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Table of Contents   
ORIGINAL ARTICLE  
Year : 2017  |  Volume : 10  |  Issue : 6  |  Page : 1637-1642
Identifying supportive care needs of patients with gastrointestinal cancer treatment in the selected centers of Isfahanin 2016


1 Master of Nursing, Department of Adult Health, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
2 Associate Professor, Cancer Prevention Research Center, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
3 Assistant Professor, Department of Adult Oncology Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
4 Instructor, Department of Biostatistics and Epidemiology, Isfahan University of Medical Sciences, Isfahan, Iran

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Date of Web Publication11-Jan-2018
 

   Abstract 


Background: The concept of supportive care needs includes essential services for people affected by cancer and their caregivers. This concept considers the need of physical, emotional, psychological, social, and informational of patients during the diagnosis, treatment, and survival. However, research studies, in which supportive care needs of patients with gastrointestinal cancers were studied, are very limited in an Iranian context. Therefore, the aim of the study was to identify supportive care needs of patients with gastrointestinal cancer treatment in the selected centers of Isfahan in 2016. Methods: This study was a cross-sectional study which was conducted in Isfahan in 2016. Supportive Care Needs Survey-Long Form 59 questionnaire was completed by 350patients who were undergoing gastrointestinal cancer treatment in the selected centers affiliated to the Isfahan University of Medical Sciences. The patients were selected by convenience sampling. This questionnaire considers supportive care needs of patient across five domains including daily life and physical, psychological, patients care and support, sex, and health system information. Demographic and clinical information of patients was also collected by a form. Results: Findings showed that the frequency of supportive care needs of patients with gastrointestinal cancer was equal to 62.6%. As well as the supportive care needs of patients were in daily life/physical 67.9%, psychological 59.6%, patients care and support 56.7%, sexual 54.7%, and health system information 74.1%. Frequency of health system information and sexual was the highest and lowest, respectively. Conclusion: According to the findings of this study, health system information need was the main supportive care needs of patients with gastrointestinal cancer in Isfahan. Some services that support these needs should be considered. It is suggested to training session for people affected by cancer should be improved.

Keywords: Cancer, nursing, supportive care needs survive

How to cite this article:
Fazeli A, Bahrami M, Mahmoodzadeh M, Hasanzadeh A. Identifying supportive care needs of patients with gastrointestinal cancer treatment in the selected centers of Isfahanin 2016. Ann Trop Med Public Health 2017;10:1637-42

How to cite this URL:
Fazeli A, Bahrami M, Mahmoodzadeh M, Hasanzadeh A. Identifying supportive care needs of patients with gastrointestinal cancer treatment in the selected centers of Isfahanin 2016. Ann Trop Med Public Health [serial online] 2017 [cited 2018 Nov 16];10:1637-42. Available from: http://www.atmph.org/text.asp?2017/10/6/1637/222688



   Introduction Top


Cancer is considered as a major public health problem, and today, it is the second leading cause of death after heart disease. Statistics show that annually about 12.7 million people suffer from this disease and 6.7 million people die due to cancer.[1] The most common cancers in the world are lung, gastric, and breast cancer. In Iran after skin cancer, breast cancer in women, gastric cancer in men, colon, rectum, esophagus, and blood cancers are the most common cancers.[2] In both gender, the most common organ involved in cancer is digestive system with more than 38% of cancer incidence and 10% of deaths caused by all types of cancer.[3] Recent advances in early diagnosis and effective treatment have led to better treatment of cancers and increased patients' lifespans in many cancers including gastrointestinal cancer.[4] However, cancer patients are exposed to a wide range of burden caused by the disease and related treatments such as physical problems, poor quality of life, psychosis, sexuality problems, difficulty in social relations, and financial concerns.[5] Hence, as the number and lifetime of cancer patients are increasing, attention and support of needs such as medical follow-up, long-term effects of treatment, chronic disability and psychosocial problems, and other long-term problems equally increase.[6] One of the concepts presented in relation to the care of patients with cancer is the concept of the need for supportive care that includes essential services(information, psychological, social, spiritual support, rehabilitation, and palliative care) for people suffering from cancer and their caregivers so that they meet their physical, emotional, psychological, social, information, and spiritual needs at the stages of diagnosis, treatment, survival, palliative care, and bereavement. In this definition, supportive care includes five areas: physical, psychological, social, information, and spiritual needs.[7] Several studies in conjunction with supportive care needs of cancer patients have been performed out abroad. For example, Hall et al. conducted a study on 696patients with blood cancer in Australia and reported that 25% of patients had unmet needs. These unmet needs were observed more in physical/daily life and psychological aspects.[8] Furthermore, some studies have been conducted on the patients with gastrointestinal cancer and the results demonstrated unmet needs in physical and psychological aspects.[9],[10] While different results have been presented by other researchers that according to each of them, sexuality,[11] patient care and support,[12] and health system and information aspects [13] must be considered as a priority for care. The tool used in such studies was Supportive Care Needs Survey-Short Form 34 whereas the completed form of the questionnaire as Supportive Care Needs Survey-Long Form 59(SCNS-LF59) is available that more accurately investigates the needs through more items.

