Explaining variation in patient-centredness between breast cancer centres taking into account structure, leadership and organizational culture of the hospitals

医学研究所将以病人为中心定义为改善医疗保健的六个目标之一，其中提供信息是一个关键的先决条件。乳腺癌患者面临着严重的诊断，需要患者做出重要决定。许多决定是一生一次的决定，需要患者了解不同的选择。有许多研究调查了乳腺癌患者对与其特定疾病相关和无关的信息的需求，包括不同治疗方案的信息，可能治疗的风险/副作用和对健康相关生活质量的影响，以及支持措施。以前的研究一致表明，乳腺癌患者对信息有很高的渴望，特别是关于他们病情的严重程度和治疗方案。最近的数据一致表明，尽管乳腺癌中心相对标准化，但德国的乳腺癌患者认为他们在医院之间获得了充分和充分的信息和参与的程度存在很大差异。很少有研究，调查为什么信息提供作为一个中心方面，以病人为中心，不同的医院，什么促进或阻碍信息提供的过程。此外，虽然有大量研究探讨社会人口学方面与信息需求和缺陷之间的关联，但相对较少的调查显示了确定哪些类型的信息适合不同患者的方法。在德国，人们并没有做太多的努力来把病人的信息缺陷与他们的阅读和理解能力（受损）（书面或口头提供的）保健信息，以及在何种程度上可以在医院内解决这一问题。拟议项目的目的是：1）评估乳腺癌中心之间在以病人为中心方面的差异，特别侧重于通过病人调查提供的信息;（2）调查乳腺癌中心的关键信息提供者以表征医院的组织文化、结构和领导：（3）采用多水平分析来确定以患者为中心的程度与癌症中心的组织文化、结构和领导的关联程度，保持患者的属性不变;和4）研究病人对资讯的需求是否因他们阅读及理解健康资讯的能力而有所不同。研究将于密歇根大学公共卫生学院进行，并由李教授及李教授督导。雅各布森

The Institute of Medicine defines patient-centredness as one of the six aims for improvement in health care, with information provision being a key antecedent. Breast cancer patients are confronted with a serious diagnosis that requires the patients to make important decisions. Many of the decisions are once-in-a-lifetime decisions and require the patient to be informed about different options. There are numerous studies that have investigated breast cancer patients' needs for information both related and unrelated to their particular illness, including information on different treatment options, on the risks/side effects and impact on health-related quality of life of possible treatments, and on support measures. Previous studies have been consistent in their findings that breast cancer patients have a high desire for information, especially concerning the severity of their condition and their treatment options. Recent data consistently demonstrate substantial differences in the degree to which breast cancer patients in Germany feel that they receive sufficient and adequate information and involvement across hospitals, even though breast cancer centres are relatively standardized. There has been little research that investigates why information provision as one central aspect of patient-centredness varies across hospitals and what facilitates or hinders processes of information provision. Additionally, while there is a large body of research into the associations between sociodemographic aspects and information needs and deficits, there are relatively few investigations that show methods to identify which kinds of information are adequate for different patients. Not much effort has been made in Germany to connect information deficits of patients to their (impaired) ability to read and understand (written or verbally provided) health-care information and to what extent this could be tackled in the hospital.The proposed project aims to 1) assess the amount of variation between breast cancer centres in terms of patient-centredness with a special focus on the information provided using a patient survey; 2) survey breast cancer centres' key informants to characterize the hospitals' organizational culture, structure and leadership; 3) employ multilevel analysis to determine the extent to which the degree of patient-centredness is associated with cancer centres' organizational culture, structure and leadership, holding constant patients' attributes; and 4) investigate whether patients' information needs vary as a result of their ability to read and understand health information.The research will be conducted at the University of Michigan School of Public Health under the supervision of Prof. Lee and Prof. Jacobson.