Jean-Pierre Pascal, Winters Paul C, Clark Jack A, Warren-Mears Victoria, Wells Kristen J, Post Douglas M, LaVerda Nancy, Van Duyn Mary Ann, Fiscella Kevin
Harper Cancer Research Institute, Notre Dame, IN, USA.
J Cancer Educ. 2013 Sep;28(3):527-34. doi: 10.1007/s13187-013-0498-5.
Patient navigation has emerged as a promising strategy for addressing racial-ethnic and socioeconomic disparities in cancer-related care. However, little is known about the impact of patients' perception of the quality of navigation on patient outcomes. We examined the impact of better-rated navigators on patients' satisfaction with cancer-related care. The sample included 1,593 adults (85.8% with abnormal cancer screening and 14.2% with confirmed cancer diagnosis) who received patient navigation. We defined better-rated navigators as those scoring above the first quartile of mean scores on the Patient Satisfaction with Interpersonal Relationship with Navigator scale. We defined patient satisfaction based on scores above or below the median of the Patient Satisfaction with Cancer-Related Care (PSCC) scale. We controlled for patient and site characteristics using backward selection logistic regression analyses. Among patients with abnormal screening, having a better-rated navigator was associated with higher score on the PSCC (p < 0.05). After controlling for other bivariate predictors of satisfaction (e.g., age, race, income, and household size), navigation by better-rated navigators was associated with a greater likelihood of having higher patient satisfaction [odds ratio (OR), 1.38; 95% confidence interval (CI), 1.05-1.82]. Similar findings between better-rated navigators and score on the PSCC were found for participants with diagnosed cancer (OR, 3.06; 95% CI, 1.56-6.0). Patients navigated by better-rated navigators reported higher satisfaction with their cancer-related care.
患者导航已成为解决癌症相关护理中种族和社会经济差异的一种有前景的策略。然而，对于患者对导航质量的认知对患者治疗结果的影响知之甚少。我们研究了评分较高的导航员对患者对癌症相关护理满意度的影响。样本包括1593名成年人（85.8%的人癌症筛查异常，14.2%的人确诊患有癌症），他们接受了患者导航服务。我们将评分较高的导航员定义为在“患者对与导航员人际关系的满意度”量表上得分高于平均得分第一四分位数的人。我们根据“患者对癌症相关护理的满意度”（PSCC）量表中位数以上或以下的得分来定义患者满意度。我们使用向后选择逻辑回归分析来控制患者和机构特征。在筛查异常的患者中，有评分较高的导航员与PSCC得分较高相关（p<0.05）。在控制了其他满意度的双变量预测因素（如年龄、种族、收入和家庭规模）后，由评分较高的导航员进行导航与患者满意度更高的可能性相关[优势比（OR），1.38；95%置信区间（CI），1.05 - 1.82]。在确诊癌症的参与者中，评分较高的导航员与PSCC得分之间也发现了类似的结果（OR，3.06；95%CI，1.56 - 6.0）。由评分较高的导航员导航的患者对其癌症相关护理的满意度更高。
