Background: Patient activation describes a willingness to take action to manage health and is associated with health outcomes. The purpose of this study was to characterize patient activation and its association with psychological outcomes and health behaviors in childhood cancer survivors. Methods: Participants were from the St. Jude Lifetime Cohort Study (SJLIFE). Activation levels (1–4, 4 = highest activation) were measured with the Patient Activation Measure (PAM). Psychological outcomes and health behaviors were obtained via self-report. Cognitive function was assessed by trained examiners. ANOVA or chi-squared tests were utilized to assess group-level differences in activation. Multivariable regression models were used to assess associations between PAM scores and outcomes of interest. Results: Among 2708 survivors and 303 controls, more survivors endorsed lower activation levels than the controls (11.3 vs. 4.7% in level 1) and fewer survivors endorsed the highest level of activation than the controls (45.3 vs. 61.5% in level 4). Not endorsing depression (OR: 2.37, 95% CI 1.87–2.99), anxiety (OR: 2.21, 95% CI 1.73–2.83), and somatization symptoms (OR: 1.99, 95% CI 1.59–2.50), general fear (OR: 1.45, 95% CI 1.23–1.71) and body-focused (OR: 2.21, 95% CI 1.83–2.66), cancer-related worry, and physical (OR: 2.57, 95% CI 2.06–3.20) and mental (OR: 2.08, 95% CI 1.72–2.52) HRQOL was associated with higher levels of activation. Lower activation was associated with not meeting physical activity guidelines (OR: 2.07, 95% CI 1.53–2.80). Conclusions: Survivors endorsed lower activation levels than peers. Interventions to improve physical and psychological health outcomes could leverage these results to identify survivors who benefit from support in patient activation.
背景：患者能动性指个体主动管理自身健康的意愿，与健康结局相关。本研究旨在描述儿童癌症幸存者的患者能动性特征，并探讨其与心理结局及健康行为之间的关联。方法：研究对象来自圣裘德终身队列研究。采用患者能动性量表评估能动性水平（1-4级，4级为最高水平）。心理结局和健康行为通过自我报告获取，认知功能由经过培训的评估员进行测定。采用方差分析或卡方检验评估能动性水平的组间差异，并运用多变量回归模型分析患者能动性评分与目标结局的关联性。结果：在2708名幸存者和303名对照者中，幸存者低能动性水平比例高于对照组（1级：11.3% vs 4.7%），高能动性水平比例低于对照组（4级：45.3% vs 61.5%）。未出现抑郁（OR: 2.37, 95% CI 1.87–2.99）、焦虑（OR: 2.21, 95% CI 1.73–2.83）及躯体化症状（OR: 1.99, 95% CI 1.59–2.50），未出现广泛性恐惧（OR: 1.45, 95% CI 1.23–1.71）与身体关注性（OR: 2.21, 95% CI 1.83–2.66）的癌症相关担忧，以及较高的生理（OR: 2.57, 95% CI 2.06–3.20）与心理（OR: 2.08, 95% CI 1.72–2.52）健康相关生活质量均与较高能动性水平显著相关。较低能动性水平与未达到体力活动指南标准相关（OR: 2.07, 95% CI 1.53–2.80）。结论：幸存者能动性水平低于同龄人群。改善身心健康的干预措施可依据本研究结果，识别可从患者能动性支持中获益的幸存者群体。
肿瘤(癌症)患者之家