Center for Interdisciplinary Population and Health Research, MaineHealth Institute for Research, Portland, ME.
The Jackson Laboratory, Augusta, ME.
JCO Precis Oncol. 2023 Mar;7:e2200631. doi: 10.1200/PO.22.00631.
Social determinants of health, such as rurality, income, and education, may widen health disparities by driving variation in patients' knowledge and perceptions of medical interventions. This effect may be greatest for medical technologies that are hard to understand and less accessible. This study explored whether knowledge and perceptions (expectations and attitudes) of patients with cancer toward large-panel genomic tumor testing (GTT), an emerging cancer technology, vary by patient rurality independent of other socioeconomic characteristics (education and income).
Patients with cancer enrolled in a large precision oncology initiative completed surveys measuring rurality, sociodemographic characteristics, and knowledge and perceptions of GTT. We used multivariable linear models to examine differences in GTT knowledge, expectations, and attitudes by patient rurality, education, and income level. Models controlled for age, sex and clinical cancer stage and type.
Rural patients had significantly lower knowledge of GTT than urban patients using bivariate models ( = .025). However, this association disappeared when adjusting for education and income level: patients with lower educational attainment and lower income had lower knowledge and higher expectations ( .002), whereas patients with higher income had more positive attitudes ( = .005). Urban patients had higher expectations of GTT compared with patients living in large rural areas ( = .011). Rurality was not associated with attitudes.
Patients' education and income level are associated with knowledge, expectations, and attitudes toward GTT, whereas rurality is associated with patient expectations. These findings suggest that efforts to promote adoption of GTT should focus on improving knowledge and awareness among individuals with low education and income. These differences may lead to downstream disparities in GTT utilization, which should be explored in future research.
健康的社会决定因素，如农村地区、收入和教育水平，可能会通过患者对医疗干预措施的了解和看法的差异，扩大健康差距。对于难以理解且不太容易获得的医疗技术来说，这种影响可能最大。本研究旨在探讨癌症患者对大型面板基因组肿瘤检测（GTT）的知识和看法（期望和态度）是否因患者的农村地区而有所不同，而与其他社会经济特征（教育和收入）无关。
参加大型精准肿瘤学计划的癌症患者完成了调查，测量了农村地区、社会人口统计学特征以及对 GTT 的知识和看法。我们使用多变量线性模型来检查 GTT 知识、期望和态度在患者的农村地区、教育程度和收入水平上的差异。模型控制了年龄、性别和临床癌症分期和类型。
使用双变量模型，农村患者对 GTT 的了解明显低于城市患者（ =.025）。然而，当调整教育和收入水平时，这种关联就消失了：教育程度较低和收入较低的患者对 GTT 的了解较低，期望较高（.002），而收入较高的患者对 GTT 的态度更为积极（ =.005）。与居住在大型农村地区的患者相比，城市患者对 GTT 的期望更高（ =.011）。农村地区与态度无关。
患者的教育和收入水平与对 GTT 的知识、期望和态度有关，而农村地区与患者的期望有关。这些发现表明，为促进 GTT 的采用而进行的努力应侧重于提高教育程度和收入较低的个体的知识和意识。这些差异可能导致未来研究中 GTT 利用的下游差异。
