与肺癌护理中的种族差异相关的文化因素。
Cultural factors associated with racial disparities in lung cancer care.
机构信息
1 Division of General Internal Medicine.
出版信息
Ann Am Thorac Soc. 2014 May;11(4):489-95. doi: 10.1513/AnnalsATS.201402-055OC.
RATIONALE
Minority patients with lung cancer are less likely to receive stage-appropriate treatment. Along with access to care and provider-related factors, cultural factors such as patients' lung cancer beliefs, fatalism, and medical mistrust may help explain this disparity.
OBJECTIVES
To determine cultural factors associated with disparities in lung cancer treatment.
METHODS
Patients with newly diagnosed lung cancer were recruited from four medical centers in New York City from 2008 to 2011. Using validated tools, we surveyed participants about their beliefs regarding lung cancer, fatalism, and medical mistrust. We compared rates of stage-appropriate treatment among blacks, Hispanics, and nonminority patients. Multiple regression analyses and structural equation modeling were used to assess whether cultural factors are associated with and/or mediate disparities in care.
MEASUREMENTS AND MAIN RESULTS
Of the 352 patients with lung cancer in the study, 21% were black and 20% were Hispanic. Blacks were less likely to receive stage-appropriate treatment (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.27-0.93) compared with whites, even after adjusting for age, sex, marital status, insurance, income, comorbidities, and performance status. No differences in treatment rates were observed among Hispanics (OR, 1.05; 95% CI, 0.53-2.07). Structural equation modeling showed that cultural factors (negative surgical beliefs, fatalism, and medical mistrust) partially mediated the relationship between black race and lower rates of stage-appropriate treatment (total effect: -0.43, indirect effect: -0.13; 30% of total effect explained by cultural factors).
CONCLUSIONS
Negative surgical beliefs, fatalism, and mistrust are more prevalent among minorities and appear to explain almost one-third of the observed disparities in lung cancer treatment among black patients. Interventions targeting cultural factors may help reduce undertreatment of minorities.
背景
肺癌的少数族裔患者接受适宜分期治疗的可能性较低。除了获得医疗服务和提供者相关因素外，患者的肺癌信念、宿命论和医疗不信任等文化因素也可能有助于解释这种差异。
目的
确定与肺癌治疗差异相关的文化因素。
方法
2008 年至 2011 年，从纽约市的四家医疗中心招募了新诊断为肺癌的患者。使用经过验证的工具，我们调查了参与者对肺癌、宿命论和医疗不信任的信念。我们比较了黑种人、西班牙裔和非少数族裔患者接受适宜分期治疗的比率。多元回归分析和结构方程模型用于评估文化因素是否与护理差异相关和/或作为护理差异的中介。
测量和主要结果
在研究中的 352 名肺癌患者中，21%是黑人，20%是西班牙裔。与白人相比，黑人接受适宜分期治疗的可能性较低（比值比[OR]，0.50；95%置信区间[CI]，0.27-0.93），即使在调整了年龄、性别、婚姻状况、保险、收入、合并症和表现状态后也是如此。西班牙裔之间的治疗率没有差异（OR，1.05；95% CI，0.53-2.07）。结构方程模型显示，文化因素（负面手术信念、宿命论和医疗不信任）部分中介了黑人种族与较低的适宜分期治疗率之间的关系（总效应：-0.43，间接效应：-0.13；文化因素解释了观察到的黑人患者肺癌治疗差异的 30%）。
结论
负面手术信念、宿命论和不信任在少数族裔中更为普遍，似乎可以解释黑人患者中观察到的肺癌治疗差异的近三分之一。针对文化因素的干预措施可能有助于减少对少数民族的治疗不足。
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