system can exert pressure on the sick individual to notify examination of the attitudes and beliefs of laymen on the
the physician, to undergo diagnostic tests, and to comply issue of cancer and their evaluation of Polish oncology. For
with medical recommendations. But it may also discourage it is laymen, functioning in specific communities, who make
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or even prohibit the sick individual from contacting medical decisions regarding their own health and they also influence
professionals [4]. the health decisions of others.
-
E- mail: m.synowiecpilat@gmail.com
Received: 22 April 2014; accepted: 29 october 2014; first published on February 2017 programmes and social campaigns) have not produced
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AAEM Annals of Agricultural and Environmental Medicine
Magorzata Synowiec-Piat. Lay beliefs on Polish oncology in the evaluation of healthy individuals
satisfactory results in the form of a positive change in the The correspondence analysis was used to determine the
attitudes and health behaviors and in the reduction of direction of the dependence between nominal and ordinal
morbidity and mortality rates. An in-depth study of ordinary variables. The values ofchi-square test statistic and Cramers
peoples beliefs regarding cancer issues and the impact of V coefficient are presented in Tables 3 and 4. Data were
those beliefs on the behaviour and attitudes toward health analyzed using the Statistica 9.0 version.
is seen as a promising way to develop effective strategies to To assess the access to oncology medical services,
fight cancer. competence of the oncologists, medical care conditions,
There is a rich scientific literature documenting the existence degree of confidence in doctors and degree of fear of cancer,
of fatalistic beliefs about cancer in Western Europe [14, 15, a 4 element version of the Likerts scale (i.e. forced choice
and 16] and United States [17]. Limited studies concerning scale) was used. In questions relating the medical knowledge,
this subject were carried out in Poland, where psychological respondents were asked 4 independent questions: do they
studies dominate and focus primarily on the issues of the know the symptoms of cancer, risk factors, types of cancer
fear of cancer and cancers consequences [18]. Very rarely prevention examination, andmethods of cancer treatment? If
the main subjects of those studies are peoples beliefs about so, they were supposed to list them. Responses were classified
cancer [19]. One of the few examples of such studies was according to the following formula: lack of response, 1. 2.
conducted in the 1990s concerning colorectal cancer [7]. 3. and above 3 correct answers.
There is a lack of sociological research on contemporary
beliefs about cancer. Sociological studies which would
present the contemporary beliefs about cancer are missing. RESULTS
The conducted studies mostly included sick patients [10],
whereas research that examined healthy individuals usually 1. Assessment of Polish oncology by healthy respondents.
concentrated on a small research sample [20]. Additionally, Less than half of the respondents (48%) assesd the
the existing research on beliefs about cancer most often focus conditions of medical care in Polish oncology hospitals
on their dependence on SES [21, 22] and the impact of those as satisfactory. The highest rated were the competencies
beliefs on the preventive behaviour of individuals [23, 24]. of oncologists, since only 21% of respondents believed
Missing are analyses regarding the socio-cultural conditions that they are low. However, the interpersonal skills of the
and the consequences of the way laymen evaluate medical specialists were poorly rated: only 57% were convinced that
oncology institutions. while in hospital cancer patients can count on emotional
support from medical staff (Tab.1).
MATERIALS AND METHOD Respondents were also asked how they assessed access
to oncological medical services (Tab. 2). Most respondents
The study was carried out between March June in 2012 believed that access to oncological hospital treatment (62%)
with a sample of 910 adult residents of Wroclaw in south-east and cancer prevention examination (59%) in Poland is
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Poland. The quota sample which reflected the structure of the unsatisfactory. An even worse assessment concerned access
study population in terms of gender, age and education was to oncologists, oncological clinics (just under 32% stated
used in the research. The study was based on an interview it is satisfactory), and the worst of all to rehabilitation
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questionnaire. The chi-square test of independence was after cancer treatment (76% of respondents believed that
used to verify the hypothesis about the independence of it is unsatisfactory).
-
sampling, ensures a significant dependence (p-value<0.05). oncology in the above dimensions is conditioned by socio-
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Annals of Agricultural and Environmental Medicine AAEM
Magorzata Synowiec-Piat. Lay beliefs on Polish oncology in the evaluation of healthy individuals
Table 2. Rating of access to oncology medical services (N = 910) as being rather weak (1824 years) and rather good (25
rather
34 years old) (p=0.00011). However, there was no clear
What in your opinion is excellent
good
rather poor very poor correlation between any category of assessment of access
access in our country to:
n % n % n % n %
to rehabilitation and the age categories 3544, and 65
years and over.
