Patient awareness and knowledge of breast cancer-related lymphedema in a large, integrated health care delivery system
Patient awareness and knowledge of breast cancer-related lymphedema in a large, integrated health care delivery system
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DOI：
10.1007/s10549-012-2199-x
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发表时间：
2012-09-01
影响因子：
3.8
通讯作者：
Thiadens, Saskia R. J.
中科院分区：
文献类型：
--
作者：
Kwan, Marilyn L.;Shen, Ling;Thiadens, Saskia R. J.
乳腺癌患者对临床医生关于乳腺癌相关性水肿风险和风险降低策略的教育表示不满。告知患者有关水肿的信息有助于降低他们发展这种疾病的风险，或者在已经受影响的患者中，防止其进一步发展。在这项横断面研究中，根据对2000年至2008年期间在Kaiser Permanente北方加州诊断为浸润性乳腺癌的389名女性进行的简短电话访谈的回答计算水肿意识评分，并且在其电子病历中有水肿相关诊断或手术的既往记录。在电话访谈中，妇女自我报告了水肿临床诊断、有水肿症状但没有水肿诊断、或既没有诊断也没有症状，并回答了关于水肿教育和支持服务以及健康知识的问题。多变量逻辑回归[比值比（OR）和95%置信区间（CI）]用于确定选定的社会人口统计学和临床因素与水肿意识（充分vs.不充分）的相关性。水肿意识评分的中位数（范围）为4（0-7）。与年龄< 50岁的患者相比，70岁以上的乳腺癌诊断患者充分意识到水肿的几率较低（OR 0.25; 95% CI 0.07，0.89），而50-59岁和60-69岁的患者有更高的充分意识的几率，尽管没有统计学意义（OR 2.05; 95% CI 0.88，4.78和OR 1.55; 95% CI 0.60，4.02;趋势p = 0.09）。较高的教育水平和较高的健康素养表明足够的认识，但并不显着。这些结果可以帮助通知教育干预措施，以加强患者的水肿风险和降低风险的做法，特别是在综合医疗保健提供设置的知识。随着乳腺癌幸存者人数的不断增加，有必要提高患者对减少水肿风险和癌症诊断后护理的认识和教育。
Breast cancer patients have voiced dissatisfaction regarding their education on breast cancer-related lymphedema risk and risk reduction strategies from their clinicians. Informing patients about lymphedema can contribute to decrease their risk of developing the condition, or among those already affected, prevent it from progressing further. In this cross-sectional study, a lymphedema awareness score was calculated based on responses to a brief telephone interview conducted among 389 women diagnosed with invasive breast cancer at Kaiser Permanente Northern California from 2000 to 2008 and had a previous record of a lymphedema-related diagnosis or procedure in their electronic medical record. During the telephone interview, women self-reported a lymphedema clinical diagnosis, lymphedema symptoms but no lymphedema diagnosis, or neither a diagnosis nor symptoms, and responded to questions on lymphedema education and support services as well as health knowledge. Multivariable logistic regression [odds ratio (OR) and 95 % confidence interval (CI)] was used to determine the associations of selected sociodemographic and clinical factors with the odds of having lymphedema awareness (adequate vs. inadequate). The median (range) of the lymphedema awareness score was 4 (0-7). Compared with patients < 50 years of age, patients 70+ years of age at breast cancer diagnosis had lower odds of adequate lymphedema awareness (OR 0.25; 95 % CI 0.07, 0.89), while patients 50-59 and 60-69 years had greater odds of adequate awareness although not statistically significant (OR 2.05; 95 % CI 0.88, 4.78 and OR 1.55; 95 % CI 0.60, 4.02, respectively; p for trend = 0.09). Higher educational level and greater health literacy were suggestive of adequate awareness yet were not significant. These results can help inform educational interventions to strengthen patient knowledge of lymphedema risk and risk reduction practices, particularly in an integrated health care delivery setting. With the growing population of breast cancer survivors, increasing patient awareness and education about lymphedema risk reduction and care after cancer diagnosis is warranted.