Use of cancer-specific mental health resources—is there an urban-rural divide?
- 329 Downloads
The purpose of this study is to establish whether mental health (MH) outcomes, attitudes towards cancer-specific MH (CSMH) resources, and the availability of such resources differ between rural and urban cancer patients.
Three months after surgery for colorectal cancer, patients received a questionnaire for completion at home assessing distress, depression, anxiety, acceptance, knowledge and use of CSMH resources and the doctor-patient relationship. We adjusted our sample to reference data of the Munich Cancer Registry and documented CSMH resources (e.g. cancer-specific information centres and cancer support groups) using a systematic Internet search.
Five hundred thirty-four patients participated with a mean age of 68.9 years; 44.5 % were female. Urban patients talked less with their doctor about their emotional state (65 %, p < 0.01) and showed poorer knowledge of CSMH resources (60 %, p < 0.002). A good doctor-patient relationship was associated with a better MH outcome. A significant predictor for acceptance was distress. Ninety-four percent of patients without a nearby support facility lived in rural areas (p < 0.001). There were no group differences concerning distress, MH outcomes, or acceptance of CSMH resources.
Despite a higher availability of CSMH resources, urban patients showed poorer doctor-patient relationships and less knowledge of such resources than rural patients. Overall, knowledge and use of these resources were poor. The amount of support facilities available therefore appears to be less important than establishing an efficient communication network between patients, doctors and providers of CSMH resources to achieve satisfaction with treatment of urban and rural cancer patients.
KeywordsColorectal cancer Mental health Urban-rural divide Doctor-patient relationship
This study was funded by the Munich Cancer Center (Tumorzentrum München). We thank all head physicians who accepted to cooperate in this study and all surgeons who supported it by patient recruitment.
Conflict of interest
The authors have no conflict of interest to declare. The authors have full control of all primary data and allow the journal to review the data if requested.
- 12.Burris JL, Andrykowski M (2010) Disparities in mental health between rural and nonrural cancer survivors: a preliminary study. Psycho-Oncology 9:637–645Google Scholar
- 13.Lyons MA, Shelton MM (2004) Psychosocial impact of cancer in low-income rural/urban women: Phase II. Online Journal of Rural Nursing and Health Care 2004. Available at: http://www.snrs.org/membership/ journal.html
- 20.Ernst et al. (2010) Versorgung und psychosozialer Betreuungsbedarf von Krebspatienten im Stadt- Land-Vergleich–eine Literaturübersicht. Dtsch med Wocheschr 35:1531–1537Google Scholar
- 22.Ley MH (1998) Doctor-patient communication. The lifeline to comprehensive cancer care. ASCO Educational Book, S. 195–202Google Scholar
- 25.Mehnert A, Müller D, Lehmann C, Koch U (2006) Die deutsche version des NCCN distress-thermometers. Empirische prüfung eines screening-instruments zur erfassung psychosozialer belastung bei krebspatienten. Z Psychiatr Psychol Psychother 54:213–223Google Scholar
- 30.Palesh OG, Shaffer T, Larson J, Edsall S, Chen XH, Koopman C, Turner-Cobb JM, Kreshka MA, Graddy K, Parsons R (2006) Emotional self-efficacy, stressful life events, and satisfaction with social support in relation to mood disturbance among women living with breast cancer in rural communities. Breast J 12:123–129CrossRefPubMedGoogle Scholar
- 31.Howat A, Veitch C, Cairns W (2006) A descriptive study comparing health attitudes of urban and rural oncology patients. Rural Remote Health 6:1–9Google Scholar
- 38.Hauenstein EJ, Petterson S, Rovnyak V, Merwin E, Heise B, Wagmer D (2006) Rurality, gender, and mental health treatment. Fam Community Health 29:16–25Google Scholar
- 43.Weis J, Mehnert A, Koch U (2003) Entwicklung von Leitlinien und Behandlungsstandards in der Psychoonkologie. FORUM DKG 18:30–32Google Scholar