Primary Health Care Professional’s Perception on the Subject of Cancer Care in Remote Area

Incidence of cancer is rising since past and diagnosing cancer when it is at an early stage is important, as the stage of disease at the time of diagnosis impact the survival of many cancers. Cancer is a substantial public health problem for all population groups. However, certain subgroups, including rural communities, are more at risk than others. Published cancer statistics may not offer an accurate picture of the number of people affected by cancer in remote areas, may go undiagnosed and consequently, untreated because of the difficulties they have when attempting to access specialty health care services [1]. Primary health care professional have a key role in cancer management as the usual first point of contact for patients with potential cancer symptoms. However, there is limited work done to investigate their perceptions towards cancer. Because of this, there has been increasing Abstract


Introduction
Incidence of cancer is rising since past and diagnosing cancer when it is at an early stage is important, as the stage of disease at the time of diagnosis impact the survival of many cancers.
Cancer is a substantial public health problem for all population groups. However, certain subgroups, including rural communities, are more at risk than others. Published cancer statistics may not offer an accurate picture of the number of people affected by cancer in remote areas, may go undiagnosed and consequently, untreated because of the difficulties they have when attempting to access specialty health care services [1].
Primary health care professional have a key role in cancer management as the usual first point of contact for patients with potential cancer symptoms. However, there is limited work done to investigate their perceptions towards cancer. Because of this, there has been increasing apjcc.waocp.com Priyanka Yadav, et al: Primary Health Care Professional's Perception on the Subject of Cancer Care in Remote Area appropriately manage patient follow up compared to patients managed by outpatient oncology clinics. In reality, general physicians are better placed to holistically handle the health problem of cancer patients, which include not only the sequelae of the cancer and its treatment but often also include other issues unrelated to cancer [4]. It has long been recognized that two way communications plays a central role in providing high-quality patient care and that effective communication improves health outcomes. The most basic element of the communication is a timely, clear and complete exchange of information between the medical professionals responsible for caring for one specific cancer patient.5 General physicians based in rural and remote areas, often out of necessity, play a much greater role in coordinating care of cancer patients, clinical interventions and psychosocial care than their urban counterparts [5].
Health literacy has been recognized as a critical factor affecting the field of cancer care, from prevention and screening, to explanations of diagnoses and treatments. It may also affect cancer patients' adherence to treatment, understanding of treatment goals like curative or palliative, and health-related decision making. Cancer patients with low or moderate health literacy are at risk of poor decision outcomes and more likely to report low levels of perceived care coordination and low satisfaction with care coordination [6].

Materials and Methods
This study survey was conceived in the primary health care professional practicing in rural field area and the adjoining area of urban district of Rajasthan. The survey sample comprised views of 157 health care professionals. This study survey was done from January 2018 to April 2018. The survey design required using an approach that would yield information about perception of health care professionals in cancer care.

Study Design
Community based prospective cross sectional survey in primary health care professionals.

Instruments and Techniques
As this survey's aim was to explore the perception of cancer care in remote areas, we considered that in-depth semi-structured questionnaire based interviews with health care professionals were the most appropriate research technique to capture the information. The questionnaire was designed by the authors to find out health care professionals preferences for involvement in managing cancer patients. As no pre-existing evaluation tool was available to measure this type of questionnaire items. The questionnaire was developed with reference to the literature on the aspects of cancer care provided by health care professionals and importance of these questioned were discussed with the clinicians and academics fellow for validity and acceptability of the questionnaire items. To maximize response rates, the questionnaire was limited to one page and was designed to be completed in approximately 5 min. Most questions were closed questions requiring responses to be ticked. Health care professionals were also invited to make comments at the end of the questionnaire.

Results
This survey investigates perception of primary health care professional in remote area and identifies common elements of practice for cancer care. To understand how cancer services are provided to rural and remote communities, it was essential to understand the insight of health care professional.
The survey sample comprised views of 157 health care professionals from Rajasthan. This study survey was done from January 2018 to April 2018. The details of responses to the pre-set 09 questionnaire are given in Table 1.
The large majority (93%) were regularly involved in oncology CMEs and conferences to update him regardless of number of cases seen in oncology areas.
Majority of the participants (58%) felt that screening camps in rural areas are important means of spreading the awareness in low health literacy level population while ~40 % participants felt that they have no time for these activities because of heavy burden of non oncology patient load at primary center and other administrative activities.
Only 32% respondents were investigate the patients initially to approach to the cancer care while a good number of respondents (66%) felt that lack of specialty and facility, motivated him to refer the cases at higher center. With the same thought 85% of participants felt that lack of specialization in oncology acted as barrier in treatment at primary center. Irrespective of clinical diagnosis all participants told that they are usually involved in the council part and provide psychological support to the patients.
However, it was noticeable that more than 70% of the responding primary care professionals were not involved in follow-up to the patients after referrals, because after a one or two follow-up visit, patients were become lost to follow-up.
More than half (57%) of our participants were aware that earlier investigation at primary center have an important impact on the treatment cycle.

Discussion
The primary health care professionals hold a custodian position, referring to their role of mediating the transition of suspected malignancy cases from primary center to appropriate specialists through referral. Ensuring this is done efficiently and not unreasonably requires health care professionals to engage in thorough diagnostic workups.
In this survey health care professionals described that remote location contributed to or hindered their involvement in cancer management. Far away location from major cities and absence of specialist oncology services in rural areas as a particularly important factor for rural health care professionals who often played a more