癌症住院患者报告的护理满意度与症状负担和医疗保健使用的关联。
Associations of patient-reported care satisfaction with symptom burden and healthcare use in hospitalized patients with cancer.
机构信息
Department of Medicine, Division of Hematology & Oncology, Massachusetts General Hospital Cancer Center & Harvard Medical School, 55 Fruit St., Yawkey 7B, Boston, MA, USA.
Department of Statistics, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA.
出版信息
Support Care Cancer. 2022 May;30(5):4527-4536. doi: 10.1007/s00520-021-06764-y. Epub 2022 Feb 3.
BACKGROUND
Hospitalized patients with cancer often experience a high symptom burden, which may impact care satisfaction and healthcare utilization.
METHODS
We prospectively enrolled patients with cancer and unplanned hospitalizations from September 2014 to April 2017. Upon admission, we assessed patients' care satisfaction (FAMCARE items: satisfaction with care coordination and speed with which symptoms are treated) and physical (Edmonton Symptom Assessment System [ESAS]) and psychological (Patient Health Questionnaire-4 [PHQ-4]) symptoms. We used regression models to identify factors associated with care satisfaction and associations of satisfaction with symptom burden and hospital length of stay (LOS).
RESULTS
Among 1,576 participants, most reported being "satisfied"/ "very satisfied" with care coordination (90%) and speed with which symptoms are treated (89%). Older age (coordination: B < 0.01, P = 0.02, speed: B = 0.01, P < 0.01) and admission to a dedicated oncology service (B = 0.20, P < 0.01 for each) were associated with higher satisfaction. Higher satisfaction with care coordination was associated with lower ESAS-physical (B = - 1.28, P < 0.01), ESAS-total (B = - 2.73, P < 0.01), PHQ4-depression (B = - 0.14, P = 0.02), and PHQ4-anxiety (B = - 0.16, P < 0.01) symptoms. Higher satisfaction with speed with which symptoms are treated was associated with lower ESAS-physical (B = - 1.32, P < 0.01), ESAS-total (B = - 2.46, P < 0.01), PHQ4-depression (B = - 0.14, P = 0.01), and PHQ4-anxiety (B = - 0.17, P < 0.01) symptoms. Satisfaction with care coordination (B = - 0.48, P = 0.04) and speed with which symptoms are treated (B = - 0.44, P = 0.04) correlated with shorter LOS.
CONCLUSIONS
Hospitalized patients with cancer report high care satisfaction, which correlates with older age and admission to a dedicated oncology service. Significant associations among higher care satisfaction, lower symptom burden, and shorter hospital LOS highlight the importance of improving symptom management and care coordination in this population.
背景
住院癌症患者通常会经历较高的症状负担，这可能会影响其对护理的满意度和医疗保健的利用。
方法
我们前瞻性地招募了 2014 年 9 月至 2017 年 4 月期间因非计划性住院的癌症患者。入院时，我们评估了患者的护理满意度（FAMCARE 项目：对护理协调和症状治疗速度的满意度）以及身体（埃德蒙顿症状评估系统 [ESAS]）和心理（患者健康问卷-4 [PHQ-4]）症状。我们使用回归模型来确定与护理满意度相关的因素，并确定满意度与症状负担和住院时间（LOS）之间的关联。
结果
在 1576 名参与者中，大多数人表示对护理协调（90%）和症状治疗速度（89%）“满意”/“非常满意”。年龄较大（协调：B<0.01，P=0.02；速度：B=0.01，P<0.01）和入住专门的肿瘤服务（B=0.20，P<0.01）与更高的满意度相关。对护理协调的满意度越高，ESAS-身体（B=−1.28，P<0.01）、ESAS-总分（B=−2.73，P<0.01）、PHQ4-抑郁（B=−0.14，P=0.02）和 PHQ4-焦虑（B=−0.16，P<0.01）症状越低。对症状治疗速度的满意度越高，ESAS-身体（B=−1.32，P<0.01）、ESAS-总分（B=−2.46，P<0.01）、PHQ4-抑郁（B=−0.14，P=0.01）和 PHQ4-焦虑（B=−0.17，P<0.01）症状越低。对护理协调的满意度（B=−0.48，P=0.04）和对症状治疗速度的满意度（B=−0.44，P=0.04）与 LOS 较短相关。
结论
住院癌症患者报告的护理满意度较高，这与年龄较大和入住专门的肿瘤服务有关。较高的护理满意度、较低的症状负担和较短的住院时间之间存在显著关联，这突出了改善该人群的症状管理和护理协调的重要性。
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