James P. Wilmot Cancer Institute, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States of America; Division of Supportive Care in Cancer, Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States of America; Roybal Center for Social Ties and Aging, Aging Institute, University of Rochester, Rochester, NY, United States of America; Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States of America.
Department of Biostatistics and Computational Biology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States of America.
J Geriatr Oncol. 2024 Nov;15(8):102061. doi: 10.1016/j.jgo.2024.102061. Epub 2024 Sep 10.
INTRODUCTION: Supporting older adults with advanced cancer to better understand their disease and its prognosis is important for shared decision-making. Social support is a potentially modifiable factor that may influence disease understanding. In this study, we examined the associations of quantity and quality of social support with patients' beliefs about the curability of their advanced cancer. MATERIALS AND METHODS: We performed a secondary analysis of a cluster-randomized trial that recruited older adults aged ≥70 with advanced incurable cancer. At enrollment, patients completed the Older Americans Resources and Services (OARS) Medical Social Support form that measures both quantity (number of close friends and relatives) and quality of social support. Quality of social support was measured using 12 questions in instrumental and emotional support, each ranging from 1 (none of the time) to 5 (all of the time). Higher cumulative scores indicated greater quality of support. For beliefs about curability, patients were asked, "What do you believe are the chances that your cancer will go away and never come back with treatment?" Responses were 0 %, <50 %, 50/50, >50 %, and 100 %. Ordinal logistic regression was used to investigate the association of quantity and quality of social support with beliefs about curability, adjusting for potential confounders. RESULTS: We included 347 patients; mean age was 76.4 years and 91 % were white. Quantity of social support was not associated with belief in curability [adjusted odds ratio (AOR) 1.03, 95 % confidence interval (CI) (0.92, 1.16)]. For every unit increase in the quality of social support (OARS Medical Social Support score), the odds of believing in curability decreased by 26.7 % [AOR 0.73, 95 % CI (0.56, 0.97)]. DISCUSSION: Our study demonstrated that the quality, but not the quantity, of social support was associated with patients' beliefs about curability. These findings suggest that bolstering social support may directly enhance disease understanding. This insight informs supportive care interventions that specifically address disease comprehension among patients.
介绍：支持晚期癌症老年患者更好地了解自身疾病及其预后对于共同决策非常重要。社会支持是一个潜在的可调节因素，可能会影响对疾病的理解。本研究旨在探讨社会支持的数量和质量与患者对晚期癌症可治愈性的信念之间的关联。
材料与方法：我们对一项招募年龄≥70 岁、患有晚期不可治愈癌症的老年患者的随机对照试验进行了二次分析。在入组时，患者完成了《老年人资源和服务》（OARS）医疗社会支持量表，该量表同时测量了社会支持的数量（亲密朋友和亲属的数量）和质量。社会支持质量使用 12 个关于工具性和情感支持的问题进行测量，每个问题的取值范围为 1（从未）到 5（总是）。累积得分越高，表明支持质量越高。对于可治愈性的信念，患者被问到：“您认为接受治疗后，癌症痊愈且不再复发的机会有多大？”答案为 0%、<50%、50/50%、>50%和 100%。我们采用有序逻辑回归来调查社会支持的数量和质量与可治愈性信念之间的关联，同时调整了潜在的混杂因素。
结果：我们纳入了 347 名患者；平均年龄为 76.4 岁，91%为白人。社会支持的数量与对可治愈性的信念无关[调整后的优势比（AOR）为 1.03，95%置信区间（CI）（0.92，1.16）]。社会支持质量每增加一个单位（OARS 医疗社会支持量表评分），对可治愈性的信念降低 26.7%[AOR 为 0.73，95% CI（0.56，0.97）]。
讨论：我们的研究表明，社会支持的质量而非数量与患者对可治愈性的信念有关。这些发现表明，增强社会支持可能会直接增强对疾病的理解。这一认识为专门针对患者疾病认知的支持性护理干预措施提供了信息。
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