前列腺癌治疗决策过程中患者观点及经济因素的前瞻性评估。
A prospective evaluation of patient perspectives and financial considerations during prostate cancer treatment decision-making.
作者信息
Rai Karnvir S, Mann Uday, Harasemiw Oksana, Tangri Navdeep, Eng Amanda, Patel Premal, Nayak Jasmir G
机构信息
Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada.
出版信息
Can Urol Assoc J. 2023 Sep;17(9):E244-E251. doi: 10.5489/cuaj.8228.
INTRODUCTION
In universal healthcare systems, patients may still encounter financial obstacles from cancer treatments, potentially influencing treatment decision-making. We investigated the relationship between socioeconomic status and treatment decision-making as it pertains to patient values, preferences, and perceived barriers to care for localized prostate cancer.
METHODS
We conducted a prospective study of patients undergoing a prostate biopsy for the initial detection of prostate cancer. Sociodemographic variables were collected, with validated instruments used to determine health literacy levels. Patients were divided into two groups using self-reported income; those with a positive identification of prostate cancer underwent additional surveys to ascertain their knowledge of their diagnosis, treatment-related preferences, and socioeconomic barriers to care. Descriptive statistics were used.
RESULTS
Of 160 patients, approximately one-third were classified as having low health literacy. Within the low-income group, education levels were lower (34.6% had less than high school education vs. 10.2% in the high-income group) and unemployment rates higher (75.0% unemployed vs. 38.9% in the high-income group). Low-income patients with prostate cancer placed greater importance on indirect out-of-pocket expenses related to treatment (78.3% vs. 33.3%, p=0.001), higher emphasis on treatment-related travel time (50% vs. 15.1%, p=0.004), and more often had difficulty paying for healthcare services in the past (30.9% vs. 9.1%, p=0.02).
CONCLUSIONS
Patients with lower household incomes have unique treatment values and decision-making preferences. They may experience additional challenges and barriers to obtaining cancer care, at least partly related to indirect costs. These findings should be considered when framing prostate cancer treatment discussions and designing patient-facing health information.
引言
在全民医疗保健系统中，患者仍可能面临癌症治疗带来的经济障碍，这可能会影响治疗决策。我们研究了社会经济地位与治疗决策之间的关系，因为它涉及患者的价值观、偏好以及对局限性前列腺癌护理的认知障碍。
方法
我们对因初步检测前列腺癌而接受前列腺活检的患者进行了一项前瞻性研究。收集了社会人口统计学变量，并使用经过验证的工具来确定健康素养水平。根据自我报告的收入将患者分为两组；确诊为前列腺癌的患者接受了额外的调查，以确定他们对诊断的了解、与治疗相关的偏好以及护理的社会经济障碍。使用描述性统计方法。
结果
在160名患者中，约三分之一被归类为健康素养较低。在低收入组中，教育水平较低（34.6%的人高中以下学历，而高收入组为10.2%），失业率较高（75.0%失业，而高收入组为38.9%）。患有前列腺癌的低收入患者更重视与治疗相关的间接自付费用（78.3%对33.3%，p = 0.001），更强调与治疗相关的出行时间（50%对15.1%，p = 0.004），并且过去更常难以支付医疗服务费用（30.9%对9.1%，p = 0.02）。
结论
家庭收入较低的患者有独特的治疗价值观和决策偏好。他们在获得癌症护理方面可能会遇到额外的挑战和障碍，至少部分与间接成本有关。在制定前列腺癌治疗讨论和设计面向患者的健康信息时应考虑这些发现。
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