How Important are Perceptions? Investigating the Effect of Perceived Care Coordination on Survival among a Stage III Colorectal Cancer SEER Surgical Patient Population Pubblico

Blaess, Breanna (Spring 2020)

Permanent URL: https://etd.library.emory.edu/concern/etds/pc289k12m?locale=it
Published

Abstract

Background

Colorectal cancer (CRC) is a major public health burden as the second leading cause of cancer death in the United States. Patients’ perceptions regarding their medical care team, quality of treatments, and communication between all providers have an important impact on the patients’ confidence and comfortability of their cancer care. We aimed to investigate the relationship between patients’ perceptions regarding care coordination and their survival.

Methods

We identified patients 21 years of age that underwent surgical resection for pathologic stage III colon or rectal cancer diagnosed between August 2011 and December 2013 in the state of Georgia and Metropolitan Detroit Surveillance, Epidemiology, and End Results (SEER) Registries’ catchment areas. Poor perceived care coordination (PCC), our primary exposure, was measured using a composite score from five questions on patients’ perceptions of their provider’s knowledge of their case and quality of communication between themselves and their providers.

Results

           Among the 1,226 patients included in our analysis, 355 (29.0%) had poor PCC and 871 (71.0%) had good PCC. Individuals with perceived care coordination that was poor were more likely to be unmarried (p<0.001), have a higher census tract poverty percentage (p < 0.001), and be on Medicare and/or Medicaid (p=0.008). Univariate analysis found that those with poor PCC had a 24% increased hazard of death compared to those with good PCC (cHR=1.24, 95% CI: (1.00, 1.53)). Multivariate analyses adjusting for age, natal sex, race/ethnicity, marital status, education, and poverty status found that those with poor PCC had a 12% increased hazard of death compared to those with good PCC (aHR=1.12, 95% CI: (0.90, 1.39)). Older patients had an increased hazard than younger patients (aHR=1.45, 95% CI: (1.30, 1.63)) and this effect size increased with increasing age. Males had an increased hazard compared to females (aHR=1.31, 95% CI: (1.06, 1.61)).

Conclusion

           Our study results suggest a slightly increased hazard of death for CRC patients with poor PCC, though this is not statistically significant. These results may be able to assist providers as well as hospital administrators and policy makers towards enhancing patient-centered cancer care.

Table of Contents

CHAPTER I: LITERATURE REVIEW........................................................................................1

CHAPTER II: MANUSCRIPT...................................................................................................10

Introduction......................................................................................................................10

Methods.............................................................................................................................12

Results...............................................................................................................................16

Discussion.........................................................................................................................18

CHAPTER III: CONCLUSIONS, PUBLIC HEALTH IMPLICATIONS, FUTURE STEPS...............24

REFERENCES.........................................................................................................................26

TABLES..................................................................................................................................31

FIGURES................................................................................................................................34

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