晚期肿瘤患者化疗期间对社区卫生服务需求的调查及影响因素研究

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 datathe 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. Thereforethis 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 Shanghaiand 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 HospitalWusong 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 questionnairesgovernment specifications and interview resultsthe final version of the demand for community health services of partial patients with advanced cancer during chemotherapy in Shanghai was formedwith a total of 3 demand dimensions psychologicalmedical caresocial supportand 38 demand items. The contents include patients' general informationdemographic and sociological informationgenderagereligious beliefseducation levelmarital statussource of medical expenses disposable monthly household incomewhether to participate in a patient grouptumor diagnosistype and time of diagnosispain scorecombining with other diseases6 items of psychological and psychological demand24 items of medical care demandand 8 items of social support demand. A 3-point scale was adopted1 was unnecessary2 was necessaryand 3 was very necessary. The higher the scorethe higher the degree of patients' demandwhich 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 demand2.31 pointsmedical care demand2.27 pointsand social support demand2.18 points. The top five average scores of all demand items were“preparation of biochemical tests such as routine bloodliver 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 treatmentexamination and rehabilitation”2.42 pointsmainly 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<0.05age and medical expenses were influencing factors of medical care of patients with advanced cancer during chemotherapy P<0.05age and whether to join a patient group were influencing factors of social support of patients with advanced cancer during chemotherapy P<0.05. ConclusionPatients with advanced cancer during chemotherapy have specific demand for community health serviceswith different levels of demand in psychologicalmedical care and social support dimensionswhich are influenced by various factors such as ageeducation leveland household income. This study provides references for community health service centers to carry out relevant medical services. In the futurenew service itemswith high level of demand can be pilotedcommunity interventions such as psychological and medical care for patients with advanced cancer during chemotherapyand their quality of survival should be followed up.