AN ASSESSMENT OF THE PSYCHOSOCIAL NEEDS OF RURAL CANCER PATIENTS

LIVING IN THE ADIRONDACK REGION OF NORTHERN NY

Alison Riley-Clark MSN RN & Barbara Pieper PhD RNThe Sage Colleges

SHSGraduate Nursing Program

RURAL AREAS: RECURRING THEMESUnique demographics and needs

Have shortages of health care providers and cancer specialists (Hughes, Ingleton, Noble & Clark, 2004)

“Although 20 % of Americans live in rural areas only 9% of MD’s practice there” (AHRQ, 2004)

Medicare reimbursements are lower for rural hospitals for the same services. (Ricketts, 2000)

Higher percentage of residents >65, more patients on Medicare, less revenues

Population has lower income and education levels (National Rural Health Association, 2008)Transportation difficulties

Isolated communities

Lack of hospitals & home health services(Baltic,Whedon, Ahles & Funciullo, 2002)Limited Internet and cell phone access

Adirondack Medical Center, Franklin Co.97 beds, cancer clinic with visiting

oncologist 2 days per week Elizabethtown Hospital, Essex Co.15 beds, just added chemotx services

Alice Hyde Medical Center, Franklin Co.76 beds. Cancer clinic, oncologist

and radiation therapy services

HAMILTON COUNTY HAS NO HOSPITAL

HOSPITALS IN THE ADIRONDACK PARK

Residents Over 65 Years by County

Essex County – 16.7%

Franklin County – 13.2%

Hamilton County – 21.5%

New York State – 13.2%

US Census, 2000

PURPOSE OF THE STUDYDescribe the self reported psychosocial needs of

rural cancer patients living in the Adk region.

Identify barriers that prevent rural cancer patients from accessing available services.

Data will be used to plan new programs for Adirondack cancer patients by local and state cancer providers.

Add to the literature on the needs of rural cancer patients

What are the self-reported psychosocial needs of rural Adirondack cancer patients?

Do these patients have access to cancer services and if not, what are the barriers to obtaining quality care and

services?

What services do patients want to have available?

What percent of patients have access to computers & online services?

What methods do patients prefer to get more information about their disease ?

RESEARCH QUESTIONS

SURVEY TOOLDesigned by researchers

Brief, only 3-5 minutes to complete7 Demographic questions8 Likert scale questionsChecklist of preferred servicesChecklist for info delivery methodsComment section

METHODS*Survey Distribution

Adirondack Medical Center Oncology CenterLocal ENT Physician OfficeCancer Support Group Meetings

*Staff gave patients survey, a pen and an envelope.

*Respondents placed the completed survey in the envelope and then in a locked collection box.

*Study approved by IRB at The Sage Colleges

Demographic Variables

Percent

Currently Receiving Cancer Treatment 32 68.1%

Gender Male 19 40.4%

Female 28 59.6%

Live in the Adirondack Park 46 97.9%Race - White (as identified by respondent) 46 97.9%Type of Cancer

Breast 13 27.7% Colon 3 6.4%

Lung 2 4.3%

Other or multiple types 19 40.4%

Table 2 Travel Time to Medical Services in Minutes.

N Mean SD RangeFamily Doctor 47 13.11 12.64 0-60.00

Cancer Doctor 47 60.32 105.77 0-480.00

Chemotherapy 47 20.11 35.91 0-150.00

Radiation Therapy 47 27.87 37.98 0-150.00

Characteristics (n=46) 97.9% never had missed an appointment due to difficulty getting a ride, buying gas or car problems. 81% have Internet access19% have no Internet access 13% never use Internet for information47% had attended a support group.72% expressed some interest to very interested in

attending a support group.47% felt scared, anxious, sad or worried several

times a month, weekly or daily.

SURVEY QUESTION 1NEVER/NOT AT

ALL

2 3 WKLY/VERY INTERESTED

5DAILY

How often do you feelScared, anxious, sad or worried?

10.6% (n=5) 42.6% (n=20)

21.3% (n=10)

12.8% (n=6)

12.8% (n=6)

How often do you get support from family and friends

4.3% (n=2) 6.4% (n=3)

12.8% (n=6)

12.8% (n=6)

61.7% ( n=29)

How often do you get help from your church or any community organization?

