Analysis On Healthcare Seeking Behaviors Of Childhood Cancer Patients And Related Influencing Factors

BackgroundChildhood cancer poses a serious threat to the lives and health of children and teenagers which is one of the main causes of death for children aged 0-14 ranking second right after the causes of accidents.At present the survival rate of childhood cancer in China is slightly lower than that of developed countries like Europe and America while the growth rate is significantly higher.An important reason for this phenomenon is that most of the patients are already in the middle and late stages of the disease when they are diagnosed.Therefore,it is of great significance to analyze the characteristics of healthcare seeking behavior of childhood cancer patients and to clarify the factors influencing healthcare seeking behavior in order to timely and effectively promote health services utilization,increase survival rate and improve the quality of life with childhood cancer patients.ObjectiveThis study through analysis the influencing factors of the choice of first-visiting hospitals for childhood cancer patients,as well as the influencing factors of delay in seeking medical treatment,to understand the healthcare seeking behavior of childhood cancer patients,find out the key factors influencing the healthcare seeking behavior,put forward suggestions to promote early diagnosis and early treatment of childhood cancer patients,so as to better meet the medical needs of childhood cancer patients.MethodsThis study were selected three tertiary hospitals providing pediatric tumor treatment services in Jinan as the survey locations for the questionnaire survey and finally 303 childhood cancer patients meeting the inclusion criteria were included.The survey mainly included the basic characteristics of patients and caregivers the characteristics of patients’ diseases and the process of patients’ medical treatment.Meanwhile as a supplement to the quantitative data,this study conducted supply-side interviews with 6 informants including administrators and pediatricians from 3 medical institutions and demand-side interviews with 29 representative and willing caregivers of childhood cancer identified during the quantitative survey.The Binary Logistic Regression model and Multiple Logistic Regression model were used in this study.ResultsThe first-visiting hospital for childhood cancer patients was mainly concentrated at the prefecture level and below(73.93%);The diagnosisd hospital were at the provincial level and above(78.22%);The first treatment(86.14%),second treatment(94.30%)were mainly concentrated at provincial-level and above hospitals.Regarding the factors influencing the choice of first-visiting hospitals for childhood cancer patients,the differences were statistically significant in five aspects:per capita annual household income,the distance of residence from the first-visiting hospital,patient origin,long-term residence and patient cancer type.The delay in healthcare seeking of childhood cancer patients was divided into the delay in first-visiting hospital,delay in diagnosis and delay in treatment.The delay rates were 16.50%37.29%and 7.92%respectively.Using binary logistic regression after controlling for the effects of other variables patients who took the initiative to go to the hospital for consultation and consultation were less likely to delay going to the hospital than those who "did nothing and waited to see if it became serious before making a decision" after the first onset of symptoms(P<0.001,OR=0.153).Patients with an annual per capita household income of RMB 10000 or less had a lower rate of delayed visits than those with an annual per capita household income of RMB 10000 or less(P=0.045,OR=0.403).Regarding the factors influencing delay in diagnosis in children with malignant tumors the difference arising from whether or not to visit multiple providers before diagnosis was statistically significant;after controlling for the effects of other variables patients who visited multiple providers before diagnosis had a higher rate of delay in diagnosis than those who did not visit multiple providers(P<0.001,OR = 3.365).Concerning factors influencing treatment delay in pediatric oncology patients differences in patient cancer type were statistically significant;after controlling for the effects of other variables treatment delay rates were higher for solid tumors compared to hematologic tumors(P=0.004 OR=10.681).Conclusions and SuggestionsIn this study childhood cancer patients from three representative medical institutions providing pediatric tumor treatment services in Jinan were used as the study subjects and a mixstudy method was used to analyze the healthcare seeking behavior of childhood cancer patients and their main influencing factors.Based on these analyses the following conclusions were drawn from this study.(1)With the development of the disease the proportion of childhood cancer patients going to higher-level hospitals from the first-visiting hospital to the treatment stage has been increasing.Proximity to home is the most important reason for childhood cancer patients to choose the first-visiting hospital while the quality of care is the main reason for patients to choose the diagnosing and treating medical institutions.(2)There are delays in first-visiting hospital diagnosis and treatment during the whole process of patients’ medical treatment among which the main delay occurs at the stage of diagnosis delay.The main influencing factors on the delay of the first-visiting hospital for childhood cancer patients were the measures taken when symptoms first appeared and the annual per capita household income;the main influencing factor on the delay of diagnosis for childhood cancer patients was the number of visits before diagnosis;the main influencing factor on the delay of treatment for childhood cancer patients was the type of cancer.In summary the following recommendations are made in response to the study results:(1)Improve the comprehensive diagnostic ability and technical level of childhood cancer patients in grassroots areas.(2)Strengthen the popularization of childhood cancer symptoms and knowledge,and improve the ability of guardians to recognize symptoms,improve the delay in healthcare seeking.(3)Improve the treatment effect of childhood cancer patients and improve the prognosis and survival of patients.