No studies have been found on supportive care needs of patients with gastrointestinal cancer in Iran. On the other hand, since the concept of supportive care depends on culture, absence of a study on this field is obvious.[14] Furthermore, since there are many opportunities for nurses to provide care and support needed to improve the experience of cancer, identifying the needs and understanding the importance of these needs by nurses can lead to better provision of supportive care by them. Hence, the present study aimed to determine the supportive care needs in patients with gastrointestinal cancer who were under treatment in the centers selected in Isfahan Town in 2015.


   Methods Top


This study was descriptive-correlational research, in which the supportive care needs of patients with gastrointestinal cancer who were under treatment in all the medical sectors of Al-Zahra, Seyyed Al-Shuhada Hospitals and Al-Zahra and Sheikh Mofid Clinics and affiliated clinics and also, selected doctors' offices in Isfahan Town in 2015 were investigated. In this study, inclusion criteria were older than 18years, the risk of one of esophagus, gastric, colorectal cancers, being hospitalized for the treatment, diagnosis of cancer confirmed by specialists, the ability to communicate, and physical and mental ability to complete the questionnaire. People who were not interested in participating in the present study and/or had another disease including other types of cancer were excluded from the study. Sample size was estimated using the following equation where z is confidence coefficient and considered 95%, s is standard deviation of patients' supportive care needs score(1.08), and d is accuracy and considered 0.11. According to the following equation and taking into account 10% dropout, sample size was estimated 350.



After project approval at Isfahan University of Medical Sciences, getting the license, and referring to selected hospitals, the patients were selected from related wards according to inclusion criteria by simple sampling method. Informed consent was gotten from all the patients and they were assured that all their information was coded and would be remained confidential. Two questionnaires were used to collect the data. First questionnaire was related to demographic characteristics of the participants and included the questions on age, gender, job, income, the number of children, type of cancer, type of treatment, disease duration, education level, marital status, place of residence, and lifestyle, and the researcher filled out the questionnaire by asking the patients and using the information contained in their records. Second questionnaire was SCNS-LF59 and the participants filled out it in 10–15min by self-report method. The permission to use this questionnaire was given from the Centre for Health Research and Psycho-oncology in Australia.

This questionnaire was designed in 2000 by Bonevski. It has 59 items including five dimensions of physical and daily living(eight questions about how the patient copes with physical symptoms, side effects of treatment, and daily activity and performance), psychological needs(24 questions about the patient's feelings and how he/she copes with the disease), the need for patient care and support(eight questions about health-care providers, physical and emotional needs, choice, and patient's privacy), sexuality needs(three questions about patient's sexual relations), and the need for health system and information(16 questions about medical center, and patient's awareness of the disease, methods of diagnosis, and treatment). Any item is answered based on 5-option Likert scale including “no need-no use,” “met need,” “low need,” “medium need,” and “high need” which were scored from 1 to 5, respectively. Ahigher score indicates further needs(Score 1: no need/no use, this item has no use for the patient, it means that this item did not occur after disease incidence or it did not cause a problem for the patient; Score 2: met need, the patient was satisfied, his/her need was met or he/she did not need it; Score 3: low need, the patients had low need in this item-Score 4: medium need, in this item, the patient had a little more need and it concerns him/her; Score 5: high need, the patient has a lot of anxiety and concern about this need). The patient's score was measured in total as well as in terms of each dimension. Validity and reliability of the questionnaire on patients with the colon, rectum, lung, prostate, breast, and skin cancers have been investigated and evaluated in terms of these five dimensions. The internal consistency(Cronbach's alpha) for mentioned dimensions was found to be 0.90, 0.97, 0.87, 0.87, and 0.96, respectively, and its validity has been evaluated by comparing the scores in different populations.[15] To be more precise, to measure its validity in the present study, face and content validity were used with open translation method. To measure the reliability, internal consistency(Cronbach's alpha) was measured and Cronbach's alpha coefficient was calculated as 0.73.

