Krok-Schoen Jessica L, Brewer Brittany M, Young Gregory S, Weier Rory C, Tatum Cathy M, DeGraffinreid Cecilia R, Paskett Electra D
Comprehensive Cancer Center, Ohio State University, Columbus, Ohio.
Center for Biostatistics, Ohio State University, Columbus, Ohio.
Cancer. 2015 Aug 15;121(16):2757-64. doi: 10.1002/cncr.29414. Epub 2015 Apr 28.
Patient navigation (PN) may improve cancer care by identifying and removing patient-reported barriers to care. In 2012, the American College of Surgeons Commission on Cancer (CoC) announced that health care facilities seeking CoC accreditation must have PN processes in place by January 1, 2015. Given these unfunded mandates, hospitals are looking for cost-effective ways to implement PN. This study examined demographic and psychosocial predictors of barriers to diagnostic resolution among individuals with a cancer screening abnormality enrolled in the Ohio Patient Navigation Research Project.
Data were obtained from patients who received care at 1 of 9 Ohio Patient Navigation Research Project intervention clinics. Descriptive statistics and logistic regression models were used.
There were 424 participants, and 151 (35.6%) reported a barrier to diagnostic resolution within 90 days of study consent. The most commonly reported barriers were misconceptions about a test or treatment (16.4%), difficulty in communicating with the provider (15.0%), and scheduling problems (11.5%). Univariate analyses indicated that race, education, employment, income, insurance, clinic type, friend support, and physical and psychological functioning were significantly associated with reporting a barrier to diagnostic resolution. Multivariate analyses found that comorbidities (odds ratio, 1.65; 95% confidence interval, 1.04-2.61) and higher intrusive thoughts and feelings (odds ratio, 1.25; 95% confidence interval, 1.10-1.41) were significantly associated with reporting a barrier to diagnostic resolution.
The results suggest that demographic and psychosocial factors are associated with barriers to diagnostic resolution. To ensure compliance with the CoC mandate and provide timely care to all patients, CoC-accredited facilities can systematically identify the patients most likely to have barriers to care and assign them to PN.
患者导航（PN）可通过识别并消除患者报告的就医障碍来改善癌症护理。2012年，美国外科医师学会癌症委员会（CoC）宣布，寻求CoC认证的医疗保健机构必须在2015年1月1日前建立PN流程。鉴于这些无资金支持的指令，医院正在寻找具有成本效益的方法来实施PN。本研究调查了参与俄亥俄州患者导航研究项目的癌症筛查异常个体中，诊断解决障碍的人口统计学和心理社会预测因素。
数据来自在俄亥俄州患者导航研究项目的9家干预诊所之一接受治疗的患者。使用了描述性统计和逻辑回归模型。
共有424名参与者，151名（35.6%）报告在研究同意后90天内存在诊断解决障碍。最常报告的障碍是对检查或治疗的误解（16.4%）、与提供者沟通困难（15.0%）和安排问题（11.5%）。单因素分析表明，种族、教育程度、就业、收入、保险、诊所类型、朋友支持以及身体和心理功能与报告诊断解决障碍显著相关。多因素分析发现，合并症（比值比，1.65；95%置信区间，1.04 - 2.61）以及更高的侵入性思维和感受（比值比，1.25；95%置信区间，1.10 - 1.41）与报告诊断解决障碍显著相关。
结果表明，人口统计学和心理社会因素与诊断解决障碍相关。为确保符合CoC指令并为所有患者提供及时护理，获得CoC认证的机构可以系统地识别最有可能存在就医障碍的患者，并将他们分配给PN。