cancer prevention
examination
19 2 353 39 390 43 148 16 Special attention should be paid to the economic situation
of the respondents, both in objective (the amount of income
oncologists, oncological
clinics
17 2 278 30 445 49 170 19 per member of the family) and subjective (evaluation of
the economic situation) terms. It was confirmed that
oncological hospital
treatment
16 2 327 36 412 45 155 17 the lower the income of respondents, the worse the
evaluation of the following: the conditions of medical
rehabilitation after
oncological treatment
14 1 208 23 445 49 243 27 care (p=0.00234), competence of oncologists (p=0.00001),
and the possibility of receiving emotional support from
Source: own research
medical personnel by cancer patients (p=0.00056). The
same direction of the correlation was confirmed in the
economic factors, in particular, by the following variables: case of the subjective evaluation of the economic situation:
education, age and economic situation of the respondents the worse the evaluation of their own economic situation,
(Tab. 3). the lower the evaluation of medical care (p=0.00097),
It was confirmed that the assessment of the competence competence of the oncologists (p=0.00003), possibility
of oncologists is dependent on education (p=0.03628): of receiving emotional support from medical personnel
the lowest educated persons (primary and vocational by patients (p=0.00019); access to: hospital treatment
education), often assess these competencies as definitely (p=0.00044), oncologists, oncology clinics (p=0.04292)
low, while respondents with secondary education perceived and rehabilitation (p=0.04482).
competence of oncologists as rather high. There was no The assessment of Polish oncology was also significantly
clear relationship between the variable of the assessment influenced by:
of competence and higher education. a) The education level of the respondents mother and
Another variable that affects the assessment of Polish father, which was related to the process of socialization,
oncology is the age of the respondents. Firstly, the increase and shaping of health behaviorus and attitudes, including
in age of the respondents increased the critical evaluation of attitudes towards medicine, by the parents. The education
the conditions of the oncological medical care in hospitals of people who influence our process of socialization had
(p=0.l01128). Secondly, older people often evaluated access the biggest impact and it was not irrelevant. It has been
to rehabilitation as very weak, while younger respondents confirmed that the lower the education of the mother
Chi2=17.90731
Education ns ns ns ns ns ns
V=0.0809904
Chi2=30.18479 Chi2=44.09736
Age ns ns ns ns ns
V=0.1051508 V=0.1270940
evaluation of economic Chi =22.54187
2
Chi =24.39768
2
Chi =13.00759
2
Chi =12.89036
2
Chi =30.48599
2
Chi =30.48599
2
ns
situation V =0.1112908 V =0.1157813 V=0.0845401 V=0.0841583 V=0.1294239 V=0.1204817
Chi2=30.51140 Chi2=44.21796 Chi2=34.49601
Income ns ns ns ns
V=0.1057182 V=0.1272677 V=0.1124095
Chi2=25.45285 Chi2=25.55086 Chi2=21.30604
mothers education ns ns ns ns
V=0.0965577 V =0.0967434 V=0.0883426
Chi2=24.29922 Chi2=22.39994 Chi2=20.87339
fathers education ns ns ns ns
V =0.0943441 V=0.0905820 V=0.0874410
suffering from chronic Chi2=8.122793
ns ns ns ns ns ns
diseases V=0.0944783
occurrence of cancer in the Chi2=12.99161 Chi2=12.76656
ns ns ns ns ns
immediate family V=0.0844882 V=0.0837532
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and father of the respondent, the worse the rating of Firstly, the worse the assessment of competence of
the competence of oncologists (p=0.01136; p=0.01323), oncologists, the lower the level of respondents knowledge
access to hospital treatment (p=0.00251; p=0.00386), and about the symptoms of cancer (p=0.00027), risk factors
access to prevention (p=0.00242; p=0.00770). (p=0.00000); preventive testing (p=0.00000) and treatment
b) The so-called family history of cancer. Firstly, it was of cancer (p=0.00000). Secondly, the worse the evaluation
confirmed that access to prevention was rated the worst of access to cancer prevention examination, the poorer
by persons suffering from chronic diseases (p=0.04355), the knowledge of symptoms (p=0.00271) and cancer risk
by respondents who had a close family where there factors (p=0.03453). Thirdly, the worse the assessment
were cases of cancer (p=0.04691), and by respondents of the medical care in oncology hospitals, the less the
who took care of a sick person with cancer (p=0.01722). knowledge about: symptoms of cancer (p=0.00150), and
Secondly, the respondents whose relatives suffered the risk factors (p=0.00012) and treatment methods
from cancer often assessed access to oncologists and (p=0.02594).
