A comparison of psychosocial care preferences of breast cancer women in Mainland China and Hong Kong

Chinese Cancer Patients' Attitudes Toward Psychotherapy and Their Willingness to Participate in Clinical Trials of Psychotherapy

Introduction

Psychotherapy is considered part of the standard treatment of cancer in Western countries. However, there is no literature on the attitudes of Chinese cancer patients toward psychotherapy.

Methods:

In a multicenter, cross-sectional study in China, a homemade questionnaire was delivered to cancer patients. The targeted population was Chinese hospitalized cancer patients who were informed of their state of illness.

Results

Five hundred and fifty cancer patients received our questionnaire, and 83.3% completed the questionnaire. Among the 458 patients, 43.2% indicated that they had never heard of psychotherapy before the survey. However, after a brief introduction of psychotherapy, most (92.1%) cancer patients indicated that psychotherapy is essential for cancer patients, and over half of patients (57.4%) were willing to take psychotherapy on the advice of the oncologist in charge. Participants aged 45 years or younger, had a family income > 10000 yuan per month, and had an ECOG PS (Eastern Cooperative Oncology Group Performance Status) of 2-4 were more willing to receive psychotherapy. Of all patients, 59.2% and 57.6% were willing to participate in individual and group psychotherapy clinical trials, respectively. Participants who had a bachelor’s degree or higher (odds ratio, OR = 2.09) and were aged 45 years or younger (OR = 1.67) were more willing to participate in individual and group psychotherapy clinical trials, respectively.

Conclusion

The unmet psychological needs of cancer patients in China remain high, and doctors’ advice is likely to positively impact the patients’ acceptance of psychotherapy. Psychological education for Chinese cancer patients should be strengthened. More high-quality clinical trials of psychotherapy should be conducted in China to achieve greater benefits for cancer patients and their families.

Emerging From the "Ku:" Fluctuating in Adjusting With Breast Cancer-A Post-Traumatic Growth Theory Situated Within Chinese Culture

This purpose of the study was to construct a model (theory) to understand Chinese women's adjustment process in living with breast cancer. A constructivist grounded theory method was adopted in this study. A total of 24 women were recruited through purposive and theoretical sampling. Semi-structured, audio-recorded interviews were undertaken in Chinese and transcribed. Initial coding, focused coding, and theoretical coding approaches were used to identify subcategories and categories, and to construct the emergent theory. The basic social process these women used to deal with the breast cancer diagnosis was identified as: Emerging from the 'ku': Fluctuating in adjusting with breast cancer. Four categories were revealed following analysis: confronting challenges, orienting to reality, accommodating the illness, and transforming their lives, which encapsulated the main cognitive and emotional processes in which Chinese women engaged in their adjustment to living with their illness. The core process was influenced by a variety of contextual influences, which were identified as personal factors, social-environmental factors, and some specific cultural factors which emphasized positive changes. Chinese cultural values such as "Wuwei" coping strategies, familial primacy, and Chinese self-disclosure contribute to Chinese women's adjustment processes and post-traumatic growth experiences. Hence, there is a need to consider Chinese cultural features, in designing culturally tailored supportive programs in multi-cultural clinical settings.

Patient-reported outcomes from the distress assessment and response tool program in Chinese cancer inpatients

PURPOSE

Distress screening using measures of patient-reported outcomes (PRO) has been introduced in China and is increasingly recognized as contributing to whole-patient care. We carried out a multi-centered cross-sectional survey of Chinese cancer inpatients to explore the symptom burden, symptom clusters, and risk factors of distress.

METHOD

Patients were recruited from five hospitals in four provinces. The Distress Assessment and Response Tool (DART) was used as the screening tool. Demographic and medical information was collected. Descriptive analysis, the chi-square test, logistics regression analysis, and hierarchical clustering analysis were used.

RESULTS

Totally 1045 valid questionnaires were collected (83.6% validity ratio). Low well-being (39.4%), lack of appetite (35.4%), tiredness (32.9%), pain (21.1%), and anxiety (19.8%) were the top five symptoms. Patients in Ci County had a heavier symptom burden than patients at other sites. Depression, anxiety, nausea, drowsiness, and pain were considered pain-illness symptoms; lack of appetite, low well-being, tiredness, and shortness of breath were considered fatigue-illness symptoms. Social difficulty was a risk factor for all symptoms. A high proportion of suicide ideation (38.8%) and suicide intention (10.5%) was identified among patients with potential depression.

CONCLUSION

The high symptom burden of Chinese cancer inpatients indicates the necessity of distress screening; well-designed screening programs such as the multidimensional DART and its acceptability in China should be further explored. Social difficulty has a universal impact on patients' well-being, and psychosocial care should be integrated into holistic symptoms management.