Perceived discrimination, trust in physicians, and prolonged symptom duration before ovarian cancer diagnosis in the African American Cancer Epidemiology Study
Perceived discrimination, trust in physicians, and prolonged symptom duration before ovarian cancer diagnosis in the African American Cancer Epidemiology Study
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DOI：
10.1002/cncr.32451
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发表时间：
2019-08-15
期刊：
影响因子：
6.2
通讯作者：
Cote, Michele L.
中科院分区：
文献类型：
--
作者：
Mullins, Megan A.;Peres, Lauren C.;Cote, Michele L.
背景歧视和信任是获得医疗保健的已知障碍。尽管在卵巢癌护理连续体中存在有据可查的种族差异，但这些障碍的作用尚未得到研究。本研究评估了日常歧视和对医生的信任与症状发作和卵巢癌诊断之间的时间间隔延长（以下称为症状持续时间延长）之间的关系。方法受试者包括非裔美国人癌症流行病学研究的病例，这是一项黑人妇女卵巢上皮癌的多中心病例对照研究。Logistic回归用于计算日常歧视和信任与症状持续时间延长（1个或多个症状持续时间长于中位症状特异性持续时间）的医生的关联的比值比（OR）和95%置信区间（CI），并控制了获得护理协变量和潜在混杂因素。结果486例患者中，有302例症状持续时间较长。在完全校正的模型中，每天辨别频率增加1个单位，症状持续时间延长的几率增加74%（OR，1.74; 95%CI，1.22-2.49），但对医生的信任与症状持续时间延长无关（OR，0.86; 95%CI，0.66-1.11）。结论：感知到的日常歧视与症状持续时间延长有关，而更常见的评估获得护理和信任医生的决定因素则无关。这些结果表明，有必要对影响卵巢癌护理的人际障碍的影响进行更多的研究。
Background Discrimination and trust are known barriers to accessing health care. Despite well-documented racial disparities in the ovarian cancer care continuum, the role of these barriers has not been examined. This study evaluated the association of everyday discrimination and trust in physicians with a prolonged interval between symptom onset and ovarian cancer diagnosis (hereafter referred to as prolonged symptom duration). Methods Subjects included cases enrolled in the African American Cancer Epidemiology Study, a multisite case-control study of epithelial ovarian cancer among black women. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for associations of everyday discrimination and trust in physicians with a prolonged symptom duration (1 or more symptoms lasting longer than the median symptom-specific duration), and it controlled for access-to-care covariates and potential confounders. Results Among the 486 cases in this analysis, 302 women had prolonged symptom duration. In the fully adjusted model, a 1-unit increase in the frequency of everyday discrimination increased the odds of prolonged symptom duration 74% (OR, 1.74; 95% CI, 1.22-2.49), but trust in physicians was not associated with prolonged symptom duration (OR, 0.86; 95% CI, 0.66-1.11). Conclusions Perceived everyday discrimination was associated with prolonged symptom duration, whereas more commonly evaluated determinants of access to care and trust in physicians were not. These results suggest that more research on the effects of interpersonal barriers affecting ovarian cancer care is warranted.