Edward Via College of Osteopathic Medicine, Spartanburg, South Carolina.
Department of Radiation Oncology, University of Utah, Salt Lake City, Utah; Department of Population Health Sciences, University of Utah, Salt Lake City, Utah.
Int J Radiat Oncol Biol Phys. 2023 May 1;116(1):60-67. doi: 10.1016/j.ijrobp.2023.01.045. Epub 2023 Jan 29.
Cancer is now the leading cause of non-AIDS death in the US population with HIV. People living with HIV (PLWH) are known to have lower cancer treatment rates and worse cancer outcomes. Disparate cancer treatment is driven by health system, patient, and clinician factors. Little attention has been given to the factors oncologists consider when making cancer treatment recommendations to PLWH. This study sought to examine oncologists' knowledge, attitudes, and practices that influence cancer treatment decision-making.
This study used qualitative methods to explore oncologists' treatment decision-making processes for PLWH and cancer. The sample included 25 radiation, medical, and surgical oncologists from 2 academic centers and 5 community practices. The interview domains were developed from the Andersen Healthcare Utilization Model, the Health Belief Model, and the PEN-3 Model, as well as our prior survey research.
This study describes elements of cancer treatment decision-making for PLWH. Oncologists highlighted the need for formal HIV education to support cancer treatment. One main concern with patient-provider interactions pertained to maintaining patient confidentiality during clinical encounters. Lastly, the importance of multidisciplinary care among health care providers allowed oncologists to facilitate both cancer care and logistical support.
As cancer becomes an increasingly common cause of death among PLWH, it is critical to understand the drivers of the observed disparities in cancer treatment. To our knowledge, this is the first qualitative study to describe oncologists' knowledge, attitudes, and practices toward patients who have a comorbid diagnosis of HIV and cancer. Several themes for future interventions emerge, including HIV training for cancer care providers, fostering interdisciplinary collaboration, enhancing HIV education for oncology learners and clinicians, and minimizing implicit bias.
癌症现已成为美国艾滋病毒感染者（HIV）人群中导致非艾滋病死亡的首要原因。已知 HIV 感染者（PLWH）的癌症治疗率较低，癌症结局较差。癌症治疗的差异是由卫生系统、患者和临床医生因素驱动的。很少有人关注肿瘤学家在向 PLWH 提出癌症治疗建议时考虑的因素。本研究旨在探讨影响肿瘤学家制定癌症治疗决策的知识、态度和实践。
本研究采用定性方法探讨肿瘤学家对 PLWH 和癌症的治疗决策过程。样本包括来自 2 个学术中心和 5 个社区实践的 25 名放射科、内科和外科肿瘤学家。访谈领域是根据安德森医疗保健利用模型、健康信念模型和 PEN-3 模型以及我们之前的调查研究制定的。
本研究描述了 PLWH 癌症治疗决策的要素。肿瘤学家强调需要进行正式的 HIV 教育，以支持癌症治疗。患者与提供者互动方面的一个主要关注点是在临床接触中维护患者的保密性。最后，医疗保健提供者之间多学科护理的重要性使肿瘤学家能够促进癌症护理和后勤支持。
随着癌症成为 PLWH 死亡的一个越来越常见的原因，了解观察到的癌症治疗差异的驱动因素至关重要。据我们所知，这是第一项描述肿瘤学家对同时患有 HIV 和癌症的患者的知识、态度和实践的定性研究。出现了几个未来干预的主题，包括为癌症护理提供者提供 HIV 培训、促进跨学科合作、加强肿瘤学学习者和临床医生的 HIV 教育以及最小化隐含偏见。
