Bernardes Christina M, Clark Paul J, Brown Cath, Stuart Katherine, Pratt Gregory, Toombs Maree, Hartel Gunter, Powell Elizabeth E, Valery Patricia C
QIMR Berghofer Medical Research Institute, Herston, QLD, Australia.
Department of Gastroenterology and Hepatology, Mater Hospitals, Brisbane, QLD, Australia.
Patient Prefer Adherence. 2021 Nov 24;15:2649-2658. doi: 10.2147/PPA.S341566. eCollection 2021.
Understanding and responding to the supportive care needs of people with cirrhosis is essential to quality care. Indigenous Australians, Aboriginal and Torres Strait Islander people, are overrepresented amongst patients with cirrhosis. This study documented the nature and extent of supportive care needs of Indigenous Australians with cirrhosis, in comparison with non-Indigenous Australians.
The supportive care needs of adult patients diagnosed with cirrhosis attending public hospitals in Queensland were assessed through the Supportive Needs Assessment tool for Cirrhosis (SNAC). Patients indicated how much additional help they needed on four subscales: 1. psychosocial issues; 2. practical and physical needs; 3. information needs; and 4. lifestyle changes. We examined the rate of moderate-to-high unmet needs based on Indigenous status (Poisson regression; incidence rate ratio (IRR)).
Indigenous (n=20) and non-Indigenous (n=438) patients included in the study had similar sociodemographic and clinical characteristics except for a lower educational level among Indigenous patients (p<0.01). Most Indigenous patients (85.0%) reported having moderate-to-high unmet needs with at least one item in the SNAC tool. Following adjustment for key sociodemographic and clinical factors, Indigenous patients had a greater rate of moderate-to-high unmet needs overall (IRR=1.5, 95% CI 1.31-1.72; p<0.001), and specifically for psychosocial issues (IRR=1.7, 95% CI 1.39-2.15; p<0.001), and practical and physical needs subscales (IRR=1.5, 95% CI 1.22-1.83; p<0.001), compared to non-Indigenous patients.
Indigenous Australians with cirrhosis more frequently had moderate-to-high unmet supportive care needs than non-Indigenous patients. Specific targeting of culturally appropriate supportive care for psychosocial, practical and physical needs may optimize cirrhosis care and improve the quality of life for Indigenous Australians with cirrhosis.
了解并回应肝硬化患者的支持性护理需求对于优质护理至关重要。澳大利亚原住民，即澳大利亚土著居民和托雷斯海峡岛民，在肝硬化患者中所占比例过高。本研究记录了澳大利亚原住民肝硬化患者与非原住民肝硬化患者支持性护理需求的性质和程度。
通过肝硬化支持性需求评估工具（SNAC）对昆士兰州公立医院确诊为肝硬化的成年患者的支持性护理需求进行评估。患者指出他们在四个子量表上需要多少额外帮助：1. 心理社会问题；2. 实际和身体需求；3. 信息需求；4. 生活方式改变。我们根据原住民身份研究了中度至高度未满足需求的发生率（泊松回归；发病率比（IRR））。
纳入研究的原住民患者（n = 20）和非原住民患者（n = 438）具有相似的社会人口统计学和临床特征，但原住民患者的教育水平较低（p < 0.01）。大多数原住民患者（85.0%）报告在SNAC工具中至少有一项存在中度至高度未满足需求。在对关键的社会人口统计学和临床因素进行调整后，原住民患者总体上中度至高度未满足需求的发生率更高（IRR = 1.5，95% CI 1.31 - 1.72；p < 0.001），特别是在心理社会问题方面（IRR = 1.7，95% CI 1.39 - 2.15；p < 0.001）以及实际和身体需求子量表方面（IRR = 1.5，95% CI 1.22 - 1.83；p < 0.001），与非原住民患者相比情况如此。
与非原住民患者相比，患有肝硬化的澳大利亚原住民更频繁地存在中度至高度未满足的支持性护理需求。针对心理社会、实际和身体需求提供具有文化适宜性的支持性护理，可能会优化肝硬化护理，并改善患有肝硬化的澳大利亚原住民的生活质量。
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