Waljee Jennifer F, Hawley Sarah, Alderman Amy K, Morrow Monica, Katz Steven J
Section of General Surgery, Department of Surgery; Robert Wood Johnson Clinical Scholars Program, University of Michigan, Ann Arbor, MI, USA.
J Clin Oncol. 2007 Aug 20;25(24):3694-8. doi: 10.1200/JCO.2007.10.9272. Epub 2007 Jul 16.
Experience and practice setting vary greatly among surgeons who treat breast cancer patients. However, less is known about how these factors influence patient satisfaction with their care.
We surveyed all ductal carcinoma in situ patients and a 20% random sample of invasive breast cancer patients diagnosed in 2002 reported to the Detroit, MI, and Los Angeles, CA, Surveillance, Epidemiology, and End Results registries. Attending surgeons were surveyed, yielding dyad information for 64.6% of patients (n = 1,539) and 69.7% of surgeons (n = 318). Logistic regression was used to examine the associations between surgeon specialization (percentage of practice devoted to breast disease) and hospital cancer program status, with four domains of patient satisfaction: (1) the surgical decision, (2) decision-making process, (3) surgeon-patient relationship, and (4) surgeon-patient communication, adjusting for patient and surgeon demographics and disease stage.
In this sample, 34.5% of patients were treated by surgeons who devoted less than 30% (low volume) of their practice to breast disease, 32.5% by surgeons who devoted 30% to 60% (medium volume) of their practice to breast disease, and 33.0% by surgeons who devoted more than 60% (high volume) of their practice to breast disease. Compared to patients treated by low-volume surgeons, patients treated by higher volume surgeons were more satisfied with the decision-making process (medium volume, odds ratio [OR], 1.16; 95% CI, 0.80 to 1.67; high volume: OR, 1.79; 95% CI, 1.14 to 2.80) and with the surgeon-patient relationship (medium volume: OR, 1.13; 95% CI, 0.72 to 1.76; high volume: OR, 1.98; 95% CI, 1.08 to 3.61). Treatment setting was not associated with patient satisfaction after controlling for other factors.
Surgeon specialization is correlated with patient satisfaction. Examining the processes underlying these associations can inform strategies to improve breast cancer care.
治疗乳腺癌患者的外科医生之间的经验和实践环境差异很大。然而，对于这些因素如何影响患者对其治疗的满意度，人们了解得较少。
我们对所有原位导管癌患者以及2002年在密歇根州底特律市和加利福尼亚州洛杉矶市上报给监测、流行病学和最终结果登记处的浸润性乳腺癌患者的20%随机样本进行了调查。对主治外科医生进行了调查，获得了64.6%的患者（n = 1539）和69.7%的外科医生（n = 318）的二元信息。使用逻辑回归分析来研究外科医生的专业领域（专注于乳腺疾病的业务比例）与医院癌症项目状况之间的关联，以及患者满意度的四个方面：（1）手术决策，（2）决策过程，（3）医患关系，（4）医患沟通，并对患者和外科医生的人口统计学特征以及疾病阶段进行了调整。
在这个样本中，34.5%的患者由专注于乳腺疾病业务不到30%（低工作量）的外科医生治疗，32.5%由专注于乳腺疾病业务30%至60%（中等工作量）的外科医生治疗，33.0%由专注于乳腺疾病业务超过60%（高工作量）的外科医生治疗。与由低工作量外科医生治疗的患者相比，由高工作量外科医生治疗的患者对决策过程（中等工作量，优势比[OR]，1.16；95%置信区间，0.80至1.67；高工作量：OR，1.79；95%置信区间，1.14至2.80）和医患关系（中等工作量：OR，1.13；95%置信区间，0.72至1.76；高工作量：OR，1.98；95%置信区间，1.08至3.61）更满意。在控制其他因素后，治疗环境与患者满意度无关。
外科医生的专业领域与患者满意度相关。研究这些关联背后的过程可以为改善乳腺癌治疗的策略提供信息。
