Assessing regional disparity in prevalence of poor psychosocial adjustment to illness among cancer patients in China

This study aseesses regional disparity in prevalence of poor psychosocial adjustment to illness (PPAI) among cancer patients in China. A total of 603 cancer patients recruited from Shanghai, Sichuan, and Zhejiang/Jiangsu constitute the sample for the study. The self-report psychosocial adjustment to illness scale PAIS-SR was used to measure poor psychosocial adjustment. The standardization and decomposition analysis (SDA) was applied to decompose the regional difference of poor PPAI prevalence into 1) the “real” difference that is attributed to factor-specific rate difference; and 2) confounding effects that are attributed to differences in compositions of specific confounding factors. Our results show that the prevalence rate of PPAI and compositions of confounding factors, such as patient-doctor communication, patient's self-efficacy, and patient's social support, significantly varies across regions. Composition differences in confounding factors significantly contribute to regional difference of PPAI prevalence. The most important confounding factors are self-efficacy and social support. For example, in comparison between Zhejiang/Jiangsu and Sichuan, the two factors accounted for 32.46% and 31.29% of the observed difference in PPAI prevalence, respectively. Although patient-doctor communication had statistically significant relationship with PPAI prevalence, its composition did not significantly vary across regions; as a result, its component effect was not statistically significant in our SDA.