Department of Epidemiology, University of Iowa College of Public Health, 145 N. Riverside Drive, S465 CPHB, Iowa City, IA, 52242, USA.
Population Research Core, University of Iowa Holden Comprehensive Cancer Center, Iowa City, IA, USA.
Support Care Cancer. 2021 Dec;29(12):7913-7924. doi: 10.1007/s00520-021-06356-w. Epub 2021 Jun 30.
Care coordination is a strategy to reduce healthcare navigation challenges for cancer patients. The objectives of this study were to assess the association between having a cancer care coordinator (CCC) and long-term health-related quality of life (HRQoL), and to evaluate whether this association differed by level of health literacy.
A population-based sample of survivors diagnosed with breast, prostate, or colorectal cancer in 2015 from the Iowa Cancer Registry participated in an online survey conducted in 2017-2018 (N = 368). Chi-squared tests and logistic regression were used to model the association between patient characteristics and having a cancer care coordinator. Linear regression was used to model the association between patient perception of having a cancer care coordinator and post-treatment physical or mental HRQoL by differing levels of health literacy while controlling for sociodemographic and clinical factors.
Most survivors (81%) reported having one healthcare professional who coordinated their cancer care. Overall, patient perception of having a coordinator was not significantly associated with physical HRQoL (p = 0.118). However, participants with low health literacy (21%) who had a coordinator had significantly higher physical HRQoL scores compared to those who did not (adjusted mean difference 5.2, p = 0.010), while not so for medium (29%) or high (51%) health literacy (p = 0.227, and p = 0.850, respectively; test for interaction p = 0.001). Mental HRQoL was not associated with having a coordinator in our analyses.
Findings suggest that care coordinators improved post-treatment physical HRQoL, particularly for participants with low health literacy. Care coordinators may be beneficial to the most vulnerable patients struggling to navigate the complex healthcare system during cancer treatment. Future research should focus on the mechanisms by which care coordination may affect post-treatment HRQoL.
协调护理是一种减少癌症患者医疗导航挑战的策略。本研究的目的是评估是否存在癌症护理协调员（CCC）与长期健康相关生活质量（HRQoL）之间存在关联，以及这种关联是否因健康素养水平而异。
本研究采用基于人群的样本，参与者为 2015 年在爱荷华癌症登记处诊断患有乳腺癌、前列腺癌或结直肠癌的幸存者，于 2017-2018 年期间参加了一项在线调查（N=368）。采用卡方检验和逻辑回归模型分析患者特征与癌症护理协调员之间的关系。采用线性回归模型分析患者对癌症护理协调员的感知与不同健康素养水平下治疗后身体或心理 HRQoL 之间的关系，同时控制社会人口学和临床因素。
大多数幸存者（81%）报告有一位协调他们癌症护理的医疗保健专业人员。总体而言，患者对协调员的感知与身体 HRQoL 无显著相关性（p=0.118）。然而，具有低健康素养（21%）的参与者，与没有协调员的参与者相比，他们的身体 HRQoL 评分显著更高（调整平均差异 5.2，p=0.010），而对于中健康素养（29%）或高健康素养（51%）的参与者则不然（p=0.227，p=0.850；交互检验 p=0.001）。在我们的分析中，心理健康 HRQoL 与是否有协调员无关。
研究结果表明，协调员改善了治疗后身体 HRQoL，特别是对于健康素养较低的参与者。协调员可能对在癌症治疗期间难以应对复杂医疗保健系统的最脆弱患者有益。未来的研究应重点关注协调护理可能影响治疗后 HRQoL 的机制。
