患者参与对乳腺癌护理质量和健康相关生活质量的重要性：农村和城市社区拉丁裔乳腺癌幸存者的横断面研究。
The importance of patient engagement to quality of breast cancer care and health-related quality of life: a cross-sectional study among Latina breast cancer survivors in rural and urban communities.
机构信息
National Institute on Minority Health and Health Disparities, National Institutes of Health, 9000 Rockville Pike, Building 3, Floor 5, Room E08, MD, 20892, Bethesda, USA.
Division of General Internal Medicine, Department of Medicine, University of California San Francisco, 3333 California St., Suite 335, San Francisco, CA, 94143-0856, USA.
出版信息
BMC Womens Health. 2021 Feb 9;21(1):59. doi: 10.1186/s12905-021-01200-z.
BACKGROUND
Compared to their white counterparts, Latina breast cancer survivors experience poorer quality of care and worse health-related quality of life. Limited English proficiency (LEP) and patient engagement in cancer care could help explain these disparities. We assessed associations between LEP status and difficulty engaging with physicians, with self-reported quality of breast cancer care and health-related quality of life (physical and emotional well-being) among rural and urban Latina breast cancer survivors.
METHODS
Analyses used cross-sectional baseline survey data from two studies that tested a stress management program among rural and urban Latina breast cancer survivors in California. Medical information was collected through medical records review. Linear regression models examined bivariate and multivariable associations of LEP status (yes or no), difficulty engaging with doctors (asking questions and participating in treatment decisions) (1-4; higher score = greater difficulty), and rural versus urban site, with three outcomes: (1) quality of breast cancer care and information; (2) physical well-being; and (3) and emotional well-being, controlling for demographic and medical factors.
RESULTS
The total sample included 304 women (151 from urban and 153 from rural sites). Mean age was 52.7 years (SD 10.9). Most were limited English proficient (84.5%) and had less than a high school education (67.8%). Difficulty engaging with doctors was inversely associated with patient ratings of quality of breast cancer care and information (B = - 0.190, p = 0.014), emotional well-being (B = - 1.866, p < 0.001), and physical well-being (B = - 1.272, p = 0.002), controlling for demographic and treatment factors. LEP (vs. not; B = 1.987, p = 0.040) was independently associated with physical well-being only. Rural/urban status was not related independently to any outcome.
CONCLUSIONS
Rural and urban Latina breast cancer survivors who report greater difficulty engaging with physicians experienced worse quality of breast cancer care and health-related quality of life. Promoting greater engagement of Latina breast cancer survivors in cancer care and providing medical interpreters when needed could improve patient outcomes among this vulnerable group.
TRIAL REGISTRATION
http://www.ClinicalTrials.gov identifier NCT02931552 and NCT01383174.
背景
与白人患者相比，拉丁裔乳腺癌幸存者的护理质量更差，健康相关生活质量更差。有限的英语水平（LEP）和患者参与癌症治疗可能有助于解释这些差异。我们评估了 LEP 状态与与医生沟通困难、自我报告的乳腺癌护理质量以及农村和城市拉丁裔乳腺癌幸存者的健康相关生活质量（身体和情绪健康）之间的关联。
方法
分析使用了加利福尼亚州农村和城市拉丁裔乳腺癌幸存者两项研究的横断面基线调查数据，这些研究测试了一项应激管理方案。通过病历回顾收集医学信息。线性回归模型检查了 LEP 状态（是或否）、与医生沟通困难（提问和参与治疗决策）（1-4；得分越高表示困难越大）以及农村与城市地点与三个结果之间的双变量和多变量关联：（1）乳腺癌护理和信息质量；（2）身体幸福感；和（3）和情绪幸福感，控制了人口统计学和医学因素。
结果
总样本包括 304 名女性（城市 151 名，农村 153 名）。平均年龄为 52.7 岁（标准差 10.9）。大多数人英语水平有限（84.5%），受教育程度低于高中（67.8%）。与医生沟通困难与患者对乳腺癌护理和信息质量（B=-0.190，p=0.014）、情绪健康（B=-1.866，p<0.001）和身体健康（B=-1.272，p=0.002）的评分呈负相关，控制了人口统计学和治疗因素。与非 LEP 患者（B=1.987，p=0.040）相比，LEP 患者仅与身体幸福感独立相关。农村/城市地位与任何结果均无独立关系。
结论
报告与医生沟通困难更大的农村和城市拉丁裔乳腺癌幸存者经历了更差的乳腺癌护理质量和健康相关生活质量。促进拉丁裔乳腺癌幸存者更多地参与癌症治疗，并在需要时提供医疗翻译，可以改善这一弱势群体的患者结局。
试验注册
http://www.ClinicalTrials.gov 标识符 NCT02931552 和 NCT01383174。
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