Factors Associated With Unmet Supportive Care Needs and Emergency Department Visits and Hospitalizations in Ambulatory Oncology.
Factors Associated With Unmet Supportive Care Needs and Emergency Department Visits and Hospitalizations in Ambulatory Oncology.
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DOI：
10.1001/jamanetworkopen.2023.19352
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发表时间：
2023-06-01
影响因子：
13.8
通讯作者：
Schlumbrecht M
中科院分区：
文献类型：
--
作者：
Penedo FJ;Natori A;Fleszar-Pavlovic SE;Sookdeo VD;MacIntyre J;Medina H;Moreno PI;Crane TE;Moskowitz C;Calfa CL;Schlumbrecht M
哪些因素与患者报告的未满足的门诊肿瘤支持性治疗需求相关，这些未满足的需求是否与急诊就诊和住院的风险相关？在这项对5236例非卧床癌症患者的队列研究中，黑人、西班牙裔、诊断后年数更长、抑郁、身体功能差和健康相关生活质量评分低与更大的未满足需求相关。与没有未满足需求的患者相比，那些报告有未满足需求的患者有更高的急诊和住院风险。这些研究结果表明，未满足的支持性护理需求与临床结局相关，特别是在种族和少数民族人群中;解决这些未满足的需求对于改善临床结局至关重要，应针对特定人群做出努力。癌症患者经历多种支持性护理需求（例如，应对和财务咨询），如果不加以解决，可能导致临床结局不良。有限的工作已经评估了与大量不同样本的门诊肿瘤患者的未满足需求相关的因素。描述与门诊肿瘤患者未满足的支持性护理需求相关的因素，并评估此类需求是否与急诊科（艾德）就诊和住院相关。在2019年10月1日至2022年6月30日期间，通过My Wellness Check（基于电子健康记录（EHR）的支持性护理需求和患者报告结局（PRO）筛查和转诊计划），在大型和多样化的门诊癌症人群中进行了横断面回顾性分析。从EHR中提取人口统计学特征、临床特征和临床结局。还收集了PRO（即焦虑、抑郁、疲劳、疼痛和身体功能）、健康相关生活质量（HRQOL）和支持性护理需求的数据。Logistic回归分析了与未满足需求相关的因素。通过调整协变量的考克斯比例风险回归模型评估艾德访视和住院的累积发生率。研究中的5236例患者的平均（SD）年龄为62.6（13.1）岁，包括2949例女性（56.3%）、2506例西班牙裔或拉丁裔患者（47.9%）和4618例白色患者（88.2%）;根据EHR，1370例患者（26.2%）表示西班牙语为首选语言。共有940例患者（18.0%）报告了1个或多个未满足的需求。黑人种族（校正比值比[AOR]，1.97 [95% CI，1.49-2.60]），西班牙裔（AOR，1.31 [95% CI，1.10-1.55]），诊断后1 - 5年（AOR，0.64 [95% CI，0.54-0.77]），诊断后5年以上（AOR，0.60 [95% CI，0.48-0.76]），焦虑（AOR，2.25 [95% CI，1.71-2.95]），抑郁（AOR，2.07 [95% CI，1.58-2.70]），身体功能差（AOR，1.38 [95% CI，1.07-1.79]）和低HRQOL评分（AOR，1.89 [95% CI，1.50-2.39]）与更大的未满足需求相关。与未满足需求的患者相比，未满足需求的患者的艾德访视（校正风险比[AHR]，1.45 [95% CI，1.20-1.74]）和住院（AHR，1.36 [95% CI，1.13-1.63]）风险显著更高。在这项非卧床肿瘤患者的队列研究中，未满足的支持性护理需求与较差的临床结局相关。来自种族和少数民族群体以及情感或身体负担更大的患者更有可能有1个或多个未满足的需求。结果表明，解决未满足的支持性护理需求可能是改善临床结果的关键，有针对性的努力应集中在特定人群。这项队列研究描述了与门诊肿瘤患者未满足的支持性护理需求相关的因素，并评估了这些需求是否与急诊科（艾德）就诊和住院相关。
What factors are associated with patient-reported unmet supportive care needs in ambulatory oncology, and are these unmet needs associated with the risk of emergency department visits and hospitalizations? In this cohort study of 5236 ambulatory patients with cancer, Black race, Hispanic ethnicity, greater number of years after diagnosis, depression, poor physical function, and low health-related quality of life scores were associated with greater unmet needs. Compared with patients without unmet needs, those who reported having unmet needs had a significantly higher risk of emergency department visits and hospitalizations. These findings suggest that unmet supportive care needs are associated with clinical outcomes, particularly in racial and ethnic minority populations; addressing these unmet needs is imperative for improving clinical outcomes, and efforts should target specific populations. Patients with cancer experience multiple supportive care needs (eg, coping and financial counseling) that, if not addressed, may result in poor clinical outcomes. Limited work has assessed the factors associated with unmet needs in large and diverse samples of ambulatory oncology patients. To characterize the factors associated with unmet supportive care needs among ambulatory oncology patients and to assess whether such needs were associated with emergency department (ED) visits and hospitalizations. Between October 1, 2019, and June 30, 2022, cross-sectional retrospective analyses were performed in a large and diverse ambulatory cancer population via My Wellness Check, an electronic health record (EHR)–based supportive care needs and patient-reported outcomes (PROs) screening and referral program. Demographic characteristics, clinical characteristics, and clinical outcomes were extracted from EHRs. Data on PROs (ie, anxiety, depression, fatigue, pain, and physical function), health-related quality of life (HRQOL), and supportive care needs were also collected. Logistic regressions examined factors associated with unmet needs. Cumulative incidence of ED visits and hospitalizations were assessed by Cox proportional hazards regression models adjusting for covariates. The 5236 patients in the study had a mean (SD) age of 62.6 (13.1) years and included 2949 women (56.3%), 2506 Hispanic or Latino patients (47.9%), and 4618 White patients (88.2%); 1370 patients (26.2%) indicated Spanish as their preferred language, according to their EHR. A total of 940 patients (18.0%) reported 1 or more unmet needs. Black race (adjusted odds ratio [AOR], 1.97 [95% CI, 1.49-2.60]), Hispanic ethnicity (AOR, 1.31 [95% CI, 1.10-1.55]), 1 to 5 years after diagnosis (AOR, 0.64 [95% CI, 0.54-0.77]), more than 5 years after diagnosis (AOR, 0.60 [95% CI, 0.48-0.76]), anxiety (AOR, 2.25 [95% CI, 1.71-2.95]), depression (AOR, 2.07 [95% CI, 1.58-2.70]), poor physical function (AOR, 1.38 [95% CI, 1.07-1.79]), and low HRQOL scores (AOR, 1.89 [95% CI, 1.50-2.39]) were associated with greater unmet needs. Patients with unmet needs had a significantly higher risk of ED visits (adjusted hazard ratio [AHR], 1.45 [95% CI, 1.20-1.74]) and hospitalizations (AHR, 1.36 [95% CI, 1.13-1.63]) relative to patients without unmet needs. In this cohort study of ambulatory oncology patients, unmet supportive care needs were associated with worse clinical outcomes. Patients from racial and ethnic minority groups and those with greater emotional or physical burden were more likely to have 1 or more unmet needs. Results suggest that addressing unmet supportive care needs may be crucial for improving clinical outcomes, and targeted efforts should focus on specific populations. This cohort study characterizes the factors associated with unmet supportive care needs among ambulatory oncology patients and assesses whether such needs were associated with emergency department (ED) visits and hospitalizations.
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