Department of Oncology, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 2115 Wisconsin Avenue, N.W., Suite 300, Washington, DC, 20007, USA.
School of Medicine, Nursing and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
Qual Life Res. 2024 Jan;33(1):253-265. doi: 10.1007/s11136-023-03501-2. Epub 2023 Aug 17.
The assumption that patient-provider communication may mediate patients' sense of control over cancer to affect health outcomes has limited evidence. This study examines whether patient-perceived cancer care communication quality (PPCQ) mediates stress appraisal and coping behavior, affecting physical functioning across different racial groups.
Two hundred and twenty Chinese American and 216 non-Hispanic White (NHW) women (ages 28-80) with stage 0-III breast cancer, 1-5 years post-diagnosis, and without recurrence, enrolled and completed a cross-sectional telephone survey. Physical functioning was measured by the NIH-PROMIS short form. Validated measures of PPCQ, patients' evaluation of their socioeconomic well-being, stress appraisal (perceived severity and control), use of coping strategies, treatment-related symptoms, and comorbidities were also assessed. Path analyses were used to examine the mediation for each racial group.
Regardless of race, treatment-related symptoms, comorbidities, and socioeconomic well-being were all directly related to physical functioning (p < 0.05). The impact of PPCQ on physical functioning was mediated by perceived control in the Chinese American group (p < 0.05), but not in the NHW group. Perceived severity and coping were not mediators of physical functioning in either group.
The mediational pathway from PPCQ to perceived control to physical functioning in Chinese American survivors may be partially explained by their lower socioeconomic well-being and culturally valued conformity to physicians as a medical authority. These sociocultural dynamics reinforce the importance of cancer care communication. For NHW survivors, the impact of treatment-related symptoms and socioeconomic well-being on physical functioning outweighed their PPCQ and perceived control.
患者与医生沟通可能会影响患者对癌症的控制感，从而影响健康结果，这一假设的证据有限。本研究检验了患者感知的癌症护理沟通质量（PPCQ）是否在不同种族群体中调节压力评估和应对行为，从而影响身体机能。
220 名中国裔美国人和 216 名非西班牙裔白人（NHW）女性（年龄 28-80 岁）患有 0-III 期乳腺癌，诊断后 1-5 年，无复发，参加并完成了一项横断面电话调查。身体机能通过 NIH-PROMIS 短式量表进行测量。还评估了 PPCQ、患者对自身社会经济福祉的评估、压力评估（感知严重程度和控制）、应对策略的使用、与治疗相关的症状和合并症等方面的有效性测量。路径分析用于检验每个种族群体的中介作用。
无论种族如何，与治疗相关的症状、合并症和社会经济福祉都与身体机能直接相关（p<0.05）。在中国裔美国人群体中，PPCQ 对身体机能的影响是通过感知控制来介导的（p<0.05），但在 NHW 群体中则不然。感知严重程度和应对策略都不是身体机能的中介因素。
在中国裔美国幸存者中，PPCQ 通过感知控制到身体机能的中介途径可能部分归因于他们较低的社会经济福祉和对医生作为医疗权威的文化上的遵从。这些社会文化动态强调了癌症护理沟通的重要性。对于 NHW 幸存者，与治疗相关的症状和社会经济福祉对身体机能的影响超过了他们的 PPCQ 和感知控制。
