Patient Activation and Shared Decision-Making Among Hispanics/Latinos With Metastatic Cancer: A Qualitative Study.

IF 3.3 2区 医学 Q2 ONCOLOGY
Julia Meguro, Mariana Khawand-Azoulai, Heidy N Medina, Magela Pons, Michael T Huber, Frank J Penedo, Patricia I Moreno
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引用次数: 0

Abstract

Background: Patient activation is established when patients are equipped with the necessary knowledge, skills, and motivation to meaningfully participate in managing their health and, along with shared decision-making, improves clinical outcomes like treatment adherence. Little is known regarding patient activation among Hispanics/Latinos with metastatic cancer, who report worse quality of life and symptom burden compared to non-Hispanic/Latino Whites.

Aims: This study aimed to characterize barriers and facilitators to patient activation and shared decision-making among English- and Spanish-speaking Hispanics/Latinos with metastatic cancer.

Methods: Three, 2-h focus groups with Hispanics/Latinos with metastatic solid tumors (N = 22) were audio-recorded and transcribed. Semi-structured interviews addressed experiences living with metastatic cancer, palliative care beliefs, and communication with healthcare team. Barriers and facilitators were identified through secondary analysis of interviews.

Results: Barriers included: (a) feeling overwhelmed by treatment decision-making; (b) lack of clarity regarding treatment and diagnosis; (c) lack of symptom management resources; and (d) concerns regarding English fluency and medical terminology. Facilitators included: (a) self-advocacy for treatment options and quality of life resources; (b) feeling comfortable asking care team questions; (c) having a skilled support system; and (d) avoiding unhelpful medical information. Patient activation levels varied, but all participants expressed a desire to be proactively included in decisions throughout care.

Conclusions: Results suggest that patient activation may be promoted in this population through the provision of information/resources that are timely, accessible, and relevant to their care needs and active inclusion of patients in decision-making. Findings will guide culturally-adapted interventions that increase patient activation and shared decision-making.

西班牙/拉丁裔转移性癌症患者的激活和共同决策:一项定性研究。
背景:当患者具备必要的知识、技能和动机来有意义地参与管理他们的健康,并与共同决策一起改善临床结果(如治疗依从性)时,就建立了患者激活。对于转移性癌症的西班牙裔/拉丁裔患者的激活情况知之甚少,与非西班牙裔/拉丁裔白人相比,他们报告的生活质量和症状负担更差。目的:本研究旨在描述英语和西班牙语西班牙裔/拉丁裔转移性癌症患者激活和共同决策的障碍和促进因素。方法:对3组2小时的西班牙裔/拉丁裔转移性实体瘤患者(N = 22)进行录音和转录。半结构化访谈涉及转移性癌症患者的生活经历、姑息治疗信念以及与医疗团队的沟通。通过对访谈的二次分析,确定了障碍和促进因素。结果:障碍包括:(a)对治疗决策感到不知所措;(b)治疗和诊断不明确;(c)缺乏症状管理资源;(d)对英语流利程度和医学术语的关注。促进者包括:(a)对治疗方案和生活质量资源的自我宣传;(b)对向护理团队提问感到自在;(c)有熟练的支助系统;(d)避免无用的医疗信息。患者的激活水平各不相同,但所有参与者都表达了在整个护理过程中主动参与决策的愿望。结论:结果表明,通过提供及时、可获取、与患者护理需求相关的信息/资源,并积极让患者参与决策,可能会促进这一人群的患者激活。研究结果将指导与文化相适应的干预措施,提高患者的积极性和共同决策。
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来源期刊
Psycho‐Oncology
Psycho‐Oncology 医学-心理学
CiteScore
6.30
自引率
8.30%
发文量
220
审稿时长
3-8 weeks
期刊介绍: Psycho-Oncology is concerned with the psychological, social, behavioral, and ethical aspects of cancer. This subspeciality addresses the two major psychological dimensions of cancer: the psychological responses of patients to cancer at all stages of the disease, and that of their families and caretakers; and the psychological, behavioral and social factors that may influence the disease process. Psycho-oncology is an area of multi-disciplinary interest and has boundaries with the major specialities in oncology: the clinical disciplines (surgery, medicine, pediatrics, radiotherapy), epidemiology, immunology, endocrinology, biology, pathology, bioethics, palliative care, rehabilitation medicine, clinical trials research and decision making, as well as psychiatry and psychology. This international journal is published twelve times a year and will consider contributions to research of clinical and theoretical interest. Topics covered are wide-ranging and relate to the psychosocial aspects of cancer and AIDS-related tumors, including: epidemiology, quality of life, palliative and supportive care, psychiatry, psychology, sociology, social work, nursing and educational issues. Special reviews are offered from time to time. There is a section reviewing recently published books. A society news section is available for the dissemination of information relating to meetings, conferences and other society-related topics. Summary proceedings of important national and international symposia falling within the aims of the journal are presented.
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