RQ (1): To what extent are perceptions of healthy people in relation to HRQOL (and its subordinated domains) of persons with cancer modulated by different social contexts?
RQ (2): To what extent gender influences perceptions of HRQOL, regardless to country of provenience?
Hypothesis 1: Participants from Romania, Finland and France will rate differently the HRQOL levels of patients with cancer in their countries.
Hypothesis 2: The level of perceived HRQOL of patients with cancer will be influenced by gender, regardless of country of provenience.
Results
Phase I
Firstly, we tested for statistically significant differences related to perceptions of overall HRQOL between the three groups using One Way Anova. Then, we continued the statistical analysis for the sub-dimensions of HRQOL and gender differences. For the second part of the questionnaire we performed frequencies analysis.The results are provided in Table 1.
The initial results show that there are differences between healthy people from Romania, Finland and France in the manner they perceive the overall HRQOL of patients with cancer (F (2, 87) =8,451; p <0,001). More specifically, the results show meaningful differences between people from Romania and Finland (MRO-MFI=18, 13; p <0,001) and between participants from France and Romania (MRO-MFR=12, 68; p = 0,019) in terms of their perceptions of HRQOL of patients with cancer. Healthy people from Romania, comparing to those from France and Finland, perceive patients with cancer having a poorer quality of life. No differences between participants from France and Finland were observed (MFR-MFI= 5, 44; p = 0,679) within this analysis. The following ANOVA revealed differences between participants in terms of how they perceive the somatic aspects of cancer ( F (2,87)=6,946; p =0,002) (e.g. Most of the
158 time persons with cancer feel having no energy, Most of people with cancer have difficulties in getting rest during sleep activity.). More specifically, differences were obtained between participants from Romania and Finland (MRO-MFI=2, 63; p =0,002) and France and Finland (MFR-MFI= 1, 90; p = 0,040). No differences were observed between participants from France and Romania at this scale (MRO-MFR=0, 72; p = 1). No differences between participants, regardless of provenience country, were obtained in terms of their perceptions of the psychological dimension of cancer (F (2, 87) = 2,413; p = 0,096), which means cancer brings similar psychological symptoms to all patients with cancer (e.g. Having cancer means having pessimistic thoughts., It is difficult for people with cancer to think optimistically of their future., Persons with cancer have a high level of self-confidence.).
The subscale causes of cancer (e.g. Pollution is one of the factors that cause cancer; Fast-food products, excessively consumed, grow the risk of cancer appearance) did not reveal differences in perceptions between the participants of the chosen three groups ( F (2,87)=1,049; p = 0,355). The following ANOVA showed differences between the participants of this study (F (2, 87) =10,275; p <0,001) in terms of their perceptions of the Activities subscale of HRQOL of patients with cancer (e.g. It is hard for persons with cancer to follow daily activities. Having cancer means interrupting daily activities). Specifically, there were statistical significant differences between participants from Romania and France (MRO-MFR=1, 98; p = 0,001) and Romania and Finland (MRO-MFI=2,10; p <0,001), in the sense that patients in Romania are perceived to have more limited activities following a diagnosis of cancer, comparing to those from Finland and France. No differences were observed between participants from Finland and France at this subscale. Significant differences were observed in the manner participants from Romania and Finland rated the psycho- medical support patients with cancer receive in their own countries (F (2, 87) =8,560; p <0,001; MRO-MFI=3, 87; p <0,001). This subscale was represented by items such as: Medical staff is competent in order to provide high quality assistance to patients with cancer. It is not difficult for people with cancer to access health services (intervention, treatment, health providing institutions, doctors etc). Medical treatment for cancer is a long and expensive process. No statistical significant differences were obtained between participants from Finland and France at this subscale. When asked to rate the level of social support of patients with cancer in their countries, no differences
159 between the participants from Romania, Finland and France were observed (F (2, 87) =2,915; p = 0,060). Items as You need support from the others when you have cancer, Families should pay more attention and encourage people with cancer more than they used to do before, If a person with cancer asks me for help I will not refuse that composed this subscale. The last ANOVA revealed differences between the participants of the three groups in terms of their ratings of the Spirituality subscale (F (2, 87) = 11, 79; p <0,001). Specifically, we observed differences between participants from Romania and Finland (MRO-MFI=2, 87; p <0,001) and from Romania and France (MRO-MFR=1, 87; p = 0,008) at this subscale. This subscale was represented by items such as: Persons with cancer often find soothe in Bible/ Coran, Most of people with cancer think that God still loves them and challenges their faith, Most of people that find out they have cancer feel punished by fate.
