素后，年龄、收入、就业和种族的关联与零无显著差异。
大量教育水平和读写能力较低的患者错误地自行填写美国泌尿外科学会症状指数，导致其症状被错误分类，这可能严重限制他们获得适当护理的机会。
