Lincoln International Institute for Rural Health (LIIRH), University of Lincoln, Lincoln, UK.
Macmillan Cancer Support, London, UK.
Psychooncology. 2022 Oct;31(10):1660-1670. doi: 10.1002/pon.6011. Epub 2022 Aug 19.
To investigate and compare self-management in people living with cancer following treatment, from rural and urban areas in the United Kingdom where there is a significant evidence gap.
A cross-sectional explanatory sequential mixed methods design. This involved a self-completion questionnaire that collected data on demographics, self-management using the PAM-13 and rural-urban residence and 34 in-depth interviews that aimed to explore and compare the barriers and facilitators to self-management in rural and urban settings.
227 participants completed the questionnaire: mean age 66.86 (±11.22). Fifty-two percent (n = 119) were female and 48% (n = 108) were male. Fifty-three percent (n = 120) resided in urban areas and 45 % (n = 103) in rural areas. Participants had a range of different types of cancer but the three most common were breast (n = 73), urological (n = 53), upper and lower gastrointestinal (n = 41). Rural respondents (63.31 ± 13.66) were significantly (p < 0.05) more activated than those in urban areas (59.59 ± 12.75). The barriers and facilitators to self-management identified in the interviews were prevalent in both rural and urban settings but some barriers were more explicit in rural settings. For example, there was a lack of bespoke support in rural areas and participants acknowledged how travelling long distances to urban centres for support groups was problematic. Equally, there were barriers and facilitators that were not necessarily unique to either geographic setting.
Whilst the active treatment phase can present considerable challenges for people living with cancer in rural areas the findings suggest that the rural environment has the potential to increase engagement with self-management in the transition to survivorship. The rigorous mixed methods design has led to different and complementary conclusions that would not have been possible had either quantitative or qualitative methods been used in isolation.
在英国农村和城市地区，针对癌症治疗后的患者自我管理情况进行调查和比较，因为在这两个地区存在显著的证据缺口。
采用横截面解释性顺序混合方法设计。这包括一份自我完成的问卷，收集人口统计学数据、使用 PAM-13 进行自我管理以及农村-城市居住情况的数据，以及 34 次深入访谈，旨在探索和比较农村和城市环境中自我管理的障碍和促进因素。
227 名参与者完成了问卷：平均年龄为 66.86（±11.22）。52%（n=119）为女性，48%（n=108）为男性。53%（n=120）居住在城市地区，45%（n=103）居住在农村地区。参与者患有多种不同类型的癌症，但最常见的三种是乳腺癌（n=73）、泌尿系统癌（n=53）、上消化道和下消化道癌（n=41）。农村受访者（63.31±13.66）的自我管理积极性明显（p<0.05）高于城市受访者（59.59±12.75）。访谈中确定的自我管理障碍和促进因素在农村和城市地区都很普遍，但有些障碍在农村地区更为明显。例如，农村地区缺乏定制化的支持，参与者认识到长途跋涉到城市中心参加支持小组存在问题。同样，也有一些障碍和促进因素不一定只存在于特定的地理环境中。
虽然农村地区的癌症患者在积极治疗阶段可能面临相当大的挑战，但研究结果表明，农村环境有可能在向生存者过渡期间增加对自我管理的参与度。严格的混合方法设计得出了不同且互补的结论，如果仅使用定量或定性方法，这些结论是不可能得出的。
