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医学生对造血干细胞捐献的知识、熟悉程度及态度:干细胞捐献行为

Medical Students' Knowledge, Familiarity, and Attitudes towards Hematopoietic Stem Cell Donation: Stem Cell Donation Behaviors.

作者信息

Narayanan Praveena, Wolanskyj Alexandra, Ehlers Shawna L, Litzow Mark R, Patnaik Mrinal S, Hogan William J, Hashmi Shahrukh K

机构信息

Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.

Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.

出版信息

Biol Blood Marrow Transplant. 2016 Sep;22(9):1710-1716. doi: 10.1016/j.bbmt.2016.06.014. Epub 2016 Jun 22.

Abstract

Hematopoietic stem cell transplantation (HSCT) is a potentially curative treatment for patients with blood disorders and genetic diseases. Approximately 70% of the HSCTs currently performed in the United States use stems cells from an unrelated donor who donated voluntarily. Medical students (MS) are a young, diverse, influential population whose willingness to engage in altruistic acts, such as donating stem cells, may be correlated with knowledge on the topic. A literature gap exists in MS perspectives towards HSCT and the bone marrow registry (BMR) and prior studies suggest that misconceptions about donation deter MS from participation on the BMR, which may decrease opportunities to educate other potential donors. We performed a cross-sectional survey among the 4-year cohort of MS at Mayo Medical School in Rochester, Minnesota. The questionnaire evaluated multiple areas including whether MS were current members of the BMR and/or prior blood donors, MS current knowledge on donor eligibility (DE) and the donation process (DP), MS familiarity with HSCT and the DP, and MS attitudes towards joining the BMR and towards donating stem cells. The responses were analyzed and assessed alongside a self-reported, standardized scale measuring students' altruistic behaviors. There were 99 out of 247 potential respondents (40%), with 45% (n = 44) of MS in preclinical years 1 or 2, 37% (n = 37) in clinical years 3 or 4, and 18% (n = 18) in research or alternative portions of their training, of which 43% (n = 41) in total were current BMR members. BMR status correlated positively with prior blood donation (P = .015) and female sex (P = .014). Respondents had a 57.7% and 63.7% average correct response rate regarding knowledge of DE and DP, respectively, with knowledge of DE not surprisingly higher in BMR members (P < .0001). The majority of MS surveyed, 68% (n = 65), had learned about HSCT during medical school. BMR status correlated with the following attitudes towards donating stem cells: lower concern with all evaluated aspects of HSCT-time, cost, pain, and side effects (for all subsections, P < .05) but not with the altruism score (P = .32). The mean altruism score for respondents was 59.9 ± 11.3 (of a possible 100 points) with no significant difference in age, race, sex, level of training, or participation in the BMR. Altruism scores did not directly correlate with lower concern with aspects of time, cost, and pain of HSCT but did with long-term side effects (P = .021). This latter correlation was regardless of BMR status. Among MS, positive predictors for participation in the BMR included prior blood donation and female sex. BMR status did not ensure knowledge of all aspects of donating stem cells, but it correlated with less concern regarding the DP and was unrelated to altruism score. Improving knowledge gaps regarding the BMR and HSCT for the next generation of physicians and health care providers through expanded medical education curriculum may be beneficial to for the recruitment and retention of donor populations to the BMR.

摘要

造血干细胞移植(HSCT)是一种对血液疾病和遗传疾病患者具有潜在治愈作用的治疗方法。目前在美国进行的HSCT中,约70%使用的是来自自愿捐赠的无关供体的干细胞。医学生(MS)是一个年轻、多样化且有影响力的群体,他们参与利他行为(如捐赠干细胞)的意愿可能与该主题的知识相关。在医学生对HSCT和骨髓登记处(BMR)的看法方面存在文献空白,先前的研究表明,对捐赠的误解阻碍医学生加入BMR,这可能会减少教育其他潜在捐赠者的机会。我们对明尼苏达州罗切斯特市梅奥医学院4年制的医学生进行了一项横断面调查。问卷评估了多个方面,包括医学生是否是BMR的现任成员和/或之前的献血者、医学生对捐赠者资格(DE)和捐赠过程(DP)的当前了解、医学生对HSCT和DP的熟悉程度,以及医学生对加入BMR和捐赠干细胞的态度。同时使用一个自我报告的标准化量表来衡量学生的利他行为,对这些回答进行分析和评估。在247名潜在受访者中有99人(40%)参与了调查,其中临床前1或2年的医学生占45%(n = 44),临床3或4年的医学生占37%(n = 37),处于研究阶段或培训其他阶段的医学生占18%(n = 18),其中共有43%(n = 41)是BMR的现任成员。BMR状态与之前的献血(P = 0.015)和女性性别(P = 0.014)呈正相关。受访者对DE和DP知识的平均正确回答率分别为57.7%和63.7%,不出所料,BMR成员对DE的了解更高(P < 0.0001)。接受调查的大多数医学生(68%,n = 65)在医学院期间了解过HSCT。BMR状态与对捐赠干细胞的以下态度相关:对HSCT所有评估方面(时间、成本、疼痛和副作用)的担忧较低(所有子部分P < 0.05),但与利他主义得分无关(P = .32)。受访者利他主义得分平均为59.9 ± 11.3(满分100分),在年龄、种族、性别、培训水平或是否参与BMR方面无显著差异。利他主义得分与对HSCT时间、成本和疼痛方面担忧较低无直接关联,但与长期副作用相关(P = 0.021)。后一种关联与BMR状态无关。在医学生中,参与BMR的积极预测因素包括之前的献血和女性性别。BMR状态并不能确保对捐赠干细胞所有方面的了解,但与对DP的担忧较少相关且与利他主义得分无关。通过扩展医学教育课程来改善下一代医生和医疗保健提供者在BMR和HSCT方面知识差距,可能有利于BMR捐赠人群的招募和保留。

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