Patient resource to improve the effectiveness of oncological care for the population

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The improvement of oncological care to the population has been identified as one of the main priorities for the development of domestic healthcare. An important role in solving the problems of improving medical care, including oncological care, is assigned to patients as full-fledged participants [1, 2]. At the same time, the patient and his characteristics are proposed to be considered as a resource for improving care. The patient resource of oncological care is understood as the completeness of the implementation of the qualitative characteristics of the patient that are significant for achieving a positive result of the help [3]. There are works in which a number of problems are noted in the implementation of the patient resource of medical care, including psychological [4-6], medical and social [7-9]. Taking into account the qualitative characteristics of patients is extremely important for solving the tasks of planning medical care, including its resource provision, determining the most vulnerable contingent from the standpoint of dissatisfaction with the services provided [10-12]. This information can serve as a basis for the formation of a competent policy of medical organizations and the search for ways to improve the quality of medical services to the insured in the conditions of compulsory medical insurance. However, there are not enough scientific papers considering the patient resource as a factor in achieving a high level of effectiveness of oncological care.

The purpose of the study. To assess the state and possibilities of improving the patient resource of oncological care.

Materials and methods. The research base is the Ivanovo Regional Oncological Dispensary of the Department of Health of the Ivanovo Region. The time of the study: 2022. Methods: sociological, expert assessment, analytical, documentary. The assessment of the patient resource of oncological care was carried out according to the original methodology, including 10 parameters (Table 1).

Table 1 - Methodology for quantifying the resource potential of an oncological patient

 

Components	Criteria	Source of information
Informational  (I)	Patient's medical awareness (0-1 points – minimal; 2-3 points – low level of awareness; 4-5 points – optimal	Patient questionnaire survey
Adherence (P)	Medical activity reflecting adherence to treatment (0-1 points – minimal; 2-3 points – insufficient; 4-5 points – optimal)	Assessment by the attending physician
Health saving (Z)	Lifestyle contributing to the preservation of health (0-1 points – low level; 2-3 points – not sufficient; 4-5 points – optimal)	Patient questionnaire survey
Motivational-value (M)	Priority of health preservation, focus on achieving results in treatment (0-1 points – low level; 2-3 points – not sufficient; 4-5 points – optimal)	Patient questionnaire survey
Communicative (K)	Implementation of communication skills with medical professionals in full–time and remote format (0-1 points – low level; 2-3 points – not sufficient; 4-5 points - optimal)	Patient questionnaire survey
Quality of life (Kv)	Implementation of vital functions and the absence of restrictions (0-1 points – low level; 2-3 points – not sufficient; 4-5 points – optimal)	Patient questionnaire survey
Family adaptation (SEa)	Implementation of family functions and family support (0-1 points – low level; 2-3 points – insufficient; 4-5 points – optimal)	Patient questionnaire survey
The quantitative assessment provided for the calculation of the patient resource index according to the formula: RP = (I+ P + Z + M + K+ Kv+ SEa)/ 21*100%, where I is the score of the information component, P is commitment; Z is the health of the K Kv Sea; 21 is the maximum score in points. Interpretation of the assessment: less than 75% - low; 76-99% - insufficient; 100% - optimal level.

 

