Improving rural cancer patients' outcomes: a group-randomized trial.
Improving rural cancer patients' outcomes: a group-randomized trial.
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改善农村癌症患者的预后：一项分组随机试验。
DOI：
10.1111/j.1748-0361.2004.tb00004.x
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发表时间：
2004
期刊：
影响因子：
--
通讯作者：
Jensen,PatriciaB
中科院分区：
文献类型：
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作者：
Elliott,ThomasE;Elliott,BarbaraA;Regal,RonaldR;Renier,ColleenM;Haller,IrinaV;Crouse,ByronJ;Witrak,MarthaT;Jensen,PatriciaB
在向农村人口提供最先进的癌症治疗方面存在重大障碍。农村医疗服务提供者的知识和实践、农村卫生保健服务系统以及与癌症专家的联系并不理想；因此，农村癌症患者的预后难以实现。目的测试针对农村医疗服务提供者及其执业环境的策略对患者就诊、满意度、经济障碍和健康相关生活质量的影响。方法在美国中北部的18个农村社区进行了一项组随机试验。其中12个社区被纳入并定义为研究患者结果部分的分析单位。针对农村医疗服务提供者及其执业环境进行干预。研究对象为来自农村社区的乳腺癌、结直肠癌、肺癌和前列腺癌患者。主要结果为患者获得医疗服务的旅行次数、对医疗服务的满意度、对医疗服务经济障碍的认知以及与健康相关的生活质量。共纳入881例患者。结果组随机化是平衡的。在癌症诊断后的第13至24个月内，接受干预的社区群体的医疗保健旅行显著减少。实验组患者的平均旅行里程为1326英里（SE = 306），对照组患者的平均旅行里程为2186英里（SE = 347） （P=0.03）。在对护理的满意度、护理的经济障碍或与健康相关的生活质量方面没有发现显著差异。结论干预显著减少了癌症患者的医疗旅行，这表明实验组患者获得医疗服务的机会有所改善。本研究的结果不允许得出对其他患者预后没有影响的结论。研究结果支持了该研究的概念框架和许多假设。
ContextSignificant barriers exist in the delivery of state‐of‐the‐art cancer care to rural populations. Rural providers' knowledge and practices, their rural health care delivery systems, and linkages to cancer specialists are not optimal; therefore, rural cancer patient outcomes are less than achievable.PurposeTo test the effects of a strategy targeting rural providers and their practice environment on patient travel for care, satisfaction, economic barriers, and health‐related quality of life.MethodsA group‐randomized trial was conducted with 18 rural communities in the north‐central United States. Twelve of these communities were included and defined as the unit of analysis for the patient outcomes portion of the study. The intervention targeted rural providers and their practice environment. The subjects were patients with breast, colorectal, lung, and prostate cancers from the rural communities. The main outcomes were patients' travel to obtain health care, satisfaction with care, perceptions of economic barriers to care, and health‐related quality of life. In total, 881 patients were included.ResultsGroup randomization was balanced. Travel for health care was significantly reduced in the community group exposed to the intervention during months 13 to 24 following cancer diagnosis. The mean miles traveled per patient were 1,326 (SE = 306) for the experimental group and 2,186 (SE = 347) for the control group (P=0.03). No significant differences in satisfaction with care, economic barriers to care, or health‐related quality of life were found.ConclusionsThe intervention significantly reduced cancer patient travel for health care, which suggests that access to care improved in the experimental group. The results of this study do not allow conclusion that there was no effect on other patient outcomes. The results supported the study's conceptual framework and many of its hypotheses.