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与癌前病变诊断相关的医疗保健利用的患者和提供者层面驱动因素:意义未明的单克隆丙种球蛋白病(MGUS)。

Patient and provider-level drivers of healthcare utilization related to a diagnosis of a precancerous condition: monoclonal gammopathy of undetermined significance (MGUS).

作者信息

Castañeda-Avila Maira A, Mazor Kathleen M, Lapane Kate L, Epstein Mara M

机构信息

Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, A6-1065O, Worcester, MA, 01605, USA.

Meyers Health Care Institute, A Joint Endeavor of the University of Massachusetts Chan Medical School, Fallon Health, and Reliant Medical Group, Worcester, MA, USA.

出版信息

Cancer Causes Control. 2023 May;34(5):449-457. doi: 10.1007/s10552-023-01675-1. Epub 2023 Feb 28.

Abstract

PURPOSE

Monoclonal gammopathy of undetermined significance (MGUS) is the precursor of multiple myeloma. This qualitative study described patient (n = 14) experiences and healthcare providers' (n = 8) opinions and practices concerning care for patients with MGUS in the US.

METHODS

Semi-structured, in-depth interviews were analyzed using thematic analysis.

RESULTS

We identified six overarching themes related to the care pathway for patients with MGUS: (1) Process of MGUS diagnosis, (2) Providers' explanations, (3) Patients' understanding, (4) Impact of the diagnosis, (5) Follow-up/management, and (6) Factors influencing healthcare utilization. Patients demonstrated a basic understanding of MGUS. However, some patients felt anxiety around the diagnosis, which may affect other aspects of their lives. Non-hematologist providers report having less MGUS-specific knowledge. Older age, high-risk MGUS, and insurance coverage/healthcare costs influenced healthcare utilization.

CONCLUSION

Patients with MGUS may have difficulty processing this premalignant diagnosis. Non-hematologist providers may have gaps in knowledge around specific care for patients with MGUS.

摘要

目的

意义未明的单克隆丙种球蛋白病(MGUS)是多发性骨髓瘤的前驱疾病。这项定性研究描述了美国患者(n = 14)的经历以及医疗服务提供者(n = 8)对于MGUS患者护理的看法和做法。

方法

采用主题分析法对半结构化的深入访谈进行分析。

结果

我们确定了与MGUS患者护理途径相关的六个总体主题:(1)MGUS诊断过程,(2)医疗服务提供者的解释,(3)患者的理解,(4)诊断的影响,(5)随访/管理,以及(6)影响医疗保健利用的因素。患者对MGUS有基本的了解。然而,一些患者在诊断时感到焦虑,这可能会影响他们生活的其他方面。非血液科医疗服务提供者报告称对MGUS的专业知识了解较少。年龄较大、高危MGUS以及保险覆盖范围/医疗保健成本影响了医疗保健的利用。

结论

MGUS患者可能难以接受这种癌前诊断。非血液科医疗服务提供者在MGUS患者的特定护理知识方面可能存在差距。

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