| ObjectiveThe purpose of this paper was to study the healthcare seeking behaviors and its influencing factors of cancer survivors which include patients of esophageal cancer,stomach cancer,bowel cancer,female breast cancer,lung cancer in rural areas of Shandong Province and to explore the behavior characteristics and discipline of cancer patients during the process of health seeking,which included perceiving the symptom and accepting the diagnosis and treatment.The study aimed to guide the rural residents to make right decision and to make suitable policies of cancer prevention and control for the governments in rural areas of Shandong Province.At the same time,the study provided the evidence and supports for distributions and allocations of health resources which made by department of health.MethodsThe study collected data by questionnaire survey and qualitative interview.About questionnaire survey,three counties were selected as research regions in Shandong Province,according to geographic locations and economic development level.By combining stratified sampling with group sampling,456 cancer survivors diagnosed between 2015 and 2017 were selected as the research objects.The questionair contains demographic characteristics,information about cancer,related information about physical examination and cancer screening,delay of health seeking and its reasons and so on.In the aspect of qualitative interview,researchers chose 10 interviewees in every sample areas by purposive sampling to carry out in-depth interviews.The interview contains the primary information of interviewee,the points about cancer and its symptom,the difficulties during the process of healthcare seeking,the ways to get information and so on.In this study,description analysis,Chi-square test were used to make the single factor analysis on the healthcare seeking behaviors and influencing factors of cancer patients.The Binary Logistic Regression model and Multiple Logistic Regression model were used to make multivariate analysis on the influencing factors of on the behaviors of cancer paients.About the qualitative interview,key words were extracted from qualitative interview content and main behavior characteristics were summarized in the course of seeking healthcare.The data analysis was mainly completed by statistical software SSPS 20.0.Results(1)Rural residents in Shandong Province didn’t have enough knowledge about cancer and its symptom.(2)The proportion of cancer patients who have been treated in district medical institutions was the highest,at 42.0%.The flow of seeking healthcare was from the basic level hospital to the municipal level and above.The main difficulties encountered by cancer patients in the process of seeking healthcare included economic difficulties,unfamiliar procedures for medical treatment,and the fact that they did not know the procedures for medical insurance reimbursement in different places.(3)The first-visiting hospital level was 20.0%,60.8%and 18.1%for hospitals at and below the township level,county-level hospitals and municipal hospitals and above.In the choice of first visit hospital for cancer patients,the single factor analysis results showed that region,age of diagnosis,"long-term work far away from home",occupation,type of tumor,stage of disease,family history of disease,"regular physical examination","whether you know early symptoms of cancer","whether you know ’three early"’,residence to the first-visiting hospital and the "who decides the first-visiting hospital" were statistically significant(P<0.05).The results of multivariate analysis showed that regions,marital status,occupation,"whether or not regular physical examination","who decides on the first-visiting hospital",and the distance to the first-visiting hospital were the factors that affected the choice of the first-visiting hospital for cancer patients.In Linqu,cancer patients whose marital status is in marriage,regular physical examination and decisions made by spouses or children had a higher probability of first diagnosis in hospitals at or above the municipal level.In Rushan,mainly by their own decision,spouses and children involved in the decision-making of cancer patients,the first diagnosis of the county hospital was more likely to choose.In Feicheng,where the occupation was a farmer and a cancer patient who made his own decision,the probability of the first visit to a township and below hospital was higher.The main reason why cancer patients chose first-treatment hospitals was that they lived close to the first-treatment medical institution.(4)The delay in medical treatment of cancer patients was divided into delay in first-visiting hospital,delay in diagnosis and delay in treatment.The delay rates were 48.6%,17.7%,and 12.8%,respectively.The main delays occurred in the delay in first-visiting hospital.The delayed rate in first-visiting hospital of patients with esophageal cancer,gastric cancer,intestinal cancer,breast cancer,and lung cancer was 29.7%,53.4%,63.3%,42.7%,and 49.0%,respectively.The single factor analysis showed that,in terms of the factors that affected the delay of cancer patients’ first visit to hospital,the differences between regions,age of diagnosis,educational level,marital status,stage of illness,"regular physical examination",and "knowledge of ’three early’" were statistically significant(P<0.05).The results of Binary Logistic Regression model analysis showed that colorectal cancer,advanced stages,below primary school,regular marital status and physical