Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
Veterans Affairs Greater Los Angeles Healthcare System, 16111 Plummer Street, Building 25, Room B111, North Hills, CA, 91343, USA.
Breast Cancer Res Treat. 2018 Aug;170(3):593-603. doi: 10.1007/s10549-018-4776-0. Epub 2018 Apr 5.
Racial/ethnic differences in cancer symptom burden are well documented, but limited research has evaluated modifiable factors underlying these differences. Our objective was to examine the role of patient-provider interactions to help explain the relationship between race/ethnicity and cancer-specific physical well-being (PWB) among women with breast cancer.
The Pathways Study is a prospective cohort study of 4505 women diagnosed with breast cancer at Kaiser Permanente Northern California between 2006 and 2013. Our analysis included white, black, Hispanic, and Asian participants who completed baseline assessments of PWB, measured using the Functional Assessment of Cancer Therapy for Breast Cancer, and patient-provider interactions, measured by the Interpersonal Processes of Care Survey (IPC) (N = 4002). Using step-wise linear regression, we examined associations of race/ethnicity with PWB, and changes in associations when IPC domains were added.
We observed racial/ethnic differences in PWB, with minorities reporting lower scores than whites (beta, black: - 1.79; beta, Hispanic: - 1.92; beta, Asian: - 1.68; p < 0.0001 for all comparisons). With the addition of health and demographic covariates to the model, associations between race/ethnicity and PWB score became attenuated for blacks and Asians (beta: - 0.63, p = 0.06; beta: - 0.68, p = 0.02, respectively) and, to a lesser extent, for Hispanic women (beta: - 1.06, p = 0.0003). Adjusting for IPC domains did not affect Hispanic-white differences (beta: - 1.08, p = 0.0002), and slightly attenuated black-white differences (beta: - 0.51, p = 0.14). Asian-white differences narrowed substantially (beta: - 0.31, p = 0.28).
IPC domains, including those capturing perceived discrimination, respect, and clarity of communication, appeared to partly explain PWB differences for black and Asian women. Results highlight opportunities to improve providers' interactions with minority patients, and communication with minority patients about their supportive care needs.
癌症症状负担方面存在明显的种族/民族差异，但是针对导致这些差异的可改变因素的研究却很少。我们的目的是评估患者-提供者的互动关系，以帮助解释在接受乳腺癌治疗的女性中，种族/民族与癌症特异性身体整体健康状况（PWB）之间的关系。
Pathways 研究是一项对 2006 年至 2013 年期间在 Kaiser Permanente Northern California 被诊断为乳腺癌的 4505 名女性的前瞻性队列研究。我们的分析包括白人、黑人、西班牙裔和亚裔参与者，他们完成了 PWB 的基线评估，使用功能性癌症治疗评估乳腺癌量表（FACT-B）进行测量，患者-提供者的互动关系使用医患互动过程量表（IPC）进行测量（N=4002）。我们采用逐步线性回归方法，检验种族/民族与 PWB 的相关性，以及当 IPC 各领域纳入后，相关性的变化。
我们观察到 PWB 存在种族/民族差异，少数族裔报告的分数低于白人（黑人：-1.79；西班牙裔：-1.92；亚裔：-1.68；所有比较的 p 值均<0.0001）。将健康和人口统计学协变量加入模型后，黑人和亚裔与 PWB 评分之间的相关性减弱（黑人：-0.63，p=0.06；亚裔：-0.68，p=0.02），而西班牙裔女性的相关性减弱程度较小（-1.06，p=0.0003）。调整 IPC 领域对西班牙裔-白人的差异没有影响（-1.08，p=0.0002），但略微减弱了黑人-白人的差异（-0.51，p=0.14）。亚裔-白人的差异明显缩小（-0.31，p=0.28）。
IPC 领域，包括那些反映感知歧视、尊重和沟通清晰度的领域，似乎部分解释了黑人和亚裔女性 PWB 差异的原因。结果突出了改善提供者与少数民族患者互动关系的机会，以及与少数民族患者就其支持性护理需求进行沟通的机会。
