Health care disparities in older patients with breast carcinoma - Informational support from physicians
Health care disparities in older patients with breast carcinoma - Informational support from physicians
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DOI：
10.1002/cncr.11211
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发表时间：
2003-03-15
期刊：
影响因子：
6.2
通讯作者：
Silliman, RA
中科院分区：
文献类型：
--
作者：
Maly, RC;Leake, B;Silliman, RA
背景。关于如何在医患互动层面影响或减轻基于患者年龄和种族的乳腺癌患者治疗差异，人们知之甚少。本研究的目的是记录医生在新诊断乳腺癌时向患者提供的信息支持，并根据患者年龄和种族群体在收到和期望的信息方面评估差异。方法。参与者是加利福尼亚州洛杉矶县的 222 名乳腺癌患者，年龄大于或等于 55 岁，他们在诊断乳腺癌后 6 个月内和/或治疗后 1 个月内接受采访。受访者被问及 10 个有形信息支持项目（例如，医生是否提供小册子、录像带、病历等）和 15 个互动信息支持项目（例如，医生是否讨论乳腺癌主题，例如复发风险或治疗选择）的接收情况和有用性。创建有形信息支持项目的索引和收到的交互式信息支持项目的规模以进行汇总分析。提取患者的病历以了解乳腺癌分期和治疗类型；还对外科医生进行了社会人口统计和实践特征的调查。结果。在多元线性回归分析中，年龄较大（β系数β标准误差[SE]，- 0.08 +/- 0.02；P = 0.001）和拉丁裔种族（β +/- SE，- 1.21 +/- 0.40；P = 0.003）与医生提供交互式信息支持呈负相关，控制患者和医生的社会人口学特征、实践特征、乳腺癌分期、合并症、乳腺癌数量就诊的医生、就诊时长、社会支持以及患者与医生互动的自我效能（模型的调整相关系数 [R-2]，0.33；P < 0.00001）。老年患者和少数族裔患者以及他们各自的比较组都认为大多数乳腺癌信息至少同样有帮助。两组人都更喜欢人际信息来源而不是书面信息来源，尽管他们接收人际信息来源的频率较低。结论。与年轻患者相比，老年乳腺癌患者和拉丁裔乳腺癌患者从医生那里获得的互动信息支持较少，在控制了广泛的社会人口统计学、社会心理和医生因素后，差异仍然存在。提高医患互动层面的沟通质量可能是减少乳腺癌患者年龄和种族治疗差异的重要途径。 (C) 2003 年美国癌症协会。
BACKGROUND. Little is known about how disparities in the treatment of patients with breast carcinoma based on patient age and ethnicity are effected or mitigated at the patient-physician interaction level. The objectives of this study were to document physician provision of informational support to patients at the time of a new diagnosis of breast carcinoma and to assess differences according to patient age and ethnic group in terms of the information received and desired.METHODS. Participants were 222 patients with breast carcinoma in Los Angeles County, California, age greater than or equal to 55 years who were interviewed within 6 months of their diagnosis of breast carcinoma and/or within 1 month posttreatment. Respondents were asked about receipt and helpfulness of 10 tangible informational support items (e.g., whether booklets, videotapes, medical records, etc. were provided by physicians) and 15 interactive informational support items (e.g., whether physicians discussed breast cancer topics, such as risk of recurrence or treatment options). An index of the tangible informational support items and a scale of the interactive informational support items received were created for summary analyses. Patients' medical records were abstracted for breast carcinoma stage and treatment type; surgeons also were surveyed about sociodemographic and practice characteristics.RESULTS. in multiple linear regression analyses, older age (beta coefficient [beta] standard error [SE], - 0.08 +/- 0.02; P = 0.001) and Latina ethnicity (beta +/- SE, - 1.21 +/- 0.40; P = 0.003) had a negative association with physician provision of interactive informational support, controlling for patient and physician sociodemographic characteristics, practice characteristics, breast carcinoma stage, comorbidity, number of physicians seen, visit length, social support, and patient self-efficacy in interacting with physicians (adjusted correlation coefficient [R-2] for the model, 0.33; P < 0.00001). Both older patients and ethnic minority patients, as well as their respective comparison groups, rated most breast cancer information as at least as helpful. Both groups preferred interpersonal sources of information to written sources, although they received interpersonal sources less frequently.CONCLUSIONS. Older patients and Latina patients with breast carcinoma received less interactive informational support from their physicians compared with younger patients, differences that persisted after controlling for a wide range of sociodemographic, psychosocial, and physician factors. Improving the quality of communication at the patient-physician interaction level may be an important avenue to reducing age and ethnic group treatment disparities among patients with breast carcinoma. (C) 2003 American Cancer Society.