| Objective: To test the reliability and validity of the traditional Chinese version of SCNS-P&C with the samples in Chinese mainland, form a tools that can assess the caregivers' needs of Chinese cancer patients, use the scales to understand the status and factors of supportive needs of caregivers in hospitals in Xi'an. Discuss on the relationship and factors between supportive needs, service provision and utilization, provide theoretical guidance for expanding services and methods of hospital, formulating relevant policies of government departments.Methods: 1 Indigenous research of supportive care needs scale of caregivers of cancer patient The amendment of traditional Chinese version of SCNS-P&C was following the steps of culture adjustment(Expert advice,pretest) and scale project analysis. Use the revised scale to investigate the reliability and validity of the scale. 2 Investigate the needs of the main caregivers of cancer patients in hospital in Xi'anThis phase used the revised SCNS-P&C scale, hospital anxiety and depression scale,social support ratings scale, the general information questionnaire of patients and caregivers, to investigate cancer patients and caregivers in 15 tumor-related departments in 5 hospitals in Xi'an. Analysised the status and related factors of supportive needs of caregivers of cancer patients in Xi'an base on the measured data. 3 Research the status of service of caregivers in some hospitals in Xi'an Use the self-designed questionnaire, to investigate cancer patients' caregivers and health care workers in 15 tumor-related departments in 5 hospitals in Xi'an. Base on the measured data to analysis the condition of medical service provided by health care workers, the status of service utilization, and the impact of both factors. Combined with the status of supportive need, to analysis the differences between supportive needs and service, to discuss the reasons and give adviceResults: 1 Indigenous research of supportive care needs scale of caregivers of cancer patient 1.1 Amend the scale of supportive care needs scale of caregivers 1.1.1 Cultural adaptation: Through the experts consulting and pre-survey 30 caregivers and 5 medical personnel to test the SCNS-P&C, final deleted item 12(case manager), the scale revised to 44 entries.Clearly defined the noun which difficult to understand in item 1,3,4, Setting of modification,modify the problem in accordance with the scale in English. 1.1.2 Scale project analysis: By testing the 363 cancer caregivers, analysised the scale discrimination, item and total scale correlation analysis,reliability test(universalism and load factors),exploratory factor analysis.After deleting 6 items,the scale from 44 items,7 dimensions to 38 items, 6 dimensions. 1.2 Detect the reliability and validity of SCNS-P&C 1.2.1 Validity Detection: Statistical analysis showed that the correlations of the scores between each item and the total scale were ranged from 0.497–0.728, which was a positive correlation and correlation were significant(P <0.01). Construct validity by factor analysis and correlation analysis test, finally six factors were extracted by exploratory factor analysis, which contributed 62.05% of the total variance.The confirmatory factor analysisresults of all model fit index values were within an acceptable range. Correlation analysis showed that the correlation coefficient between the total score and each dimension were ranged from 0.502- 0.899(P <0.01). 1.2.2 Reliability detection: The scale of the internal consistency coefficient was 0.961, and 0.690- 0.900 for the 6 subscales.The split-half reliability coefficient was 0.865 for the total score and 0.691-0.870 for the 6 subscales.The test-retest reliability coefficient was 0.875. 2 Investigate the needs of the main caregivers of cancer patients in hospital in Xi'an 2.1 The situation of caregivers need:The results showed that 71.8% caregivers reported at least 5 moderate or high needs, and 52.5% reported at least 10 moderate or high needs. The unmet need rate of economic needs and information needs was 76.3% and 68.5%, which was among the highest unmet need. The item which unmet need rate living in the top three were “finding out about financial support and government benefits for you and/or the person with cancer”, “reducing stress in the person with cancer's life”, “managing concerns about the cancer coming back”. 2.2 The factors of unmet need:Multivariate stepwise regression analysis showed that There were 11 factors that effected caregivers unmet need,anxiety score and taking care of other people were common factors. KPS scores of patient influenced information, emotional and psychological needs and the total of needs. Education of caregiver influenced information, health care service needs and the total of needs. Subjective support influenced health care service, social and economic needs. Work status influenced daily needs and the total of needs. Gender of caregiver influenced health care service needs. Burden of medical expenses and depression scores influenced economic needs. Care experience influenced information needs. 3 Research the status of service of caregivers in some hospitals in Xi'an 3.1 The situation of support services: By analyzing the data of 136 medical staffs and caregivers. The results showed that, there were no significant difference between demand rate, supply rate, and utilization of the service content of disease information, care knowledge, health care service. The demand rate of remaining service was 72.8%-94.9%, the supply rate was 44.9%-89.7%, and the utilization was 16.2%-68.4%.The demand rate,supply rate, and utilization of internet transmission service mode were 24.3%,12.5%,3.7%, rent bed services were 46.0%,33.6%,30.9%, special diseases fund were 77.1%,62.3%, 54.5%, reduced health care costs were 11.9%,6.6%,4.5%, pressure release training were 35.7%,18.3%,18.2%,face to face counseling,care workers and symptomatic medication were supply rate> utilization > demand rate, and the rest service mode were supply rate> demand rate > utilization. 3.2 The factors of the supply and supply of supportive services:Medical staff services supplied: The medical staffs who were younger than 30 years old provided more financial services than other age groups. Doctors and the medical staffs who were junior titles provided more communication services. Nurses provided more daily service than doctors. Caregiver services utilization: Caregivers who were female, age ?50 and almost no economic burden used more daily life services. Caregivers who had heavy burden of medical costs, expenditure over income used more mental emotion service.Conclusion: 1 The revised SCNS-P & C scale had good reliability and validity, suitable for evaluation the supportive need of primary caregivers of cancer patients in China. 2 Supportive need of caregivers of hospitalized patients with cancer in Xi'an had poor condition. The degree of unmet needs of economic needs and information needs was highest. Unmet needs were affected by many factors. 3 Besides disease information, care knowledge and health care service, other services existed demand rate>supply rate>utilization.The demand rate, supply rate and utilization of service mode were unbalanced, Most services exist high supply rate, but the applicability is not good, lead to the low utilization. |
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