Harvard Medical School, Boston, MA, USA.
Ministry of Health, Gaza, Palestine.
BMC Health Serv Res. 2021 Jan 6;21(1):28. doi: 10.1186/s12913-020-06044-1.
Several factors might contribute to the delay to get cancer care including poor cancer awareness and having barriers to seeking help. This study described these barriers in Gaza and their association with recalling and recognizing cancer symptoms and risk factors.
A cross-sectional study was conducted in Gaza. Adult visitors (≥18 years) to the largest three governmental hospitals and adolescent students (15-17 years) from ten high schools were recruited. A translated-into-Arabic version of the validated Cancer Awareness Measure (CAM) was used to collect data in face-to-face interviews. It described demographic data, barriers to seek cancer care as well as recall and recognition of cancer symptoms and risk factors. Responses were compared between adults and adolescents as well as males and females.
Of 3033 participants approached, 2886 completed the CAM (response rate= 95.2%). Among them, 1429 (49.5%) were adult (702 females; 49.1%) and 1457 (50.5%) were adolescent (781 females; 53.6%). The mean age± standard deviation (SD) of adult and adolescent participants was 33.7±11.7 years and 16.3±0.8 years, respectively. Emotional barriers were the most common barriers with 'feeling scared' as the most reported barrier (n=1512, 52.4%). Females and adolescents were more likely to report 'feeling scared' as a barrier than males and adults, respectively. Higher recall scores for cancer symptoms were associated with lower likelihood to report 'embarrassment', 'worry about wasting doctor's time' and 'difficulty arranging transport'. This was also seen for recalling risk factors, where 'embarrassment' and all practical barriers showed significant inverse associations with higher scores. In addition, greater recognition scores of cancer risk factors were inversely associated with reporting 'embarrassment' and 'feeling scared'.
The most commonly perceived barriers to seeking cancer care were 'feeling scared' and 'feeling worried about what the doctor might find', followed by practical and service barriers. Females and adolescents were more likely to report 'fear' as a barrier to seek medical advice. Having a higher recall of cancer symptoms and risk factors was inversely associated with reporting most barriers. To improve patient outcome, early presentation can be facilitated by targeting barriers specific to population groups.
导致癌症患者延迟就医的因素有很多，包括癌症意识差以及寻求帮助存在障碍。本研究描述了加沙地区的这些障碍，以及它们与回忆和识别癌症症状和危险因素的关联。
本研究是一项在加沙进行的横断面研究。在最大的三家政府医院招募成年就诊者（≥18 岁）和来自十所高中的青少年学生（15-17 岁）。使用经过验证的癌症意识量表（CAM）的阿拉伯语翻译版收集面对面访谈中的数据。它描述了人口统计学数据、寻求癌症治疗的障碍以及回忆和识别癌症症状和危险因素。将成年人和青少年以及男性和女性的结果进行了比较。
在 3033 名受访者中，2886 人完成了 CAM（应答率=95.2%）。其中，1429 人（49.5%）为成年人（702 名女性；49.1%），1457 人（50.5%）为青少年（781 名女性；53.6%）。成年和青少年参与者的平均年龄±标准差（SD）分别为 33.7±11.7 岁和 16.3±0.8 岁。情绪障碍是最常见的障碍，“感到害怕”是报告最多的障碍（n=1512，52.4%）。女性和青少年比男性和成年人更有可能报告“感到害怕”是一个障碍。癌症症状的回忆得分越高，报告“尴尬”、“担心浪费医生的时间”和“难以安排交通”的可能性越低。这也适用于回忆危险因素，其中“尴尬”和所有实际障碍与较高的分数呈显著负相关。此外，对癌症危险因素的识别得分越高，与报告“尴尬”和“感到害怕”呈负相关。
寻求癌症治疗最常见的障碍是“感到害怕”和“担心医生可能发现什么”，其次是实际和服务障碍。女性和青少年更有可能报告“恐惧”是寻求医疗建议的障碍。回忆癌症症状和危险因素的能力越高，与报告大多数障碍的可能性越低。为了改善患者的预后，可以通过针对特定人群的障碍来促进早期就诊。