examinations were more likely to be delayed on first-visiting hospital of cancer patient.The main reason for delayed visits to first hospital of cancer patients was the lack of understanding of the symptoms or signs of the disease.The delayed diagnosis rates of esophageal cancer,gastric cancer,intestinal cancer,breast cancer and lung cancer were 10.9%,22.4%,24.1%,16.9%,and 12.5%,respectively.The single factor analysis showed that the difference between the age of diagnosis,the level of education,the stage of the disease,the type of hospital diagnosed,and the distance between the place of residence and the hospital diagnosed was statistically significant in terms of the factors that affected the delay in diagnosis of cancer patients(P<0.05).The results of the Binary Logistic Regression model analysis showed that compared to lung cancer patients,the probability of delayed diagnosis of gastric cancer patients(P=0.031,OR = 2.291)and bowel cancer patients(P = 0.018,OR = 2.664)was higher;Compared to patients with high school and above,the probability of delayed diagnosis of patients with education below primary school was higher(P=0.021,OR = 6.056);Compared to confirmed hospitals at the municipal level and above,hospitals at the township level and below had a higher probability of delayed diagnosis(P = 0.031,OR = 5.749).The main reason for delayed diagnosis of cancer patients was misdiagnosis by doctors.The delayed rates of treatment for esophageal cancer,gastric cancer,intestinal cancer,breast cancer and lung cancer were 14.1%,11.2%,13.9%,14.6%,and 11.5%,respectively.The single factor analysis showed that the difference in the number of visits to different hospitals before and after the treatment was statistically significant(P<0.05).The results of Binary Logistic Regression model analysis showed that the probability of delayed treatment in patients in Linqu was higher than that in patients in Rushan(P= 0.019,OR = 2.524);Compared to patients who did not go to multiple hospitals before treatment,patients who went to multiple hospitals were more likely to have delayed treatment(P = 0.001,OR = 7.225).The main reason for the delay in treatment of cancer patients was economic.(5)Cancer patients used simple surgical treatment,surgical + chemotherapy,traditional Chinese medicine treatment,and other treatments accounted for 25.7%,38.3%,10.6%,and 25.4%,respectively.In terms of the choice of treatment methods for cancer patients,the results of single factor analysis show that the differences in regions,tumor types,time between diagnosis and investigation,and disease stages were statistically significant(P<0.05).The results of multivariate analysis showed that family annual income,age of diagnosis,occupation,and type of cancer are the factors that affected the choice of treatment methods for cancer patients.Patients with an annual household income of 20,000 to 50,000 yuan had a higher probability of choosing surgery + chemotherapy;Patients with lung cancer and diagnosed age of 60 or older had a higher probability of choosing traditional Chinese medicine for treatment;Patients who were occupational farmers had a higher probability of choosing simple surgical treatment.In the course of treatment,9.5%of cancer patients had been interrupted.The main reason for the interruption of treatment for cancer patients was that they could not afford high medical expenses.Cancer patients have sought informal treatment methods including partial remedies,secret recipes,superstitions,etc.,accounting for 15%.In terms of the informal treatment of cancer patients,the single factor analysis results showed that the difference in tumor type and disease stage was statistically significant.The results of Binary Logistic Regression model analysis showed that the probability of early cancer patients choosing informal treatment was lower than that of advanced cancer patients(P = 0.001,OR = 0.252);Compared to patients with high school and above,patients with cancer below primary school had a higher probability of choosing informal treatment(P=0.029,OR = 5.665);Compared to cancer patients with a family annual income of more than 50,000 yuan,cancer patients with a family annual income of 5000-20000 yuan were less likely to choose informal treatment(P= 0.043,OR = 0.043).Conclusions and SuggestionsIn rural areas of Shandong province,cancer patients have insufficient knowledge of cancer and symptoms,and there is a general phenomenon of delay in seeking healthcare.The delay of seeking healthcare of cancer patients is divided into the delay of first-visiting hospital,the delay of diagnosis and the delay of treatment,the main delay is the delay of first-visiting hospital.Health education should be actively carried out to raise the level of rural residents ’awareness of cancer,guide rural residents to establish a correct awareness of medical treatment,and ensure timely medical treatment.At the same time,we should continue to carry out screening and early diagnosis and treatment for the main high incidence of cancer,and increase the rate of early diagnosis of cancer patients.The diagnosis and treatment of cancer patients in rural areas of Shandong Province mainly occurred in grassroots medical institutions.The diagnosis level of primary medical institutions in rural areas should be strengthened,timely diagnosis and treatment should be achieved,the prognosis effect of treatment should be enhanced,and the quality of life of patients should be improved. |
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