A survey of 1000 oncological patients at different stages of diagnosis and treatment of malignant neoplasms was conducted and an analysis of its results was carried out taking into account the factors of the stage of the oncological process, the medical and demographic characteristics of patients. The questionnaire included 15 closed-type questions divided into 3 blocks: medical and demographic characteristics of patients (5 questions), assessment of the patient's resource potential, satisfaction with care. A feature of the study was a prospective assessment of the resource of patients at different stages of care: initial (diagnosis of malignant neoplasm), intermediate (follow-up and initiation of treatment), final (completion of the first stage of treatment). The evaluation of the effectiveness of 1000 cases of provision of oncological medical services was carried out. The criteria for evaluating the effectiveness of care were: patient satisfaction with the help (satisfied, not satisfied) according to the survey, the degree of achievement of the planned clinical result of care (achieved, not achieved) according to expert assessment, the degree of deviation of actual costs from the normative planned (correspond, there is an excess of costs) according to the medical and economic examination of cases by experts of insurance companies. Information about the results of care was copied from the primary accounting documentation, and patient survey data was also used. 2 comparison groups were formed: with a high and low level of aid effectiveness. Statistical data analysis was carried out using SPSS-version 20 software. The normal distribution of all the studied parameters was verified using the Kolmogorov-Smirnov test. The student's coefficient t and the paired coefficient t were used for variables that were distributed normally, for variables that do not have a normal distribution, the Mann-Whitney and Wilconson method was used. In addition, Spearman correlation was used to analyze the data. The limit values corresponded to the values of p<0.05.

Research results.

The majority of participants in this study were women - 543 respondents (86.5%), age range from 18 to 75 years. The general demographic characteristics of cancer patients are presented in table 2.

Table 2. Demographic characteristics of cancer patients (n=1000) Table 2. Demographic characteristics of cancer patients (n=1000)

Table 2. Demographic characteristics of cancer patients (n=1000)

Indicators		Quantity	Percentage
Gender	Female	543	86,5
	Male	467	13,5
Age	18-29 years old	3	16
	30-45 years	120	56
	46-60 years	253	26,5
	Over 60 years old	627	1,5
Marital status	Single	180	40
	Married (married)	705	57,5
	Divorced	95	2,5
Educational level	Secondary, specialized secondary	161	80,5
	Higher	37	18,5
	Academic degree	2	1
Place of residence	City	137	68,5
	Village	59	29,5
Employment status	Not working (unemployed, retired)	49	24,5
	Employed	68	34
	Businessman	83	41,5
Stages of the malignant process	Stage 1 (T1N0M0)	26	13
	Stage 2 (T1N0M0)	17	8,5
	Stage 3 (T1N0M0)	63	31,5
	Stage 4 (T1N0M0)	94	47

 

Analysis of the survey data showed that only 68.5% of patients follow a certain daily routine and allocate enough time for proper rest. The majority of patients do not follow the principles of rational nutrition (65.5%). It was found that 84.5% of patients living in the city and 83.7% of rural residents regularly carry out personal hygiene procedures. Regular self-examination of their body (skin, mammary glands, genitals, lymph nodes) for the presence of pathological changes is carried out by 18.5% of urban residents and 12.5% of rural residents, while 71.5% and 87.5%, respectively, do not own these methods. Analysis of data on the level of household culture showed that 50.2% of patients living in urban conditions and 30.5% of rural patients maintain a favorable microclimate in their homes (humidity, light, ventilation, temperature, regular wet cleaning and ventilation are carried out, plumbing facilities are in good condition), while 49.8% and 69.5%, respectively% of patients indicated that they do not care about it. 15.8% of urban patients and 10.5% of rural residents have everything they need to maintain their health, 74.2% and 89.5%, respectively, indicated the lack of necessary funds and conditions. There is a home first aid kit at home, selected according to the recommendations of the attending physician in 57.5% of patients-citizens and 34.5% of villagers, however, respectively 42.5% and 65.5% of patients noted its absence or arbitrary formation. 35% of urban patients and 29.8% of rural residents have everything they need to provide first aid at home, while 65% and 70.2%, respectively, are not provided with these funds in full.

The effectiveness of the patient's interpersonal interaction with the subjects of the social environment (doctor, nursing staff, patients undergoing treatment together in the ward) assumes that he has a certain level of culture of behavior. In this regard, the analysis of the state of the parameter "culture of behavior" in patients was carried out. It was found that 59% of urban patients and 39.8% of rural residents are familiar with the rules of behavior in the hospital, while 30.1% and 40.5% of patients, respectively, know about them in general, and 9.9% and 19.7% are not informed about them at all. 38.5% of urban patients and 22.5% of rural residents are familiar with the principles of effective communication and successfully apply them, but 61.5% and 77.5% of patients are not familiar with them, respectively. 12.5% of urban patients and 10.6% of rural residents gave a high assessment of their etiquette skills and assimilation of ethical norms, 87.5% and 89.4% of patients gave a satisfactory and unsatisfactory assessment, respectively.

