Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, Connecticut, USA.
Otolaryngology Surgery, New Haven, Connecticut, USA.
Otolaryngol Head Neck Surg. 2024 Oct;171(4):1069-1082. doi: 10.1002/ohn.819. Epub 2024 May 26.
Characterizing factors associated with palliative care (PC) use in patients with stage III and VI head and neck cancer using Anderson's behavioral model of health service use.
A retrospective study of the 2004 to 2020 National Cancer Database.gg METHODS: We used multivariate logistic regression to assess the association of predisposing, enabling, and need factors with PC use. We also investigated the association of these factors with interventional PC type (chemotherapy, radiotherapy, surgery) and refusal of curative treatment in the last 6 months of life.
Five percent of patients received PC. "Predisposing factors" associated with less PC use include Hispanic ethnicity (adjusted odds ratio [aOR], 086; 95% confidence interval [CI], 0.76-0.97) and white and black race (vs white: aOR, 1.14; 95% CI, 1.07-1.22). "Enabling factors" associated with lower PC include private insurance (vs uninsured: aOR, 064; 95% CI, 0.53-0.77) and high-income (aOR, 078; 95% CI, 0.71-0.85). "Need factors" associated with higher PC use include stage IV (vs stage III cancer: aOR, 2.25; 95% CI, 2.11-2.40) and higher comorbidity index (vs Index 1: aOR, 1.58; 95% CI, 1.42-1.75). High-income (aOR, 0.78; 95% CI, 0.71-0.85) and private insurance (aOR, 0.6; 95% CI, 0.53, 0.77) were associated with higher interventional PC use and lower curative treatment refusal (insurance: aOR, 0.82; 95% CI, 0.55, 0.67; income aOR, 0.48; 95% CI, 0.44, 0.52).
Low PC uptake is attributed to patients' race/culture, financial capabilities, and disease severity. Culturally informed counseling, clear guidelines on PC indication, and increasing financial accessibility of PC may increase timely and appropriate use of this service.
利用安德森健康服务利用行为模型，描述与 III 期和 VI 期头颈部癌症患者姑息治疗（PC）使用相关的因素。
这是一项对 2004 年至 2020 年国家癌症数据库的回顾性研究。
我们使用多变量逻辑回归评估倾向因素、促成因素和需求因素与 PC 使用的关系。我们还调查了这些因素与干预性 PC 类型（化疗、放疗、手术）以及生命最后 6 个月拒绝接受有治愈可能的治疗之间的关系。
5%的患者接受了 PC。与 PC 使用率较低相关的“倾向因素”包括西班牙裔（调整后的优势比[aOR]，0.86；95%置信区间[CI]，0.76-0.97）和白人及黑人种族（与白人相比：aOR，1.14；95%CI，1.07-1.22）。与 PC 使用率较低相关的“促成因素”包括私人保险（与无保险相比：aOR，0.64；95%CI，0.53-0.77）和高收入（aOR，0.78；95%CI，0.71-0.85）。与 PC 使用率较高相关的“需求因素”包括 IV 期（与 III 期癌症相比：aOR，2.25；95%CI，2.11-2.40）和更高的合并症指数（与指数 1 相比：aOR，1.58；95%CI，1.42-1.75）。高收入（aOR，0.78；95%CI，0.71-0.85）和私人保险（aOR，0.6；95%CI，0.53-0.77）与更高的干预性 PC 使用和更低的拒绝接受有治愈可能的治疗相关（保险：aOR，0.82；95%CI，0.55-0.67；收入 aOR，0.48；95%CI，0.44-0.52）。
PC 使用率低归因于患者的种族/文化、财务能力和疾病严重程度。提供文化知情咨询、明确 PC 适应证指南以及增加 PC 的经济可及性，可能会增加对该服务的及时和适当使用。
