Demand and Influencing factors for community health services during chemotherapy of patients with advanced cancer^☆

Abstract

Background: Implementing effective, rational support and comprehensive services for patients with advanced cancer undergoing chemotherapy is a significant challenge in community health services. According to recent data, the mortality rate from malignant tumors in Shanghai residents now ranks second only to cardiovascular and cerebrovascular diseases. Attention toward patients with advanced cancer undergoing chemotherapy is gradually increasing. This study aims to understand the primary care demands of such patients and the factors influencing these demands.
Objective: To investigate the demand and influencing factors for community health services during chemotherapy for patients with advanced cancer in Shanghai and to develop community interventions and services tailored to these patients' demands.
Methods: Patients with advanced cancer undergoing chemotherapy who regularly visited or were 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 government specifications, previous research findings from surveys on questionnaires and interviews, the final version of the "Community Health Services Demand Questionnaire for Patients with Advanced Cancer in Shanghai" was developed. It includes three demand dimensions (psychological, medical care, social support) and 38 demand items. The contents cover general information such as demographic and sociological information(educational level, marital status, source of medical expenses, disposable monthly household income, patient group participation), and tumor diagnosis(type and time of diagnosis, pain score, comorbidities), along with items on psychological demand (6 items), medical care demand (24 items), and social support demand (8 items). A 3-point scale was employed: 1 for unnecessary, 2 for necessary, and 3 for very necessary. Demand levels were ranked according to the average score of each item. Logistic regression analyses were used to identify the influencing factors of community health service demand among these patients.
Results: The demand dimensions, ranked from highest to lowest, were psychological demand (2.31 points), medical care demand (2.27 points), and social support demand (2.18 points). The top five demands were “preparation for pathological tests such as routine blood, liver and kidney functions before chemotherapy” (2.48 points), “education on chemotherapy knowledge” (2.48 points), “care for peripherally inserted central catheter(PICC) catheterization during chemotherapy” (2.45 points), “management of myelosuppression after chemotherapy” (2.43 points) and "providing updated information on treatment, examination and rehabilitation” (2.42 points), primarily focusing on the medical care demand dimension. Logistic regression analysis showed that educational level and disposable monthly household income significantly influenced psychological demand, while age and source of medical expenses influenced medical care demand, and age and patient group participation affected social support demand (P < 0.05).
Conclusion: Patients with advanced cancer undergoing chemotherapy have specific demands for community health services across psychological, medical care, and social support dimensions, influenced by factors such as age, educational level, and household income. This study offers recommendations for community health centers to develop relevant medical services. Future initiatives could introduce new service items in high demand and monitor the effectiveness of community interventions, such as psychological and medical care support for these patients, to improve their quality of life.

Keywords

Neoplasms / Advanced cancer / Chemotherapy patients / Community health services / Health services needs and demand / Cross-sectional studies / Root cause analysis

Declarations

Not applicable.

Authors' contributions

Overall design of the paper, L.Q. and C.R.; Methodology, L.Q. and C.R.; Data collection, L.Q. and Z.W.; data analysis, L.Q.; Project administration, Z.W.; Supervision, Z.Y. and J.B.; Validation, L.Q.; First draft, L.Q. and L.F.; Draft review and editing, L.Q. and L.F. All authors have read and agreed to the published version of the manuscript.

Ethics approval and consent to participate

The study received approval from Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital Ethics Review Committee (SH9H-2021-T480-1).

Consent for publication

Not applicable.

Availability of data and materials

Not applicable.

Authors' other information

Not applicable.

Declaration of competing interest

The authors declare that they have no competing interests.

Funding

This research was supported by grants from Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital (JYLJ202019).

Acknowledgements

Thanks to Wusong Hospital and Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine for their support and assistance in data collection.

References

[1] Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021; 71(3):209-249. doi: 10.3322/caac.21660.

[2] Shanghai Statistical Yearbook 2022. (Chinese). [cited 2022-07-03]. Available from: https://tjj.sh.gov.cn/tjnj/20230206/804acea250d44d2187f2e37d2e5d36ba.html.

[3] Chen YC, Sun LH, Li XP, et al. Spatial epidemiological analysis on mortality and probability of premature death caused by cancer in Pudong New Area of Shanghai, 2010 —2020. (Chinese) Chin J Cancer Prev Treat. 2022; 29(6):393-399. doi: 10.16073/j.cnki.cjcpt.2022.06.03.

