在 SEER-CAHPS 伴有多种合并症的患者中，患者对护理的体验、种族和族裔与接受 CRC 治疗之间的关系。
Associations Between Patient Experience With Care, Race and Ethnicity, and Receipt of CRC Treatment Among SEER-CAHPS Patients With Multiple Comorbidities.
机构信息
Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, California.
USC Norris Comprehensive Cancer Center, Los Angeles, California.
出版信息
J Natl Compr Canc Netw. 2023 Dec 27;22(1D):e237074. doi: 10.6004/jnccn.2023.7074.
BACKGROUND
Patients with colorectal cancer (CRC) and multiple comorbidities are less likely to receive guideline-concordant treatment (GCT), a disparity exacerbated by racial and ethnic disparities in GCT. Yet, positive patient experiences with care are associated with more appropriate care use. We investigated associations between patient experiences with care, race and ethnicity, and receipt of GCT for CRC among older adults with multiple comorbidities.
METHODS
We used SEER-Consumer Assessment of Healthcare Providers and Systems (CAHPS) data to identify participants diagnosed with CRC from 2001 to 2017 at age ≥67 years with additional chronic conditions. Stage-specific GCT was identified following recommendations in the NCCN Guidelines for Colon and Rectal Cancer. Patient experiences with care were identified from CAHPS surveys. Multivariable log-binomial regression estimated associations between race and ethnicity and receipt of GCT by experiences with care.
RESULTS
A total of 2,612 patients were included. Those reporting excellent experience with getting care quickly were 5% more likely to receive GCT than those reporting less-than-excellent experience (relative risk [RR], 1.05; 95% CI, 1.04-1.05). When reporting less-than-excellent experience with getting care quickly, non-Hispanic Black (NHB) patients were less likely than non-Hispanic White (NHW) patients to receive GCT (RR, 0.80; 99.38% CI, 0.78-0.82), yet NHB patients were more likely to receive GCT than NHW patients when reporting excellent experience (RR, 1.05; 99.38% CI, 1.02-1.09). When reporting less-than-excellent experience with getting needed care, Hispanic patients were less likely than NHW patients to receive GCT (RR, 0.91; 99.38% CI, 0.88-0.94), yet Hispanic patients were more likely to receive GCT than NHW patients when reporting excellent experience (RR, 1.06; 99.38% CI, 1.03-1.08).
CONCLUSIONS
Although excellent patient experience among those with multiple comorbidities may not be strongly associated with receipt of GCT for CRC overall, improvements in experiences of accessing care among NHB and Hispanic patients with CRC and additional comorbidities may aid in mitigating racial and ethnic disparities in receipt of GCT.
背景
患有结直肠癌 (CRC) 和多种合并症的患者不太可能接受符合指南的治疗 (GCT)，而 GCT 方面的种族和民族差异加剧了这种差异。然而，患者对护理的积极体验与更适当的护理使用有关。我们调查了老年合并多种疾病的患者对护理的体验、种族和民族与接受 CRC 的 GCT 之间的关联。
方法
我们使用 SEER-Consumer 评估医疗保健提供者和系统 (CAHPS) 数据，从 2001 年至 2017 年，在年龄≥67 岁的患者中确定了患有 CRC 且有其他慢性疾病的患者。根据 NCCN 结肠癌和直肠癌指南的建议，确定了特定于阶段的 GCT。从 CAHPS 调查中确定了患者对护理的体验。多变量对数二项式回归估计了种族和民族与经历与接受 GCT 之间的关联。
结果
共纳入 2612 名患者。与报告体验不佳的患者相比，报告快速获得护理体验良好的患者接受 GCT 的可能性高 5%（相对风险 [RR]，1.05；95%CI，1.04-1.05）。当报告快速获得护理的体验不佳时，非西班牙裔黑人 (NHB) 患者接受 GCT 的可能性低于非西班牙裔白人 (NHW) 患者（RR，0.80；99.38%CI，0.78-0.82），但 NHB 患者报告体验良好时接受 GCT 的可能性高于 NHW 患者（RR，1.05；99.38%CI，1.02-1.09）。当报告获得所需护理的体验不佳时，西班牙裔患者接受 GCT 的可能性低于 NHW 患者（RR，0.91；99.38%CI，0.88-0.94），但西班牙裔患者报告体验良好时接受 GCT 的可能性高于 NHW 患者（RR，1.06；99.38%CI，1.03-1.08）。
结论
尽管患有多种合并症的患者的良好患者体验可能与 CRC 的 GCT 总体接受率没有很强的关联，但改善 NHB 和西班牙裔 CRC 患者和其他合并症患者获得护理的体验可能有助于缓解 GCT 接受率方面的种族和民族差异。
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