The analysis of the state of the information culture of patients receiving medical care showed that 12.5% of urban and 7.5% of rural patients have information skills, but the majority of patients (77.5% and 92.5%, respectively) do not have them. It is noted that 96.2% of urban patients and 98.2% of rural residents are limited to using only one source to obtain medical information. The decrease in this culture parameter is mainly due to the limitation of the information field of patients due to the use of a narrow range of information sources and a low level of its assimilation skills. The analysis of the state of the ethical and legal information culture of patients showed that the quantitative assessment of its implementation averaged 65.5% relative to the optimal level. Thus, it was determined that every second respondent did not know where, in what legal documents his rights as a patient and an insured person were prescribed, every third respondent had never read the rights of a patient and insured persons, every fourth respondent did not know about the possibility of obtaining medical legal information in information and legal systems.

             The results of a quantitative assessment of the resource potential of an oncological patient are presented in Table 3.

Table 3. Results of quantitative assessment of the resource potential of an oncological patient

 

Assessment	Сomponents by stages of the therapeutic and diagnostic process
	First stage		Second stage		Third stage
	Implementation index	Resource reserve	Implementation index	Reserve	Implementation index	Resource reserve
Information	65,5	34,5	72,5	27,5	74,5	25,5
Commitment	74,5	25,5	87,3	12,7	89,7	10,3
Health savings	68,5	31,5	89,2	10,8	91,2	8,8
Motivational and value	82,3	17,7	90,5	9,5	92,4	7,6
Communicative	69,5	30,5	70,5	29,5	71,2	28,8
Quality of life	73,4	26,6	65,5	34,5	61,4	38,6
Family adaptation	82,5	17,5	73,2	26,8	67,8	32,2

 

Sufficiency, reliability and timeliness of information plays an important role in healthcare. The patient, as a full-fledged participant in the treatment and diagnostic process, has the right and must have a sufficient amount of reliable and understandable information for decision-making. The survey showed that the information component of the patient resource of oncological care had a positive dynamics in the process of observation – at the first stage 65.5%, at the second 27.5%, at the third 74.5% (p<0.05), however, there is a reserve resource of 25.5%, which indicates insufficient work of medical professionals to increase medical awareness of patients.

The patient's commitment to treatment in oncology is one of the significant conditions for the success of therapeutic measures, reflecting the patient's willingness to be a doctor's partner in the implementation of the planned plan of therapeutic measures. According to the survey, the resource of patient adherence at the first stage of follow–up was realized only by 74.5%, at the second by 87.3%, at the third by 89.7% (p<0.05), which indicates that most patients realize the need to follow the recommendations of doctors and perform all appointments. However, every fifth patient ignores the recommendations of doctors, which negatively affects the success of treatment.

The focus of patients on health care, including the rejection of bad habits and the implementation of the principles of a healthy lifestyle, are the foundation for building a trajectory to achieve a positive result in oncology. The health-saving resource at the beginning of patient follow-up is quite low (68.5%), but after diagnosis, the value of health in patients increases, as indicated by an increase in the assessment to 89.2% at the second stage and to 91.2% at the third stage (p<0.05). However, some patients continue to lead the same, unhealthy lifestyle.

Without the desire of the patient himself, without his motivation to achieve a positive result in treatment with active personal participation, a successful clinical path cannot be built. However, the survey showed that the motivational and value resource of oncological patients was realized at the first stage of the diagnostic and treatment process in 82.3% of patients, subsequently increasing to 90.5% at the second stage and to 92.4% at the third stage (p<0.05). It was noted that 7.6% of patients do not value life and health, are not motivated to preserve it.

