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卫生保健的六个目标之一，提供信息是关键的先决条件。乳腺癌患者面临着严重的诊断，需要患者做出重要的决定。许多决定是一生只有一次的决定，需要患者被告知不同的选择。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，包括关于不同治疗方案的信息、可能的治疗方法的风险/副作用和对与健康相关的生活质量的影响以及支持措施。以前的研究结果是一致的，即乳腺癌患者对信息的渴望很高，特别是关于他们病情的严重性和他们的治疗选择。最近的数据一直表明，尽管乳腺癌中心相对标准化，但德国的乳腺癌患者在多大程度上感觉到他们在不同医院得到了充分和充分的信息和参与。很少有研究调查为什么信息提供作为以患者为中心的一个中心方面在不同的医院有所不同，以及是什么促进或阻碍了信息提供的过程。此外，虽然有大量关于社会人口学方面与信息需求和缺陷之间的关联的研究，但显示出哪些类型的信息适合不同患者的方法的调查相对较少。在德国，在将患者的信息缺陷与他们(受损的)阅读和理解(书面或口头提供的)保健信息的能力联系起来，以及在医院可以在多大程度上解决这一问题方面，没有做太多的努力。拟议的项目旨在1)评估乳腺癌中心之间在以患者为中心方面的差异，特别关注使用患者调查提供的信息；2)调查乳腺癌中心的关键信息者，以表征医院的组织文化、结构和领导；3)使用多层次分析来确定以患者为中心的程度与癌症中心的组织文化、结构和领导层之间的关联程度，并保持患者的属性不变；以及4)调查患者的信息需求是否因他们阅读和理解健康信息的能力而有所不同。这项研究将在密歇根大学公共卫生学院进行，李教授和雅各布森教授将指导这项研究。

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.