Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California 90095-1772, USA.
J Urol. 2011 Nov;186(5):1855-61. doi: 10.1016/j.juro.2011.06.059. Epub 2011 Sep 25.
Self-efficacy is associated with increased participation in treatment decision making and improved health related quality of life. We examined the influence of perceived efficacy in patient-physician interactions on health related quality of life among low income, uninsured men with prostate cancer during a 2-year period.
We analyzed data derived on participants enrolled in a state funded program providing free prostate cancer treatment and care to indigent men. We used validated instruments to measure patient self-efficacy (confidence in interacting with physicians), and the general and prostate specific health related quality of life outcomes of urinary, sexual and bowel bother, symptom distress, psychological well-being and vitality. We performed repeated measures analysis with general linear mixed modeling to estimate the association of sociodemographic and clinical covariates with health related quality of life.
Our cohort included a total of 472 observations in 99 men. Self-efficacy had a measurable effect on subjective measurements of general and disease specific health related quality of life. Men with the lowest self-efficacy had inferior mean health related quality of life scores across all outcomes. Low self-efficacy was significantly associated with worse bowel bother and general symptom distress during the 2-year study period. Similar health related quality of life outcomes trajectories were observed across self-efficacy categories.
Of disadvantaged men with clinically localized prostate cancer those with the lowest self-efficacy in physician interactions fared worst across all measured domains of health related quality of life. Interventions to improve patient-physician communication in this population may provide physicians with a supplemental method by which to address health perceptions, mitigate symptom experience and improve health outcomes.
自我效能感与增加参与治疗决策和改善健康相关生活质量有关。我们研究了在两年期间，在患有前列腺癌的低收入、无保险男性中，患者与医生互动中的感知效能感对健康相关生活质量的影响。
我们分析了在一个为贫困男性提供免费前列腺癌治疗和护理的州立项目中招募的参与者的数据。我们使用经过验证的工具来衡量患者的自我效能感（与医生互动的信心），以及一般和前列腺特异性健康相关生活质量的结果，包括尿、性和肠困扰、症状困扰、心理幸福感和活力。我们使用重复测量分析和广义线性混合模型来估计社会人口统计学和临床协变量与健康相关生活质量的关联。
我们的队列包括 99 名男性的总共 472 次观察。自我效能感对一般和疾病特异性健康相关生活质量的主观测量有一定的影响。自我效能感最低的男性在所有结果上的健康相关生活质量评分都较差。在两年的研究期间，低自我效能感与更严重的肠困扰和一般症状困扰显著相关。在自我效能感类别中观察到相似的健康相关生活质量结果轨迹。
在患有临床局限性前列腺癌的劣势男性中，与医生互动中自我效能感最低的男性在所有健康相关生活质量测量领域的表现最差。在该人群中，改善医患沟通的干预措施可能为医生提供一种补充方法，以解决健康认知、减轻症状体验和改善健康结果。