All the data were analyzed usingSPSS18 software (SPSS Inc., Chicago, IL, USA). Statistical methods used in this study were descriptive statistics including frequency distribution, mean, and standard deviation. To examine the relationship between total score and the scores of different supportive care needs dimensions and other characteristics of participants, Pearson's correlation coefficient, t-test, and one-way analysis of variance were used. Significance level was considered<0.05(P<0.05).


   Results Top


Mean age of patients was 52.8years with standard deviation of 9.8years, their mean disease duration was 12.9months with standard deviation of 5.7months, and their mean number of children was 2.4 with standard deviation of 1.2 children[Table1].
Table 1: The patients' mean age, disease duration, and number of children

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Nearly 50.3% of studied population suffered from colorectal cancer, 34.1% suffered from gastric cancer, and 15.6% of them suffered from esophageal cancer. Nearly 70% of them lived in town and 30% of them lived in villages and the majority of them(66.4%) spent more than their incomes[Table2].
Table 2: Frequency distribution of income, place of residence, lifestyle, and type of cancer

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Furthermore, the mean score of supportive care needs of patients was 62.6 of 100. The highest mean was related to information and health system(74.14±8.6) and the lowest mean was related to sexuality(54.7±10.3). Pearson's correlation coefficient showed that there were significant and direct relationships between age and total score of supportive care needs and the scores of dimensions of physical/daily living, patient care and support, and information and health system and there were significant and inverse relationships between it and the scores of psychological dimension and sexuality. Furthermore, there were significant and direct relationships between disease duration and total score of supportive care needs and the scores of dimensions of physical/daily living, patient care and support, and information and health system and there were no significant relationships between it and the scores of psychological dimension and sexuality. Significant and direct relationship was observed between the number of children and the dimensions of physical/daily living but no significant relationship was observed between it and total score of supportive care needs and its other dimensions[Table3].
Table 3: Pearson's correlation coefficients between age, disease duration and the number of children, and the scores of supportive care needs and its dimensions

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The results of t-test showed that the mean scores of supportive care needs and the dimensions of physical/daily living, patient care and support, and information and health system in female patients were higher compared to male patients, but the score of sexuality dimension in male patients was higher compared to female patients and in terms of psychological dimension, no significant difference was observed between them[Table4].
Table 4: Mean scores of supportive care needs and its dimensions in gender

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   Discussion Top


Our study aimed to determine the supportive care needs in patients with gastrointestinal cancer. The results showed significant frequencies of supportive care needs in these patients in physical and daily living, psychological, patient care and support, sexuality, and health system and information dimensions, of which the health system and information had the highest frequency. However, the total score of aspects was important and significant that expressed the high need in all mentioned dimensions in patients with gastrointestinal cancer in Isfahan Town.

As previously mentioned, no study has investigated the dimensions of supportive care needs of patients with gastrointestinal cancer in Iran. However, since the importance of these dimension is closely related to the quality of life of patients with gastrointestinal cancer [5],[16] and lack of attention to them imposes secondary health-care costs to the health system,[17],[18] it has been the focus of attention in many research studies. Blaney et al. in a study on patients with gastric cancer reported that 73% of them knew fatigue as their main problem and also experienced emotional, cognitive, and social performance problems.[9] Ernstmann et al. in their study on cancer patients in Germany concluded that about one-third of patients had unmet needs in connection with psychological support or using psychosocial services.[10] However, different results have been suggested by other researchers with most declaring sexuality,[11] patient care and support,[12] health system and information aspects [13] as a priority for care.

