Underuse of Breast Cancer Adjuvant Treatment: Patient Knowledge, Beliefs, and Medical Mistrust
Underuse of Breast Cancer Adjuvant Treatment: Patient Knowledge, Beliefs, and Medical Mistrust
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DOI：
10.1200/jco.2009.22.9773
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发表时间：
2009-11-01
影响因子：
45.3
通讯作者：
Leventhal, Howard
中科院分区：
文献类型：
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作者：
Bickell, Nina A.;Weidmann, Jessica;Leventhal, Howard
PurposeLittle是知道为什么妇女与乳腺癌谁有手术不接受有效的术后辅助treatments.MethodsWe调查了258名妇女谁最近接受了手术治疗在6个纽约市医院的早期乳腺癌对他们的照顾，知识和信念乳腺癌及其治疗。根据国家指南，所有妇女都应接受辅助治疗。辅助治疗数据来自住院和门诊病历。因子分析被用来创建量表得分为100的治疗信念和知识，医疗不信任，和医生沟通有关的治疗。双变量和多变量分析评估了治疗和未治疗妇女之间的差异。结果与治疗妇女相比，未治疗妇女不太可能知道辅助治疗可以增加生存率（100分制; 66比75; P < .0001），（64 v53; P = .001），自我效能感较低（92 v97; P <0.05）;医生关于治疗的沟通并不影响患者对治疗益处的了解（r = 0.8; P = 0.21）。多变量分析发现，未经治疗的妇女更有可能是70岁或以上（校正相对风险[aRR]，1.11; 95% CI，1.00 - 1.13），合并症（aRR，1.10; 95%CI，1.04 - 1.12），并表达对医疗服务系统的不信任（aRR，1.003; 95% CI，1.00至1.007），即使他们更可能相信辅助治疗是有益的（aRR，0.99; 95% CI，0.98至0.99;模型c，0.84; P
PurposeLittle is known about why women with breast cancer who have surgery do not receive proven effective postsurgical adjuvant treatments.MethodsWe surveyed 258 women who recently underwent surgical treatment at six New York City hospitals for early-stage breast cancer about their care, knowledge, and beliefs about breast cancer and its treatment. As per national guidelines, all women should have received adjuvant treatment. Adjuvant treatment data were obtained from inpatient and outpatient charts. Factor analysis was used to create scales scored to 100 of treatment beliefs and knowledge, medical mistrust, and physician communication about treatment. Bivariate and multivariate analyses assessed differences between treated and untreated women.ResultsCompared with treated women, untreated women were less likely to know that adjuvant therapies increase survival (on a 100-point scale; 66 v 75; P < .0001), had greater mistrust (64 v 53; P = .001), and had less self-efficacy (92 v 97; P < .05); physician communication about treatment did not affect patient knowledge of treatment benefits (r = 0.8; P = .21). Multivariate analysis found that untreated women were more likely to be 70 years or older (adjusted relative risk [aRR], 1.11; 95% CI, 1.00 to 1.13), to have comorbidities (aRR, 1.10; 95% CI, 1.04 to 1.12), and to express mistrust in the medical delivery system (aRR, 1.003; 95% CI, 1.00 to 1.007), even though they were more likely to believe adjuvant treatments were beneficial (aRR, 0.99; 95% CI, 0.98 to 0.99; model c, 0.84; P