[4] Huang XL, Hong CR, Dai KJ, et al. Community intervention requirement in breast cancer patients and family members in Changning district Shanghai. (Chinese). Chin Public Health. 2009; 25(11):1367-1368.

[5] Gu WJ, Shi YX, Yuan W, et al. Health service needs of terminal inpatients with advanced malignant tumor in community hospice care pilot settings in shanghai. (Chinese). Chinese General Practice. 2015; 18(22):2655-2661. doi: 10.3969/j.issn.1007-9572.2015.22.009.

[6] Miao J, Cao WQ, Wang XY, et al. Investigation on community care needs of patients with cancer and their family members in a community in Shanghai. (Chinese). Chinese Nursing Research. 2016; 30(19):2386-2390. doi: 10.3969/j.issn.1009-6493.2016.19.021.

[7] Tang Y, Wan YH, Zhou H, et al. Analysis on demand status and influencing factors of female breast cancer patients undergoing postoperative chemotherapy. (Chinese). China Medical Herald. 2022; 19(20):45-48.

[8] Huang YW, Song JY, Cai JY, et al. Study on status quo and influencing factors of supportive care needs of 160 patients with breast cancer undergoing chemotherapy. (Chinese). Chin J School Doctor. 2022; 36(9):651-655.

[9] Chinese Society of Clinical Oncology, Editorial Board of Chinese Journal of MedicineChinese society of clinical oncology guidelines for clinical diagnosis and treatment of lung Cancer (2022 Edition). (Chinese). National Medical Journal of China. 2022; 102(23):1706-1740. doi: 10.3760/cma.j.cn112137-20220413-00795.

[10] Chinese Society of Clinical Oncology, Editorial Board of Chinese Journal of MedicineChinese society of clinical oncology guidelines for clinical diagnosis and treatment of gastric cancer (2021 Edition). (Chinese). National Medical Journal of China. 2022; 102(16):1169-1189. doi: 10.3760/cma.j.cn112137-20220127-00197.

[11] Bureau of Medical Administration and Medical Administration of the National Health and Family Planning Commission of the PRC, Chinese Society of Clinical OncologyChinese guidelines for the diagnosis and treatment of colorectal cancer (2015 edition). (Chinese). Chinese Journal of Digestive Surgery. 2015; 14(10):783-799. doi: 10.3760/cma.j.issn.1673-9752.2015.10.001.

[12] Zheng JW, Li JZ, Tu WY, et al. The protocol of treatment guideline of oral and maxillofacial malignant neoplasms. (Chinese). China Journal of Oral and Maxillofacial Surgery. 2010; 8(2):98-106.

[13] Chen MS. Chinese guidelines for the integrated diagnosis and treatment of liver cancer (2022 concise edition). (Chinese). Chinese Journal of Clinical Oncology. 2022; 49(17):865-873.

[14] National Health Commission of the People’s Republic of China. Guidelines for the diagnosis and treatment of renal cancer (2022 edition). (Chinese). (2022-04-11) [cited 2022-07-03]. Available from: http://www.nhc.gov.cn/yzygj/s7659/202204/a0e67177df1f439898683e1333957c74.shtml.

[15] National Health Commission of the People’s Republic of China. Guidelines for the diagnosis and treatment of bladder cancer (2022 edition). (Chinese). (2022-04-11) [cited 2022-07-03]. Available from: http://www.nhc.gov.cn/yzygj/s7659/202204/a0e67177df1f439898683e1333957c74.shtml.

[16] National Health Commission of the People’s Republic of China. Guidelines for the diagnosis and treatment of prostate cancer (2022 edition). (Chinese). (2022-04-11) [cited 2022-07-03]. Available from: http://www.nhc.gov.cn/yzygj/s7659/202204/a0e67177df1f439898683e1333957c74.shtml.

[17] National Health Commission of the People’s Republic of China. Guidelines for the diagnosis and treatment of breast cancer (2022 edition). (Chinese). (2022-04-11) [cited 2022-07-03]. Available from: http://www.nhc.gov.cn/yzygj/s7659/202204/a0e67177df1f439898683e1333957c74.shtml.

