删除种族纠正的肺功能测试对非裔美国患者的临床影响,这些患者需要为肺癌进行手术
Sidra N Bonner1,2,3, Kiran Lagisetty4,5, Rishindra M Reddy5,6
1Department of Surgery, University of Michigan, Ann Arbor.
JAMA surgery
|August 16, 2023
概括
从肺功能测试 (PFT) 中删除种族校正可能会改变非裔美国患者的肺癌手术建议. 这种变化可能会扩大手术护理现有的差异.
科学领域:
- 肺部医学 肺部医学
- 健康 公平 卫生 公平
- 手术瘤学手术瘤学
背景情况:
- 肺功能测试 (PFTs) 中的种族校正是有争议的,它将社会结构与生物学混为一谈,并假定非洲裔美国人的下肺功能.
- 从PFT中删除种族校正对非裔美国患者肺癌治疗决策的影响仍然未知.
研究的目的:
- 确定在进行肺癌手术的医院的PFT中种族校正的流行率.
- 评估非洲裔美国患者的种族校正和预测肺功能之间的关联.
- 评估消除种族纠正对外科医生的治疗建议的影响.
主要方法:
- 一项质量改进研究调查了医院关于PFT种族校正使用的情况.
- 对于接受肺癌切除的非裔美国患者,使用种族纠正和种族中性方程计算了手术前和后1秒内强迫呼气体积 (FEV1).
- 心胸外科医生被随机分配,接受不同PFT结果的临床简报 (对非裔美国人,其他/多种族或种族中立进行种族纠正).
主要成果:
- 16家医院中有15家 (93.8%) 在接受肺癌手术的非裔美国患者中使用了种族纠正.
- 使用种族中立方程将预测的术前FEV1降低9.2%,术后FEV1降低7.6%.
- 与接受种族中立结果的外科医生相比,呈现给非裔美国患者的种族校正PFT的外科医生更有可能推叶切除术.
结论:
- 在PFT中删除种族校正可能会影响外科医生对肺癌患者的治疗决定.
- 对于外科医生来说,意识到这些PFT变化至关重要,以避免潜在地加剧非洲裔美国患者手术护理的现有差异.
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