Zhongguo quanke yixue (Nov 2023)
Demand and Influencing Factors for Community Health Services during Chemotherapy of Patients with Advanced Cancer
Abstract
Background How to implement effective and reasonable support and comprehensive services for patients with advanced cancer during chemotherapy is an issue worthy of attention in community health services at present. According to the latest data, the mortality rate of malignant tumors among residents in Shanghai has become the second place after cardiovascular and cerebrovascular diseases. The current attention to patients with advanced cancer during chemotherapy is also gradually increasing. Therefore, this study tries to understand the demand for primary care among such patients and the influencing factors. Objective To investigate the demand and influencing factors for community health services during chemotherapy of partial patients with advanced cancer in Shanghai, and to explore how to develop community interventions and services to address the demand of such patients. Methods Patients with advanced cancer during chemotherapy who regularly visited or hospitalized at Shanghai Ninth People's Hospital, Wusong Hospital and Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine from December 2021 to March 2022 were selected as the study subjects. Based on previous relevant questionnaires, government specifications and interview results, the final version of the demand for community health services of partial patients with advanced cancer during chemotherapy in Shanghai was formed, with a total of 3 demand dimensions (psychological, medical care, social support) and 38 demand items. The contents include patients' general information (demographic and sociological information: gender, age, religious beliefs, education level, marital status, source of medical expenses, disposable monthly household income, whether to participate in a patient group; tumor diagnosis: type and time of diagnosis, pain score, combining with other diseases), 6 items of psychological and psychological demand, 24 items of medical care demand, and 8 items of social support demand. A 3-point scale was adopted: 1 was unnecessary, 2 was necessary, and 3 was very necessary. The higher the score, the higher the degree of patients' demand, which was ranked according to the average score of each demand item. Univariate and multivariate Logistic regression analyses were used to explore the influencing factors of the demand for community health services of patients with advanced cancer during chemotherapy. Results The average scores of each demand dimension were ranked in order of psychological demand (2.31 points), medical care demand (2.27 points) and social support demand (2.18 points). The top five average scores of all demand items were "preparation of biochemical tests such as routine blood, liver and kidney functions before chemotherapy" (2.48 points), "education on chemotherapy knowledge" (2.48 points), "care of PICC catheterization during chemotherapy" (2.45 points), "management of myelosuppression after chemotherapy" (2.43 points) " and "providing of updated information on treatment, examination and rehabilitation" (2.42 points), mainly focus on the medical care demand dimension. Multivariate Logistic regression analysis showed that education level and disposable monthly household income were influencing factors of psychological demand of patients with advanced cancer during chemotherapy (P<0.05) ; age and medical expenses were influencing factors of medical care of patients with advanced cancer during chemotherapy (P<0.05) ; age and whether to join a patient group were influencing factors of social support of patients with advanced cancer during chemotherapy (P<0.05) . Conclusion Patients with advanced cancer during chemotherapy have specific demand for community health services, with different levels of demand in psychological, medical care and social support dimensions, which are influenced by various factors such as age, education level, and household income. This study provides references for community health service centers to carry out relevant medical services. In the future, new service items with high level of demand can be piloted, community interventions such as psychological and medical care for patients with advanced cancer during chemotherapy, and their quality of survival should be followed up.
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