[18] Liu Y. Research On What Palliative Home Care Services Should Community Health Centers Delivery For Advanced Cancer Patients and Their Informal Caregivers in Shanghai. (Chinese). Shanghai: Second Military Medical University; 2008.

[19] Yu J, Li X, Wang YJ, et al. Current status and development strategies of hospice care services in China. (Chinese). J Mod Med Health. 2022; 38(17):2950-2954.

[20] Regarding the implementation of the 2012 municipal government practical project for palliative care (end-of-life care). (Chinese). (2014-04-09) [cited 2022-07-03]. Available from: http://wsjkw.sh.gov.cn/xxfb4/20180525/0012-28097.html.

[21] Notification on the issuance of "Basic Standards for the Establishment of Shanghai Community Health Service Centers" and "Basic Standards for the Establishment of Shanghai Community Health Service Stations" (Effective). (Chinese). (2016-06-29) [cited 2022-07-03]. Available from: http://wsjkw.sh.gov.cn/jcws1/20180815/0012-60037.html.

[22] Ni P, Chen JL, Liu N. Sample size estimation for quantitative studies in nursing research. (Chinese). Chin J Nurs. 2010; 45(4):378-380. doi: 10.3761/j.issn.0254-1769.2010.04.037.

[23] Zheng Y, Gong YM, Zhou XW, et al. From community practice to public health policy —planning and implementation of the Shanghai colorectal cancer screening program. (Chinese). Shanghai J Prev Med. 2017; 29(2):89-94, 113. doi: 10.19428/j.cnki.sjpm.2017.02.001.

[24] Wu CX, Zheng Y. Practice of the Cancer Prevention and Control Week in Shanghai. (Chinese). Shanghai Journal of Preventive Medicine. 2016; 28(2):73-76. doi: 10.19428/j.cnki.sjpm.2016.02.001.

[25] Tang Q. Analysis of the reasons for the younger age of incidence of primary liver cancer. (Chinese). World Latest Medicine Information. 2015; 15(53):95.

[26] Liu F. Overview and prospect of reform of China’s medical insurance and policy evolution. (Chinese). The Chinese Banker. 2022(8):118-123. doi: 10.3969/j.issn.1671-1238.2022.08.032.

[27] Policies and practices for the protection of freedom of religious belief in China. (Chinese). (2018-04-03) [cited 2022-07-03]. Available from: http://www.gov.cn/xinwen/2018-04/03/content_5279419.htm.

[28] Vehling S, Kissane DW, Lo C, et al. The association of demoralization with mental disorders and suicidal ideation in patients with cancer. Cancer. 2017; 123(17):3394-3401. doi: 10.1002/cncr.30749.

[29] Zhang YP, Zeng QZ, He YL, et al. Investigation on mental health knowledge of family doctors in 9 community health service centers in shanghai. (Chinese). Chinese Primary Health Care. 2020; 34(3):71-74. doi: 10.3969/j.issn.1001-568X.2020.3.0020.

[30] Liu ML, Li YT, Su ZF, et al. Research progress on the psychology of family members of palliative care patients. (Chinese). Nursing Practice and Research. 2021; 18(22):3376-3379.

[31] Wang JY, Chen M, Zhou LM, et al. A survey on the demand for PICC maintenance outpatient services in community hospitals among cancer patients. (Chinese). Electronic Journal of Clinical Medical Literature. 2020; 7(36):99. doi: 10.16281/j.cnki.jocml.2020.36.089.

[32] Wang YJ, Xu S, Guo PP, et al. Application analysis of the integrated PICC maintenance network model of hospital-community-home in the nursing of cancer chemotherapy patients with PICC catheterization. (Chinese). Mod Diagn Treat. 2021; 32(12):1982-1983.

[33] Wang ZY, Yang H, Guo RX, et al. Study on Correlation between resilience, coping style and social support in patients with advanced cancer. (Chinese). Journal of Qilu Nursing. 2022; 28(9):1-4. doi: 10.3969/j.issn.1006-7256.2022.09.001.

[34] Pan F. Meeting patient needs is the driving force to promote the development of cancer prevention and treatment in China - The Chinese Anti-Cancer Association releases the top ten advancements in the field of cancer that the public is most concerned about. (Chinese). China Modern Medicine. 2021; 28(27):1-3. doi: 10.3969/j.issn.1674-4721.2021.27.002.