Ware Megan E, De La Cruz Angelica, Dong Qian, Shelton Kyla, Brinkman Tara M, Huang I-Chan, Webster Rachel, Potter Brian, Krull Kevin, Mirzaei Sedigheh, Ehrhardt Matthew, Hudson Melissa M, Armstrong Gregory, Ness Kirsten
Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
Department of Kinesiology, Health Promotion, and Recreation, University of North Texas, Denton, TX 76201, USA.
Cancers (Basel). 2024 Sep 21;16(18):3220. doi: 10.3390/cancers16183220.
Patient activation describes a willingness to take action to manage health and is associated with health outcomes. The purpose of this study was to characterize patient activation and its association with psychological outcomes and health behaviors in childhood cancer survivors.
Participants were from the St. Jude Lifetime Cohort Study (SJLIFE). Activation levels (1-4, 4 = highest activation) were measured with the Patient Activation Measure (PAM). Psychological outcomes and health behaviors were obtained via self-report. Cognitive function was assessed by trained examiners. ANOVA or chi-squared tests were utilized to assess group-level differences in activation. Multivariable regression models were used to assess associations between PAM scores and outcomes of interest.
Among 2708 survivors and 303 controls, more survivors endorsed lower activation levels than the controls (11.3 vs. 4.7% in level 1) and fewer survivors endorsed the highest level of activation than the controls (45.3 vs. 61.5% in level 4). Not endorsing depression (OR: 2.37, 95% CI 1.87-2.99), anxiety (OR: 2.21, 95% CI 1.73-2.83), and somatization symptoms (OR: 1.99, 95% CI 1.59-2.50), general fear (OR: 1.45, 95% CI 1.23-1.71) and body-focused (OR: 2.21, 95% CI 1.83-2.66), cancer-related worry, and physical (OR: 2.57, 95% CI 2.06-3.20) and mental (OR: 2.08, 95% CI 1.72-2.52) HRQOL was associated with higher levels of activation. Lower activation was associated with not meeting physical activity guidelines (OR: 2.07, 95% CI 1.53-2.80).
Survivors endorsed lower activation levels than peers. Interventions to improve physical and psychological health outcomes could leverage these results to identify survivors who benefit from support in patient activation.
患者激活度描述了采取行动管理健康的意愿，且与健康结果相关。本研究的目的是描述儿童癌症幸存者的患者激活度及其与心理结果和健康行为的关联。
参与者来自圣裘德终身队列研究（SJLIFE）。使用患者激活度量表（PAM）测量激活水平（1 - 4级，4级表示最高激活度）。心理结果和健康行为通过自我报告获得。认知功能由经过培训的检查人员评估。采用方差分析或卡方检验评估激活度的组间差异。多变量回归模型用于评估PAM分数与感兴趣的结果之间的关联。
在2708名幸存者和303名对照者中，与对照者相比，更多的幸存者认可较低的激活水平（1级中分别为11.3%对4.7%），且认可最高激活水平的幸存者比对照者更少（4级中分别为45.3%对61.5%）。不认可抑郁（比值比：2.37，95%置信区间1.87 - 2.99）、焦虑（比值比：2.21，95%置信区间1.73 - 2.83）、躯体化症状（比值比：1.99，95%置信区间1.59 - 2.50）、一般恐惧（比值比：1.45，95%置信区间1.23 - 1.71）和聚焦身体的症状（比值比：2.21，95%置信区间1.83 - 2.66）、癌症相关担忧以及身体（比值比：2.57，95%置信区间2.06 - 3.20）和心理（比值比：2.08，95%置信区间1.72 - 2.52）健康相关生活质量与较高的激活水平相关。较低的激活水平与未达到身体活动指南相关（比值比：2.07，95%置信区间1.53 - 2.80）。
幸存者认可的激活水平低于同龄人。改善身体和心理健康结果的干预措施可以利用这些结果来识别那些能从患者激活支持中受益的幸存者。
