RTI International, Research Triangle Park, NC, USA.
Durham Veterans Affairs Health Care System, Durham, NC, USA.
Cancer Causes Control. 2021 Sep;32(9):977-987. doi: 10.1007/s10552-021-01451-z. Epub 2021 May 27.
Cancer patients' care experiences encompass the range of interactions with the health care system and are an important indicator of care quality, which may influence survival outcomes. This study evaluates relationships between care experiences and survival using a large, nationally representative sample of cancer patients.
We used linked SEER (Surveillance Epidemiology and End Results)-CAHPS (Consumer Assessment of Healthcare Providers and Systems) data to identify people diagnosed 8/2006-12/2013, focusing on 10 solid tumor cancer sites with the highest mortality rates among those > 65. CAHPS measures included 5 global ratings and 3 composite scores. We used survey-weighted Cox proportional hazard models comparing survival time for those who had lower (0-8) vs higher ratings (9-10) and lower (0-89) vs higher (90-100) composite scores, adjusting for case-mix and additional covariates.
We identified 2,263 eligible people; 26% died by 5-year post-survey completion or end of follow-up (12/31/2017). We found lower Prescription Drug Plan (PDP) ratings were significantly associated with lower mortality (adjusted HR = 0.67, p = 0.03). Lower Getting Needed Care scores were also significantly associated with lower mortality (adjusted HR = 0.79, p = 0.04). For other care experience measures, general health status, cancer stage, and comorbidities were more predictive of survival (p < .05).
Except for PDP and Getting Needed Care, survival was similar for those with worse versus better care experiences. Patients with poorer cancer prognoses may perceive better services from their drug plan and more responsive care from clinical providers compared to those with better prognoses. Further research is needed examining processes underlying perceptions of care experiences and survival.
癌症患者的护理体验涵盖了与医疗保健系统的一系列互动，是护理质量的重要指标，可能会影响生存结果。本研究使用来自癌症患者的大型全国代表性样本评估了护理体验与生存之间的关系。
我们使用链接的 SEER（监测、流行病学和最终结果）-CAHPS（医疗保健提供者和系统的消费者评估）数据来确定 2006 年 8 月至 2013 年 12 月期间诊断出的人群，重点关注 10 个固体肿瘤癌部位，这些部位在>65 岁人群中的死亡率最高。CAHPS 测量包括 5 个总体评分和 3 个综合评分。我们使用调查加权 Cox 比例风险模型比较了评分较低（0-8）与评分较高（9-10）以及评分较低（0-89）与评分较高（90-100）的人群的生存时间，同时调整了病例组合和其他协变量。
我们确定了 2263 名符合条件的人；5 年随访结束或随访结束后（2017 年 12 月 31 日），26%的人死亡。我们发现，较低的处方药计划（PDP）评分与较低的死亡率显著相关（调整后的 HR=0.67，p=0.03）。较低的获得所需护理评分也与较低的死亡率显著相关（调整后的 HR=0.79，p=0.04）。对于其他护理体验测量指标，一般健康状况、癌症分期和合并症对生存的预测性更强（p<0.05）。
除了 PDP 和获得所需护理外，护理体验较差与较好的患者的生存情况相似。与预后较好的患者相比，预后较差的癌症患者可能会从他们的药物计划中获得更好的服务，并且从临床提供者那里获得更积极的护理。需要进一步研究探讨护理体验和生存之间的感知过程。