53.2% (n=25)

6.4% (n=3)

8.5% (n=4)

27.7% (n=13)

2.1% (n=1)

Have you ever been interested in talking with a counselor about coping with cancer?

42.6% (n=20)

21.3% (n=10)

25.5% (n=12)

8.5% (n=4)

How interested are you in trying yoga or relaxation classes?

36.2% (n=17)

12.8% (n=6)

17% (n=17)

31.9% (n=15)

Services patients preferred to help deal with their cancer.

0

10

20

30

40

50

60

7059.6

48.9

40.4

14.9 1712.8

10.6

Respondent’s Preferred Methods For Cancer In-formation

Method

Perc

enta

ge

RECOMMENDATIONSExplore providing laptop computers/epads with Internet

access during treatments. Locate and apply for additional grant funding for

yoga/guided imagery/massage sessions Expand availability of counseling and education

specific to coping with cancer & stress.Expand support group services and explore strategies to

connect patients to each other.Continue to provide written educational materials as

well as print-outs/computer discs from cancer websites for those without access

Explore using ebooks and enlarging patient lending library.

Contact Information

Alison Riley-Clark518-523-2212

arclark59@gmail.com

QUESTIONS?

American Society of Clinical Oncology. (2006, May). Organizations collaborate to improve the quality of cancer care. Journal of Oncology Practice, 2 (3). Retrieved on line from http://qualityalliance.stateaffiliates-asco.org/jop.pdf

Baltic, T., Whedon, M.B., Ahles, T., & Fanciullo, G..( 2002). Improving pain relief in a rural cancer center. Cancer Practice, 10, Ps39-S44.

Braveman, P. (2007). Do we have real poverty in the United States of America? Preventing Chronic Disease, 4 (4) p. 1-2. Retrieved from www.cdc.gov

Celaya, M., Rees, J., Gibson, J., Riddle, B. & Greenberg, E.. (2006) Travel distance and season of diagnosis affect treatment choices for women with early-stage breast cancer in a predominantly rural population (United States). Cancer Causes Control 17, p. 851-856.

Desch, C., Smith, T., Breindel, C. & Simonson, C.. (1992). Cancer treatment in rural areas. Hospital & Health Services Administration, 37(4), 449-463.

Franzak, F., Smith, T. & Desch, C. (1995) Marketing cancer care to rural residents. Journal of Public Policy & Marketing, 14 (1) 76-87.

Hughes, P., Ingleton, M., Noble, B. & Clark, D. (2004) Providing cancer and palliative care in rural areas: a review of patient and carer needs. Journal of Palliative Care, 20 (1) p. 44-49.

Hartley, D. & Gale, J. (n.d.) Rural health care safety nets. Retrieved from Agency of Health Research and Quality website: http://www.ahrq.gov/data/safetynet/hartley.htm

Health Care Disparities in Rural Areas: Selected Findings from the 2004 National Healthcare Disparities Report. AHRQ Publication No. 05-P022, May 2005. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/ruraldis/ruraldispar.htm

Ide, B. (2000) Rural Practice Forum: understanding rural health care. Online Journal of Rural Nursing and Health Care, 1 (1), Spring 2004.

Im, E., Chee, W., Guevara, E., Lim, H., & Shin, H.. (2008). Gender and ethnic differences in cancer patients’ needs for help: an internet survey. International Journal of Nursing Studies, 45, 1192-1204.

Improving Health Care for Rural Populations. Research in Action Fact Sheet. AHCPR Publication No. 96-P040, (March 1996). Agency for Health Care Policy and Research, Rockville, MD. Retrieved from: http://www.ahrq.gov/research/rural.html

References

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Lewis, L. (2006). Discussion and recommendations: addressing barriers in the management of cancer survivors. American Journal of Nursing, 106 (3) p 91-95.

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Shugarman, L.R., Sorbero, M.E.S., Tian, H., Jain, A.K., & Ashwood, J.S.. (2008). An exploration of urban and rural differences in lung cancer survival among Medicare beneficiaries. American Journal of Public Health, 98, 1280-1287.

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The adironack rural health network service area and community. (2008) Retrieved from the Adirondack Rural Health Network: Http://www.arhn.org/ourregion

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