Bendheim Integrative Medicine Center, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Hematology-Oncology, Olive View-UCLA Medical Center, Sylmar, California.
Pain Med. 2019 Oct 1;20(10):2060-2068. doi: 10.1093/pm/pnz087.
In response to the national opioid crisis, governmental and medical organizations have called for broader insurance coverage of acupuncture to improve access to nonpharmacologic pain therapies, especially in cancer populations, where undertreatment of pain is prevalent. We evaluated whether cancer patients would be willing to use insurance-covered acupuncture for pain.
We conducted a cross-sectional survey of cancer patients with pain at one academic center and 11 community hospitals.
We used logistic regression models to examine factors associated with willingness to use insurance-covered acupuncture for pain.
Among 634 cancer patients, 304 (47.9%) reported willingness to use insurance-covered acupuncture for pain. In univariate analyses, patients were more likely to report willingness if they had severe pain (odds ratio [OR] = 1.59, 95% confidence interval [CI] = 1.03-2.45) but were less likely if they were nonwhite (OR = 0.59, 95% CI = 0.39-0.90) or had only received high school education or less (OR = 0.46, 95% CI = 0.32-0.65). After adjusting for attitudes and beliefs in multivariable analyses, willingness was no longer significantly associated with education (adjusted OR [aOR] = 0.78, 95% CI = 0.50-1.21) and was more negatively associated with nonwhite race (aOR = 0.49, 95% CI = 0.29-0.84).
Approximately one in two cancer patients was willing to use insurance-covered acupuncture for pain. Willingness was influenced by patients' attitudes and beliefs, which are potentially modifiable through counseling and education. Further research on racial disparities is needed to close the gap in utilization as acupuncture is integrated into insurance plans in response to the opioid crisis.
为应对全国性阿片类药物危机，政府和医疗组织呼吁扩大针灸保险覆盖范围，以增加非药物性疼痛疗法的可及性，尤其是在癌症患者人群中，因为这些人群普遍存在疼痛治疗不足的情况。我们评估了癌症患者是否愿意使用保险覆盖的针灸来缓解疼痛。
我们在一家学术中心和 11 家社区医院对患有疼痛的癌症患者进行了横断面调查。
我们使用逻辑回归模型来检验与使用保险覆盖的针灸缓解疼痛的意愿相关的因素。
在 634 名癌症患者中，有 304 名（47.9%）报告愿意使用保险覆盖的针灸缓解疼痛。在单因素分析中，如果患者疼痛严重（比值比[OR] = 1.59，95%置信区间[CI] = 1.03-2.45），则更有可能报告愿意使用针灸，但如果患者是非裔美国人（OR = 0.59，95% CI = 0.39-0.90）或仅接受过高中或以下教育（OR = 0.46，95% CI = 0.32-0.65），则不太可能报告愿意使用针灸。在多变量分析中调整态度和信念后，意愿与教育程度不再显著相关（调整后的比值比[aOR] = 0.78，95% CI = 0.50-1.21），而非裔美国人的种族与意愿更负相关（aOR = 0.49，95% CI = 0.29-0.84）。
大约每两名癌症患者中就有一名愿意使用保险覆盖的针灸来缓解疼痛。意愿受到患者态度和信念的影响，这些因素可以通过咨询和教育来改变。需要进一步研究种族差异，以缩小利用差距，因为在应对阿片类药物危机时，针灸已被纳入保险计划。