oncological clinic as rather weak and very weak. In In the literature concerning cancer issues the problem
contrast, respondents where nobody in the family was of the existence of the fear of cancer phenomena is
sick with cancer considered them to be rather good and often raised. Therefore, in the interview questionnaire,
rather weak (p=0.04318). respondents were asked if they feel anxious when thinking
c) Attitude towards doctors. Two variables were taken into about cancer. The great majority of respondents (80%)
account: the perception of competence of oncologists experienced anxiety, although with varying levels of
and the degree of confidence in doctors overall. The intensity: 10% very high, 33% -to a big extent, and 37%
perception of competence of oncologists affects all to a lesser extent. Only 20% of respondents said they did
the indicators taken into account when assessing the not feel anxiety when thinking about cancer. Particularly
Polish oncology. It was confirmed that the higher the noteworthy is the fact that the level of fear of cancer affects
assessment of competence of oncologists, the better how Polish oncology is evaluated. The level of fear of cancer
the rating of the conditions of medical care (p=0.0000), is higher when worse is the assessment of the conditions of
possibility of obtaining emotional support from medical medical care in hospitals (p=0.04291), and evaluation of
staff by patients (p=0.0000), access to hospital treatment access to preventive testing (p=0.02919) (Tab. 4).
(p=0.0000), oncologists, oncological clinics (p=0.0000),
prevention (p=0.0000) and rehabilitation (p=0.00000).
Also, the degree of confidence in doctors affected all DISCUSSION
indicators of assessment of Polish oncology. It was
confirmed that the higher the confidence in doctors, the Analysis of the data showed a negative image of Polish
better the rating of conditions of medical care (p=0.0000), oncology, according to the study participants. The
competence of oncologists (p=0.0000), possibility of respondents were dissatisfied with both the treatment
obtaining emotional support from medical personnel conditions, and with access to medical services. Almost
by patients, access to hospital treatment (p=0.00000), half of the respondents (48%) did not believe in the efficacy
oncologists, oncological clinics (p=0.00000); prevention of modern medicine in the fight against cancer. Instrumental
(p=0.00000) and rehabilitation (p=0.00000). competences of oncologists were assessed relatively highly
(79%). The interpersonal skills of medical personnel and
3. The influence of the assessment of Polish oncology on the their emotional support were much more critically perceived.
degree of fear and the medical knowledge about cancer- There are a number of variables affecting the assessment
related issues. The level of medical knowledge related to of Polish oncology. Particular attention should be paid to
oncology issues is affected by the following variables: the issue of inequality in health and disease. Low-income
assessment of competence of oncologists, assessment of respondents poorly evaluated the quality of oncology
the medical care in oncology hospitals, and assessment of medical services (treatment conditions in hospitals, doctors
access to cancer prevention examination (Tab. 4). and their competence, and interpersonal skills) and access
Table 4. Influence of the assessment of Polish oncology on the degree of fear of cancer and medical knowledge of respondents
to hospital treatment, oncologists and oncological clinics reporting to a doctor [10]. In addition, when the individual
and rehabilitation. Numerous studies have confirmed that observes alarming symptoms and begins to interpret them
access to specialist medical services in Poland, in the case of as cancer symptoms, it usually triggers the fear of pain and
low-income persons, is difficult [25], and it may perpetuate suffering, fear of a very invasive and incriminating treatment
passivity in seeking medical help. In addition, fatalistic beliefs (surgical operation, chemotherapy), and hospitalization
about cancer are more prevalent among those with lower itself. Concerns may indeed also be raised by the health
SES [15, 17, 21, 22]. care system, perceived lack of access to medical services
The individual pattern of behaviour when healthy and and the professionalism of the medical staff. The issue of
ill depends largely on the immediate environment of the trust in the professional medical health care system should
individual. The primary socialization with the particular be addressed. A low level of trust in medicine, or lack of it,
role of parents is of undeniable importance. It has been reduces the likelihood of a quick contact with specialists if
confirmed that the lower the education of the parents of one notices symptoms of the illness [26].
the respondent, the worse the rating of the competence of The presented study has confirmed that the great majority
oncologists, assessment of the access to hospital treatment, of respondents (80%) experienced anxiety when thinking
and access to prevention. In the process of socialization of about cancer and when the level of that fear was higher,
people in the lower social class, an unfavourable image of the worse they assessed the conditions of medical care in
Polish oncology is being formed, which may lead to taking hospitals and access to preventive testing.
on or the continuation of inappropriate health behaviours
and passivity toward the health care services.
The choice of a behavioural strategy in health and illness CONCLUSIONS
behaviour; whether an individual will establish contact with
medicine, depends on the diagnosis that one gives on the Negative assessment of Polish oncology deepens with the fear
basis of his or her knowledge, and depends on social status. of cancer and promotes the preservation of fear of cancer in
Knowledge of the individual is enriched by the experiences of the society. There is a need for constant improvement in the
illness, family members experience (i.e. family history of the quality of medical oncology services and building public
disease), and those in the immediate and distant environment. trust in physicians, fighting inequalities in health, and the
Family history of cancer promotes fatalistic beliefs [9] and, taking into account of the laymans perspective in developing
consequently, can act as a barrier to undertaking effective strategies to fight cancer.
measures to promote health [16]. In the presented study,
previous experience of chronic disease and the occurrence
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