Department of Family Medicine, College of Medicine, Ohio State University, Columbus, OH, USA.
Department of Family Medicine, College of Medicine, Ohio State University, Columbus, OH, USA; Division of Health Services Management and Policy, College of Public Health, Ohio State University, Columbus, OH, USA.
J Natl Med Assoc. 2016 Winter;108(4):211-219. doi: 10.1016/j.jnma.2016.08.002. Epub 2016 Sep 15.
Black men with prostate cancer are diagnosed later, have poorer treatment outcomes, and higher mortality from the disease than all other racial groups. While existing literature has explored differences in the treatment decision making process between black and white men with localized prostate cancer, little is known about how environmental factors may affect the treatment decision process for men with clinically significant disease for whom treatment improves survival. The aim of this study was to compare and contrast the treatment decision process, from both patients' and treating physicians' perspectives, in a resource-rich and a resource-poor hospital.
Qualitative interviews and focus groups were conducted with patients and their treating physicians from two urban hospitals. Patients were identified through retrospective review of pathology and tumor registries; their charts abstracted to ascertain treatments. Treating physicians were identified and contacted to discuss the treatment decision process. Physicians were also asked to discuss patients who did not receive definitive treatment. Transcripts were analyzed deductively using themes from the Health Belief Model, and inductively to explore emergent themes.
Overall, patients and physicians discussed similar factors that influenced the decision making process at both hospitals. However, a few important differences were found: providers at the resource-poor hospital discussed cost as a barrier, highlighted having limited treatment options for their patients, and noted issues with follow-up as external factors affecting treatment decisions. Patients at the resource-poor hospital expressed greater fear and anxiety, and less self-efficacy and motivation in comparison to patients treated at the hospital with greater resources. Importantly, patients at both hospitals described significant trust in their physician, yet only at the resource-poor hospital did patients suggest that they lacked knowledge regarding treatment side-effects, despite physicians at both hospitals describing their attempt to disclose all side-effects.
These findings identify both medical-system factors, and practice-level factors that can help guide the development of interventions to reduce prostate cancer treatment disparities.
与其他所有种族群体相比，患有前列腺癌的黑人男性的诊断时间较晚，治疗效果较差，死于该病的风险更高。虽然现有文献已经探讨了黑人和白人患有局限性前列腺癌的男性在治疗决策过程中的差异，但对于环境因素如何影响那些接受治疗可提高生存率的患有临床显著疾病的男性的治疗决策过程知之甚少。本研究的目的是比较和对比资源丰富和资源匮乏的两家医院中，从患者和治疗医生的角度来看，治疗决策过程的异同。
对两家城市医院的患者及其治疗医生进行了定性访谈和焦点小组讨论。通过对病理和肿瘤登记处的回顾性审查来确定患者；通过提取图表来确定治疗方法。确定并联系了治疗医生以讨论治疗决策过程。还要求医生讨论未接受明确治疗的患者。使用健康信念模型中的主题对转录本进行演绎分析，并进行归纳分析以探讨新出现的主题。
总体而言，患者和医生在两家医院讨论了影响决策过程的相似因素。但是，发现了一些重要的差异：资源匮乏医院的提供者将成本作为障碍进行讨论，强调为患者提供的治疗选择有限，并指出随访问题是影响治疗决策的外部因素。与在资源丰富的医院接受治疗的患者相比，资源匮乏医院的患者表现出更大的恐惧和焦虑，自我效能感和动力较低。重要的是，两家医院的患者都对他们的医生表示出极大的信任，但只有在资源匮乏的医院，患者才表示他们对治疗副作用缺乏了解，尽管两家医院的医生都表示他们试图透露所有的副作用。
这些发现确定了医疗系统因素和实践水平因素，这些因素可以帮助指导干预措施的制定，以减少前列腺癌治疗差异。
