Department of Public Health, Baylor University.
Department of Surgery, University of Rochester Medical Center.
Health Commun. 2020 Sep;35(10):1289-1294. doi: 10.1080/10410236.2019.1625006. Epub 2019 Jun 5.
We examined whether the patient-provider relationship (PPR) is associated with Black survivors' health outcomes and whether this association was mediated by the quality of care. The outcome variables were survivors' quality of care and health outcome, and the predictor variable was PPR (communication, emotional support, time spent, and survivors' shared-decision making). A sample of 223 Black cancer survivors (age 63.0 ± 14.0 years) provided evaluable data. The most common cancer types reported by the participants were: gynecologic (32.7%), genitourinary (21.5%), and gastrointestinal cancers (11.2%). After controlling for covariates. A Structural Equation Model (SEM) showed that PPR was significantly associated with both health outcome ( = .015) and quality of care ( = .002). When PPR and quality of care were tested in the mediation model, the direct association between PPR and health outcome was attenuated, and it was no longer significant (b = -0.05, SE = 0.11, = .65). However, indirectly, there was a strong association between PPR and health outcome through the quality of care (b = 0.22, SE = 0.08, = .003), indicating full mediation. Providers' interpersonal relationships had a significant influence on the health of Black survivors, and this influence may be due to the increased positive perception of the quality of care. The implications of these findings for further research are discussed.
我们考察了医患关系(PPR)是否与黑人幸存者的健康结果相关,以及这种关联是否通过护理质量来介导。因变量是幸存者的护理质量和健康结果,预测变量是 PPR(沟通、情感支持、花费时间和幸存者的共同决策)。我们的样本包括 223 名黑人癌症幸存者(年龄 63.0±14.0 岁),他们提供了可评估的数据。参与者报告的最常见癌症类型是:妇科(32.7%)、泌尿生殖系统(21.5%)和胃肠道癌症(11.2%)。在控制协变量后,结构方程模型(SEM)显示,PPR 与健康结果( =.015)和护理质量( =.002)显著相关。当在中介模型中检验 PPR 和护理质量时,PPR 与健康结果之间的直接关联减弱,且不再显著(b = -0.05,SE = 0.11, =.65)。然而,间接的,PPR 通过护理质量与健康结果之间存在很强的关联(b = 0.22,SE = 0.08, =.003),表明完全中介。提供者的人际关系对黑人幸存者的健康有重大影响,这种影响可能是由于对护理质量的积极认知增加所致。讨论了这些发现对进一步研究的意义。