Search

Purpose: Socially disadvantaged patients may lack self-efficacy to navigate a complex health system making them vulnerable to healthcare inequity. We aimed to develop an Index of social vulnerability that predicts increased risk of negative healthcare events (e.g. emergency hospitalization), independent of chronic disease burden. The analysis illustrates the conceptual and practical steps leading to the development of a pragmatic Index of social vulnerability to limited healthcare self-efficacy. Methods: Using data from a 3-year cohort of 2507 adult primary care patients in Québec (Canada), we applied two complementary structural equation modelling approaches—Partial Least Squares Path Modelling (PLS-PM) and Multiple indicators and Multiple Causes (MIMIC) modelling—to identify a minimal set of social characteristics that could be summed into an Index related to limited healthcare self-efficacy. We then used logistic regression to determine if the Index predicted: hospital emergency department use; hospital admissions; unmet need for care, and others. We privileged parsimony over explanatory capacity in our analytic decisions to make the Index pragmatic for epidemiologic and clinical use. Results: The Individual Social Vulnerability Index is the weighted sum of five indicators: two indicators of social support; educational achievement; financial status; limited language proficiency. The Index predicts increased likelihood of all negative healthcare outcomes except unmet need, with a clear threshold at Index ≥ 2. The effect is independent of chronic disease burden. Conclusion: When social deficits outweigh social assets by two or more (Index ≥ 2), there is an increased risk of negative healthcare events beyond the risk attributable to poor health. The Index is a pragmatic tool to identify a minority of patients who will require additional support to receive equitable healthcare. [ABSTRACT FROM AUTHOR]

PURPOSE: This study was designed to elicit patient's preferences with regard to adjuvant postoperative chemoradiation therapy in rectal cancer. METHODS: Forty-seven previously treated colorectal cancer patients underwent a structured interview and were presented with two scenarios involving surgery for rectal cancer: surgery alone, or surgery followed by postoperative chemoradiation therapy. Acute and long-term health states for each options were described. Their willingness to trade-off side-effects for treatment efficacy was evaluated by using the probability trade-off method. RESULTS: The age and gender distribution of the cohort were comparable with the general colon cancer population. Rectal cancer had been diagnosed in 20 individuals. The majority of patients valued their disease-free status in light of the anticipated long-term effects on their quality of life. The median point at which patients switched their preference was 5 percent, a value reflecting the critical local recurrence rate acceptable. The important items that influenced decisions were the effects on bowel function and fear of recurrence. CONCLUSIONS: This small study demonstrates a substantial variation in patient's preferences with regard to postoperative chemoradiation for rectal cancer. Further studies in the preoperative setting are warranted. [ABSTRACT FROM AUTHOR]