Johnson Timothy V, Schoenberg Evan D, Abbasi Ammara, Ehrlich Samantha S, Kleris Renee, Owen-Smith Ashli, Gunderson Kristin, Master Viraj A
School of Medicine Department of Urology, Emory University, Atlanta, Georgia, USA.
J Urol. 2009 Jan;181(1):230-7. doi: 10.1016/j.juro.2008.09.010. Epub 2008 Nov 14.
Recent research suggests that low education and illiteracy may drive misunderstanding of the American Urological Association Symptom Score, a key tool in the American Urological Association benign prostatic hyperplasia guidelines. It is unclear whether misunderstanding is confined to patients of low socioeconomic status. Therefore, we reevaluated the prevalence and impact of this misunderstanding in a county vs university hospital population.
This prospective study involved 407 patients from a county hospital and a university hospital who completed the American Urological Association Symptom Score as self-administered and then as interviewer administered. Responses were compared by calculating correlation coefficients and weighted kappa statistics to assess patient understanding of the American Urological Association Symptom Score. Multivariate logistic regression analyses were used to examine the association between patient characteristics and poor understanding of the American Urological Association Symptom Score.
Of the patients 72% understood all 7 American Urological Association Symptom Score questions. Of the measured demographic variables only education level significantly affected this understanding. Compared to patients with more than 12 years of education county hospital patients with less than 9 years of education were 57.06 times more likely to misunderstand the American Urological Association Symptom Score (95% CI 14.32-329.34) while university hospital patients with less than 9 years of education were 38.27 times more likely to misunderstand the American Urological Association Symptom Score (95% CI 1.69-867.83). Of county hospital patients 31% and of university hospital patients 21% significantly misrepresented their symptom severity according to current guidelines.
Patients with low education regardless of location are more likely to misunderstand the American Urological Association Symptom Score, misrepresent their symptoms and, therefore, receive inappropriate treatment.
近期研究表明，低教育水平和文盲状态可能导致对美国泌尿外科学会症状评分产生误解，该评分是美国泌尿外科学会良性前列腺增生指南中的关键工具。尚不清楚这种误解是否仅限于社会经济地位较低的患者。因此，我们在县级医院与大学医院人群中重新评估了这种误解的发生率及其影响。
这项前瞻性研究纳入了来自一家县级医院和一家大学医院的407名患者，他们先自行填写美国泌尿外科学会症状评分，然后由访员进行询问。通过计算相关系数和加权kappa统计量来比较回答情况，以评估患者对美国泌尿外科学会症状评分的理解。采用多因素逻辑回归分析来检验患者特征与对美国泌尿外科学会症状评分理解不佳之间的关联。
72%的患者理解了美国泌尿外科学会症状评分的所有7个问题。在所测量的人口统计学变量中，只有教育水平对这种理解有显著影响。与接受过12年以上教育的患者相比，县级医院中接受过不到9年教育的患者误解美国泌尿外科学会症状评分的可能性高57.06倍（95%置信区间14.32 - 329.34），而大学医院中接受过不到9年教育的患者误解美国泌尿外科学会症状评分的可能性高38.27倍（95%置信区间1.69 - 867.83）。根据现行指南，县级医院31%的患者和大学医院21%的患者显著误报了他们的症状严重程度。
无论身处何地，教育水平低的患者更有可能误解美国泌尿外科学会症状评分，误报其症状，从而接受不恰当的治疗。
