Department of Palliative Care and Rehabilitation Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
J Pain Symptom Manage. 2013 Sep;46(3):376-85. doi: 10.1016/j.jpainsymman.2012.08.015. Epub 2012 Nov 22.
Understanding cancer patients' preferences in decisional roles is important in providing quality care and ensuring patient satisfaction. There is a lack of evidence on decisional control preferences (DCPs) of Hispanic Americans, the fastest growing population in the U.S.
The primary aims of this study were to describe DCPs of Hispanics with advanced cancer in the U.S. (HUSs) and compare the frequency of passive DCPs in this population with that of Hispanics with advanced cancer in Latin America (HLAs).
We conducted a prospective survey of patients with advanced cancer referred to outpatient palliative care clinics in the U.S., Chile, Argentina, and Guatemala. Information was collected on sociodemographic variables, Karnofsky Performance Scale scores, acculturation (Marin Acculturation Assessment Tool), and DCP (Control Preference Scale). Chi-square tests were used to determine the differences in DCPs between HUSs and HLAs.
A total of 387 patients were surveyed: 91 in the U.S., 100 in Chile, 94 in Guatemala, and 99 in Argentina. The median age of HUSs was 56 years, 59% were female, and the median Karnofsky Performance Scale score was 60; the corresponding values for HLAs were 60 years, 60%, and 80. HLAs used passive DCP strategies significantly more frequently than HUSs did with regard to the involvement of the family (24% vs. 10%; P=0.009) or the physician (35% vs. 16%; P<0.001), even after age and education were controlled for. Eighty-three percent of HUSs and 82% of HLAs preferred family involvement in decision making (P=non-significant). No significant differences were found in DCPs between poorly and highly acculturated HUSs (P=0.91).
HUSs had more active DCPs than HLAs did. Among HUSs, acculturation did not seem to play a role in DCP determination. Our findings confirm the importance of family participation for both HUSs and HLAs. However, HUSs were less likely to want family members to make decisions on their behalf.
了解癌症患者在决策角色中的偏好对于提供高质量的护理和确保患者满意度至关重要。在美国，西班牙裔美国人是增长最快的人群，但关于他们的决策控制偏好（DCP）的证据不足。
本研究的主要目的是描述美国晚期癌症西班牙裔患者（HUSs）的 DCP，并比较该人群与拉丁美洲晚期癌症西班牙裔患者（HLAs）的被动 DCP 频率。
我们对美国、智利、阿根廷和危地马拉的门诊姑息治疗诊所转介的晚期癌症患者进行了前瞻性调查。收集了社会人口统计学变量、卡诺夫斯基表现量表评分、文化适应（马林文化适应评估工具）和 DCP（控制偏好量表）信息。使用卡方检验确定 HUSs 和 HLAs 之间 DCP 的差异。
共调查了 387 名患者：美国 91 名，智利 100 名，危地马拉 94 名，阿根廷 99 名。HUSs 的中位年龄为 56 岁，59%为女性，卡诺夫斯基表现量表评分为 60；HLAs 的相应值为 60 岁、60%和 80。即使在控制年龄和教育程度后，HLAs 在涉及家庭（24%对 10%；P=0.009）或医生（35%对 16%；P<0.001）时使用被动 DCP 策略的频率明显高于 HUSs。83%的 HUSs 和 82%的 HLA 希望家庭参与决策（P=非显著）。在 DCP 方面，文化适应程度较差和较高的 HUSs 之间没有发现显著差异（P=0.91）。
HUSs 的 DCP 比 HLA 更积极。在 HUSs 中，文化适应似乎并没有在 DCP 确定中发挥作用。我们的研究结果证实了家庭参与对 HUSs 和 HLA 都很重要。然而，HUSs 不太可能希望家庭成员代表他们做出决定。
