Patient navigation to address sociolegal barriers for patients with cancer: A comparative-effectiveness study.
Patient navigation to address sociolegal barriers for patients with cancer: A comparative-effectiveness study.
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癌症治疗的社会法律障碍被定义为与健康相关的社会需求，如负担得起的健康住房，稳定的公用事业服务和食品安全，这些需求可以通过公共政策，法律，法规或规划来解决。法律的支持尚未在癌症护理中进行研究。作者对2014年至2017年在波士顿安全网医疗中心新诊断出癌症的患者进行了一项随机对照试验，比较了标准患者导航与与法律的倡导者合作的增强导航，以识别和解决社会法律障碍。在诊断后30天内，讲英语、西班牙语或海地克里奥尔语的乳腺癌和肺癌患者符合条件。主要结局是在诊断后90天内及时治疗。次要结局包括基线和6个月时患者报告的结局（痛苦、癌症相关需求和导航满意度）。总共有201名乳腺癌患者和19名肺癌患者入组（应答率为78%）。患者平均年龄为55岁，51%的患者为黑人，22%为西班牙裔，20%讲西班牙语，8%讲海地克里奥尔语，73%有公共医疗保险，77%报告了1个或多个社会法律障碍，最常见的是住房和就业障碍。96%的乳腺癌患者和73%的肺癌患者在90天内开始治疗。在乳腺癌（比值比，0.88; 95% CI，0.17-4.52）或肺癌（比值比，4.00; 95% CI，0.35-45.4）受试者中，未观察到增强导航对及时接受治疗的显著影响。治疗组间未观察到患者报告结局的差异。通过获得法律的咨询和支持增强导航对及时治疗、患者痛苦或患者需求没有影响。尽管大多数患者都报告存在社会法律障碍，但很少有人需要导航员无法解决的强化法律的服务。在癌症患者中，讨论了社会法律障碍的护理经验，如不稳定的住房，公用事业服务，或粮食不安全。通过法律的信息和援助来解决这些障碍，可以改善护理。本研究比较了乳腺癌和肺癌患者的标准患者导航与与法律的倡导者合作的增强导航。两个导航组的几乎所有患者都得到了及时的护理，并且报告了相同水平的痛苦、需求和对导航的满意度。虽然研究中75%的患者至少有1个社会法律障碍，但很少有人需要法律的宣传，而不是接受法律的信息和指导的导航员所能提供的。
Sociolegal barriers to cancer care are defined as health-related social needs like affordable healthy housing, stable utility service, and food security that may be remedied by public policy, law, regulation, or programming. Legal support has not been studied in cancer care. The authors conducted a randomized controlled trial of patients who had newly diagnosed cancer at a safety-net medical center in Boston from 2014 through 2017, comparing standard patient navigation versus enhanced navigation partnered with legal advocates to identify and address sociolegal barriers. English-speaking, Spanish-speaking, or Haitian Creole-speaking patients with breast and lung cancer were eligible within 30 days of diagnosis. The primary outcome was timely treatment within 90 days of diagnosis. Secondary outcomes included patient-reported outcomes (distress, cancer-related needs, and satisfaction with navigation) at baseline and at 6 months. In total, 201 patients with breast cancer and 19 with lung cancer enrolled (response rate, 78%). The mean patient age was 55 years, 51% of patients were Black and 22% were Hispanic, 20% spoke Spanish and 8% spoke Haitian Creole, 73% had public health insurance, 77% reported 1 or more perceived sociolegal barrier, and the most common were barriers to housing and employment. Ninety-six percent of participants with breast cancer and 73% of those with lung cancer initiated treatment within 90 days. No significant effect of enhanced navigation was observed on the receipt of timely treatment among participants with breast cancer (odds ratio, 0.88; 95% CI, 0.17-4.52) or among those with lung cancer (odds ratio, 4.00; 95% CI, 0.35-45.4). No differences in patient-reported outcomes were observed between treatment groups. Navigation enhanced by access to legal consultation and support had no impact on timely treatment, patient distress, or patient needs. Although most patients reported sociolegal barriers, few required intensive legal services that could not be addressed by navigators. In patients with cancer, the experience of sociolegal barriers to care, such as unstable housing, utility services, or food insecurity, is discussed. Addressing these barriers through legal information and assistance may improve care. This study compares standard patient navigation versus enhanced navigation partnered with legal advocates for patients with breast and lung cancers. Almost all patients in both navigation groups received timely care and also reported the same levels of distress, needs, and satisfaction with navigation. Although 75% of patients in the study had at least 1 sociolegal barrier identified, few required legal advocacy beyond what a navigator who received legal information and coaching could provide.
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影响因子：
3.8
作者：
Battaglia, Tracy A.;Darnell, Julie S.;Calhoun, Elizabeth
通讯作者：
Calhoun, Elizabeth
影响因子：
6.2
作者：
Bayraktar, Ulas Darda;Chen, Emerson;Rocha-Lima, Caio Max S.
通讯作者：
Rocha-Lima, Caio Max S.
影响因子：
1.6
作者：
Freeman, Harold P.
通讯作者：
Freeman, Harold P.
影响因子：
6.2
作者：
Freeman HP;Rodriguez RL
通讯作者：
Rodriguez RL
影响因子：
1.9
作者：
Calhoun, Elizabeth A.;Whitley, Elizabeth M.;Valverde, Patricia A.
通讯作者：
Valverde, Patricia A.