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癌症幸存者多重慢性病对医患沟通和健康自我效能的影响:来自健康信息国家趋势调查的结果。

Implications for patient-provider communication and health self-efficacy among cancer survivors with multiple chronic conditions: results from the Health Information National Trends Survey.

机构信息

Department of Health Promotion Behavioral Science, UTHealth School of Public Health in Dallas, Harry Hines Blvd, Dallas, TX, 75390, USA.

Center for Energy Balance, Department of Behavioral Science, MD Anderson Cancer Center, Cancer Prevention Building, Unit 1330, 1155 Pressler St, Houston, TX, 77030, USA.

出版信息

J Cancer Surviv. 2019 Oct;13(5):663-672. doi: 10.1007/s11764-019-00785-7. Epub 2019 Jul 15.

Abstract

PURPOSE

Cancer survivors with multiple chronic conditions experience significant challenges managing their health. The six core functions of patient-centered communication (PCC)-fostering healing relationships, exchanging information, responding to emotions, managing uncertainty, making decisions, and enabling patient self-management-represent a central component to facilitating a survivor's confidence to manage their health that has not been investigated in cancer survivors with multiple chronic conditions.

METHOD

Nationally representative data across two iterations of the Health Information National Trends Survey (HINTS) were merged with combined replicate weights using the jackknife replication method. Adjusted linear regression examined the association between PCC and health self-efficacy in a sample of breast, colorectal, and prostate cancer survivors and by multiple chronic conditions.

RESULTS

53.9% reported that providers did not always respond to their emotions and 48.9% reported that they could not always rely on their providers to help them manage uncertainty. In the adjusted linear regression models, there was a significant positive association between PCC and health self-efficacy (β = 0.2, p = 0.01) for the entire sample. However, the association between PCC and health self-efficacy was attenuated in cancer survivors with multiple chronic conditions (β = 0.1, p = 0.53).

CONCLUSION

PCC alone is not enough to improve a cancer survivor's confidence in their ability to manage their health in the presence of multiple chronic conditions.

IMPLICATIONS FOR CANCER SURVIVORS

Cancer survivors with multiple chronic conditions need ongoing support, in addition to PCC, that render them prepared to manage their health after cancer.

摘要

目的

患有多种慢性病的癌症幸存者在管理健康方面面临重大挑战。以患者为中心的沟通(PCC)的六个核心功能——促进建立治疗关系、交流信息、回应情绪、管理不确定性、做出决策和促进患者自我管理——代表了促进幸存者对管理自身健康的信心的一个核心组成部分,但尚未在患有多种慢性病的癌症幸存者中进行研究。

方法

利用 jackknife 复制方法,将两个迭代的健康信息国家趋势调查(HINTS)的全国代表性数据与合并的重复权重合并。调整后的线性回归检验了 PCC 与乳腺癌、结直肠癌和前列腺癌幸存者以及多种慢性病患者健康自我效能之间的关联。

结果

53.9%的人报告说,医生并不总是回应他们的情绪,48.9%的人报告说,他们不能总是依赖医生来帮助他们管理不确定性。在调整后的线性回归模型中,PCC 与健康自我效能之间存在显著正相关(β=0.2,p=0.01)。然而,在患有多种慢性病的癌症幸存者中,PCC 与健康自我效能之间的关联减弱(β=0.1,p=0.53)。

结论

仅靠 PCC 不足以提高癌症幸存者在患有多种慢性病的情况下对自身管理健康能力的信心。

对癌症幸存者的意义

患有多种慢性病的癌症幸存者除了需要 PCC 外,还需要持续的支持,使他们有能力在癌症后管理自己的健康。

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