The survey in the dynamics of the therapeutic and diagnostic process showed that the communicative resource of patients has low values: 69.5% at the first stage, 70.5% at the second stage, 71.2% at the third stage. This indicates a violation of mutual understanding between doctors and patients, which makes conflict situations more likely, creates "noises" of communications.

One of the key indicators of the success of therapeutic and diagnostic measures is the "quality of life" of the patient. The dynamics of the evaluation of the "quality of life" indicator showed that there was a decrease in its implementation from 73.4% at the first stage, to 65.5% at the second and 61.4% at the third stage of the treatment process (p<0.05), which indicates insufficient attention to medical and social issues of patient support from medical organizations.

The family is an important resource for adapting a person to the situation of illness. However, the survey showed that the resource of family adaptation due to the presence of cancer is realized at the first stage of treatment only in 82.5%, and then decreases at the second stage to 73?2%, and in the third to 67.8% (p<0.05). This requires building an action plan for socio-psychological support of patients in the family on the basis of information, educational and psychological correction measures.

The analysis of the effectiveness of medical care in groups of patients with a low and optimal level of resource realization showed that in the first group the frequency of violations of the effectiveness of care is 3 times higher (34 per 100 cases of care) than in the second group (11 per 100 cases) (p<0.05). A direct correlation was established between the effectiveness of oncological care and the level of realization of the patient's resource (r = 0.89; p<0.05).

Discussion.

The data obtained in the course of the study indicate a decrease in the patient resource of oncological care for all its selected components and its established relationship with the effectiveness of care, which requires improving the medical and organizational technology of working with oncological patients. The medical and organizational technology of providing assistance to patients with oncological profile in the conditions of their passing through the stages of the therapeutic and diagnostic process, including:

1. Formation of a computer database on the risks of violation of the success of the treatment and diagnostic process by patients according to the components of the patient resource.
2. Improvement of the monitoring and observation system of the patient, including the inclusion of parameters in it: assessment of the psychological and medical-social status of the patient, family adaptation; assessment of the dynamics of the quality of life.
3. Formation of a multiprofessional patient support system at the stages of the therapeutic and diagnostic process and correction of the patient's resource potential, including: individual correction of rejection of negative attitudes and anxiety; building an individual program of medical, social and socio-psychological support, consultations on the formation of health-saving behavior, legal and medical literacy. Involvement of medical volunteers from among students of medical universities and colleges in this work. Carrying out targeted correction of the patient resource of oncological care by: increasing the availability of sources of medical information at the individual, group and public levels; involving social service specialists and psychologists, conducting conversations, group lectures.
4. Improving the interaction of an oncologist, psychologist, administration and social workers through the creation of a multiprofessional team of specialists, as well as the formation of a unified schedule of interaction of specialists.

Conclusion. Thus, according to the results of the study, 10 components of the patient resource were identified, its important role in ensuring the effectiveness of oncological medical care was established, the levels and nature of the decline in assessments of its current state were determined, measures were proposed to increase the patient resource, which may be in demand by practitioners, management of medical institutions, health management bodies.

About the authors

Vladimir A. Kozlov

Ivanovo Regional Oncology Center

Email: ivood-va@yandex.ru
ORCID iD: 0000-0003-3735-0728
SPIN-code: 4805-4551

Cand. Sci. (Med.)

Russian Federation, Ivanovo

Iurii V. Samsonov

National Medical Research Radiological Centre; Hertsen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Centre

Email: samsonovu@list.ru

Cand. Sci. (Med.), National Medical Research Radiological Centre, Hertsen Moscow Oncology Research Institute – branch of the National Medical Research Radiological Centre

Russian Federation, Moscow; Moscow

Dmitrii L. Mushnikov

Ivanovo State Medical Academy

Author for correspondence.
Email: 89158113918@yandex.ru
ORCID iD: 0000-0003-4175-7969
SPIN-code: 7180-1923

Cand. Sci. (Med.), Assistant Professor

Russian Federation, Ivanovo

References

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