Then, we tested to see whether groups of men differed from groups of women concerning their perceptions of HRQOL of patients with cancer. For this, we tested for statistically significant differences between groups using independent t-tests. No significant differences were observed at this level, regardless of country of provenience: F=1, 60; p=0,209; t(88)=0,922; p =0,359 (Somatic aspects of cancer: F=0,129, p = 0,720, t(88)= 0,494, p= 0,644; Psychological dimension of cancer: F=1,248, p= 0,267, t(88)=0,779, p=0,438; Causes of cancer: F= 1,116, p= 0,294, t (88)=-0,288, p= 0,774; Activities: F=0,331, p= 0,567, t(88)= 1,133, p= 0,260; Pycho- medical support: F=2,168, p= 0,144, t(88)= 1,268, p= 0,208; Social support: F=2,795, p=0,098, t(88)=0,418, p= 0,677, Spirituality: F= 5,258, p= 0,024, t(88)=0,722, p =0,474).
160
Phase II
Table2. Items aimed at analysing peoples’ perceptions of medical and social services in
Romania, France and Finland
Item Frequencies
Romania
N=29 France N=30 Finland N=31
In my country there are programs that provide information
about cancer and people with this
illness.
No answer: 10
‘I don’t know”: 9
Prevention and fundraising programs: 6 Media: 12 Advertisements: 11 No answer: 11 No answer: 11 NGOs: 5 Prevention and fundraising campaigns: 8 The general attitude
towards patients with cancer is my country is described such as it
follows…
Compassion: 11 Indifference: 5 Avoidance and pity: 4
Positiveness: 16 Compassion: 5 Warmth: 7 Positiveness: 6 No answer: 6 Encouragement: 5 In my country there
are different f NGOs that provide support to
people with cancer.
‘I don’t know”: 14
No answer: 9 National agencies for prevention and fighting
against cancer: 2
The National League against Cancer: 16
No answer: 11 Self-help associations: 4
No answer: 10
‘I don’t know”: 9
Hospitals and private organisations: 3
Patients with cancer in my country have the
possibility to use the following medical procedures… Chemotherapy: 15 Surgery: 6 Radiation therapy: 4 Surgery: 19 Chemotherapy: 17 Radiation therapy: 16 No answer: 14 Medical treatment: 6 Surgery: 5 My opinion about the
services provided to patients with cancer in my country is that they
are…
No answer: 6 Poor and superficial: 5
Insufficient: 3
Performant treatments: 11 No answer: 8 Financial support from
the Government:5
No answer: 9 Good: 6 Of high quality: 5 Rate, using a scale of
1 (not at all) to 10 (frequantly) the degree with what patients with cancer in
your country use medical services, psychological services
and naturist treatments.
Mean assessed levels Medical services: 8,03 Psychological services: 4,03 Naturist treatments: 5,85 Medical services: 9,62 Psychological services: 5,34 Naturist treatments: 3,35 Medical services: 9,54 Psychological services: 6,19 Naturist treatments:4,41
As data show, only six out of 29 participants from Romania had knowledge about fundraising and prevention programs for people with cancer. Interestingly, when asked to name different NGOs that provide support for people with cancer, 14 participants out of 29 said that they did not have such information. Only two participants could name such NGOs. A similar result was obtained when we analysed the data in Finland: 9 out of 31 participants did not have such information and 10 participants did not answer this question. Only three participants believed hospitals and private organisations could provide support to people with cancer. In France, for example, 16 participants mentioned people with cancer could receive support from
161 National leagues and from self-help groups (4 participants), whereas 11 participants out of 30 did not answer this question.
Meaningful differences were observed when participants were asked to describe the general attitude people in their countries have toward patients with cancer. In
France and Finland descriptors as “positiveness”, “compassion”, “warmth” and “encouragement” were higly rated, while participants from Romania found the general attitude toward patients with cancer represented by “compassion”, “indifference”, “avoidance” and “pity”. Furthermore, while services provided for patients with cancer in France and Finland were described as “performant’’, “financially supported by Government” , “good” and “of high quality”, participants from Romania peceived such
services as being “poor”, “superficial” and “insufficient”.
Fig.1. Perceived attitudes toward patients with cancer and quality of services