PDF(Pubmed)
Abstract：
Adolescent and young adult (AYA) cancer patients receive palliative medicine consultation at a late stage and face diagnostic delays. Failure to address social determinants of health (SDOH) and AYA-specific needs can adversely impact patient experience. This retrospective observational cohort study used data from chart review to assess the frequency of SDOH impacting AYA patients and setting of initial diagnosis at a US urban safety-net hospital. The association of SDOH variables with delays in treatment, loss of follow-up, and no-shows was tested using Chi-square and t-tests. One hundred seventy five patient charts were reviewed. Sixty-two percent were diagnosed in acute care settings. Substance use disorders, financial, employment, and insurance issues were associated with delayed treatment, with weak to moderate effect sizes. Mental health diagnoses, substance use disorder, homelessness, and financial burdens were associated with patient no-shows, with moderate to large effect sizes. Twenty-five percent of patients received palliative medicine consultation; 70% of these occurred at end of life. This study demonstrates the impact of SDOH on AYA cancer care and the need for policy allowing for intervention on SDOH.
摘要：
青少年和年轻成人（AYA）癌症患者在晚期接受姑息医学咨询，并面临诊断延误。未能解决健康的社会决定因素（SDOH）和AYA特定需求可能会对患者体验产生不利影响。这项回顾性观察性队列研究使用来自图表审查的数据来评估SDOH影响AYA患者的频率以及美国城市安全网医院的初始诊断设置。SDOH变量与治疗延迟的关联，失去随访，无显示采用卡方检验和t检验。回顾了175例患者图表。62％的人在急性护理环境中被诊断出。物质使用障碍，金融,employment,保险问题与延迟治疗有关，具有弱到中等的效果大小。心理健康诊断，物质使用障碍,无家可归,经济负担与病人缺席有关，具有中等到大的效果大小。25％的患者接受了姑息医学咨询；其中70％发生在生命末期。这项研究证明了SDOH对AYA癌症护理的影响以及对允许对SDOH进行干预的政策的必要性。