Furthermore, in this study, although different dimensions show significant frequencies in unmet needs, health system and information, and physical and daily living dimensions showed the highest frequencies, and sexuality dimension showed the lowest frequency. Health system and information include the questions in relation with the need to get explanations about test results, the need to get information about different aspects of disease management and its side effects, the need to know about what the patient can do to help themselves to be better, the need to get enough information about the pros and cons of treatment before the patient decides to select it, and the need to be informed about how far the disease is under control and steadily improving. Furthermore, in physical and daily living dimension, physical symptoms of illness and the need to help in doing things were discussed.

In justifying the priority of needs in the dimension of health system and information in Iran, studies indicated that, most patients tended to get information, especially about side effects of treatment and prognosis but most of them were unaware of their status, did not get enough information from their doctors, thereby sought for information from other sources.[19],[20] Moreover, educating cancer patients is poor in Iran and patients have more needs to get information about treatment, general information about cancer, and risk and prevention factors.[21] Furthermore, since care team, including doctors or nurses are very busy, patients are not educated completely and timely. Hence, patients are encountered with many uncertainties and questions about the disease and treatment. Furthermore, fewer unmet needs in sexuality dimension do not mean that cancer patients in Iran have no needs as it can be related to Asian culture, especially Iran's culture, in which talking about sexuality issues is associated with many restrictions. One of the reasons for the differences between the priorities of needs in different dimensions in various studies is the differences between the levels of services and the economy of various countries. Since supportive care needs depend on the culture, the results of this study are inconsistent with the results of other studies.[14] According to different reports, the priorities of patients' needs in European countries were in psychological dimension,[22],[23] whereas in eastern communities, majority of needs are in health system and information.[23],[24] On the other hand, since cancer patients have different conditions at every stage of disease and treatment in terms of physical, mental, acceptance and belief of patients, information, and even family and social support aspects, they may have different needs at every stage.

The results of investigation of relationships between the dimensions of supportive care needs with other variables showed that with aging, sexuality, and psychological needs reduce but the needs in physical and daily living, support, and health system and information dimensions increase. Hence, patient's age can be used as a factor in determining the priority of patients' needs, and with this knowledge, medical staff and patient can interact better with each other to meet these patients' essential needs. Furthermore, there is a significant and direct relationship between disease duration and physical and daily living, support, and health system and information dimensions. This shows that these patients have some needs in long-term period that should not be neglected. It is essential that the needs of cancer survivors are examined in longer periods(for example, after 3 or 5years). The results of investigation of relationships between age and supportive care needs showed that female patients significantly had more general supportive care needs and the needs in daily life/physical, support, and health system and information areas than male but male patients significantly had more sexuality needs compared to female patients. Therefore, it is necessary that medical team and supportive institutions prioritize the patients' needs according to their gender then take necessary measures to meet them.

In this study, there were some limitations that can be considered in interpreting the results of this study. For example, simple sampling method and difficulty in filling in the questionnaires according to the specific conditions of cancer patients may have overshadowed the responses. It is suggested to perform such a study with larger sample size and in other groups of cancer patients to provide better evidence to take care of them.


   Conclusion Top


The results showed the supportive care needs of patients with gastrointestinal cancer; then, the dimension of health system and information was identified as their main need. Due to the importance of the need to improve the quality of life of patients, it is necessary that health care centers develop some strategies to improve it. Increased interaction between nurses and patients with information support approach can play a significant role in reducing the supportive care needs and improving patients' quality of life.

Acknowledgment

The present study was the result of master's thesis (code: 394900) defended at Isfahan University of Medical Sciences. Ihereby thank the authorities of Isfahan University of Medical Sciences, management and staff of Al-Zahra, Seyyed Al-Shuhada hospitals and Al-Zahra and Sheikh Mofid Clinics and especially patients for their cooperation in the fulfillment of this plan.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Correspondence Address:
Alireza Fazeli
Kharrazi Dormitory, Hezar Jarib Street, Isfahan
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ATMPH.ATMPH_569_17

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