This study was approved by the Ethics Committee of Soochow University (No. SUDA 20200225H08). Before the survey, patients were required to sign an informed consent.
From January to September 2020, CRC patients were recruited from the Oncology and Radiotherapy Departments of four hospitals (the First Affiliated Hospital of Soochow University, the Second Affiliated Hospital of Soochow University, Soochow Municipal Hospital, and Soochow Hospital of Traditional Chinese Medicine) to participate in the survey. The inclusion criteria are as follows: (i) over 18 years old; (ii) diagnosed with colorectal cancer; (iii) currently receiving treatment or follow-up, (iv) agree to participate in this study. The exclusion criteria were as follows: (i) unable to communicate; (ii) unaware of their disease diagnoses; (iii) with other severe physical diseases, mental or mental disorders; (iv) participating in other studies.
General information questionnaire
The general information questionnaire is developed upon reviewing the literature on supportive care needs for cancer patients, consulting professors with relevant research experience and oncology specialists, and research group discussion. It mainly includes age, gender, nation, marital status, education, occupation, religious belief, per capita monthly income of family, payment method of medical expenses, CRC family history, CRC cognition, cancer types, metastasis, current treatment, and other diseases.
Comprehensive Needs Assessment Tool in cancer for patients, CNAT
CNAT was constructed by Korean scholars in 2011, which contains 59 items and seven dimensions (physical symptoms, psychological problems, health care staff, information, social/religious/spiritual support, hospital facilities and services, and practical support). The four-point scoring method is adopted: 0 (no need) ~3 (high need). It was introduced into China by Zhao in 2017, and the domain scores were calculated by averaging the score for each domain with subsequent linear transformation to a scale of 0-100 based on the European Organization for Research and Treatment of Cancer (EORTC) scoring guideline . The specific scoring method is the score of each dimension= (actual score of each dimension ×100) / (number of items×3). Cronbach’s α coefficient of the total scale was 0.95 (each dimension: 0.82~0.95), the split-half coefficient was 0.81 (each dimension: 0.73~0.84), and the test-retest reliability was 0.82 (each dimension: 0.79~0.90); eight factors were extracted, and could explain 70.33% of the total variance (The health care staff need was divided into the need for doctors and the need for nurses. For statistical convenience, this study still makes statistics according to seven dimensions of the original scale).
M.D. Anderson Symptom Inventory, MDASI
MDASI is a multi-symptom assessment scale, which was developed by Anderson Cancer Center in 2000, including two parts: symptom severity and symptom interference. There were 13 items of symptom severity to evaluate cancer patients’ symptoms in the past 24 hours, including fatigue, numbness, nausea, disturbed sleep, forgetfulness, sadness, and the like. Symptom interference involves six aspects: general activity, emotion, and working, and the like. The score of each item is 0~10. The higher the score, the more serious the symptoms or symptom distress. The scale was translated into Chinese in 2004, Cronbach’s α coefficient of the Chinese version scale is 0.82 ~ 0.94.
Hospital Anxiety Depression scale, HADs
Zigmond and Snaith formulated HADs in 1983, mainly used to screen anxiety and depression of hospital patients. There are 14 items on the scale, odd items are used to evaluate anxiety, and even items are used to evaluate depression. The score of each item is 0~3. The lower the score, the lighter the anxiety and depression. The scale’s internal consistency is good; Cronbach’s α coefficient of the total scale and two subscales are higher than 0.82.
Social Support Rating Scale, SSRS
SSRS was developed by Chinese researcher Xiao Shuiyuan in 1986. The scale has ten items, covering three dimensions: subjective support (items 1, 3, 4, and 5), objective support (items 2, 6, and 7), and utilization of social support (items 8, 9, and 10); except for items 6 and 7, which are scored according to the number of supported sources, the scores of other items are 1~4. The higher the score, the higher the social support. The total score ≤22 is low level, 23~44 is medium level, and 45~66 is high level; Cronbach’s α coefficient of the scale is 0.89~0.94, and the test-retest reliability coefficient is 0.92.
Epidata 3.1 software was used for data input by two researchers, and SPSS 21 software was used to complete data analysis. Patients’ general information was described by frequency, rate, mean and standard deviation, and the supportive care needs were described by mean, standard deviation, percentile.
The correlation between supportive care needs and symptom burden, anxiety, depression, and social support was analyzed by Spearman correlation analysis. Univariate analysis and multiple stepwise linear regression analysis were used to explore the influencing factors of supportive care needs. In univariate analysis, T-test or analysis of variance were used for normal distribution, and Mann-Whitney U test or Kruskal-Wallis H test was used for non-normal distribution data . The variables with statistical differences in correlation analysis and univariate analysis were used as independent variables in multiple stepwise linear regression analysis, α=0.05 and α=0.10 were entry and exclusion criteria, respectively. The inspection level is bilateral inspection, p<0.05 was statistically significant.