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Objective To investigate current status and influencing factors of patient delay in patients with advanced hepatocellular carcinoma and provide a theoretical evidence for the early diagnosis of HCC. Methods All patients with a primary diagnosis of advanced HCC admitted at Department of Hepatobiliary Medicine I, Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University from January 2015 to October 2015 were investigated prospectively. The current status of patient delay was assessed by medical records and influencing factors of patient delay were analyzed by the self-designed questionnaires. Results Rate of patient delay in the patients with advanced HCC was 27.7%(53/191). The univariate analysis demonstrated that significant influencing factors for patient delay included age, education levels, economic status, place of residence, medical insurance, knowledge about follow-up examination for chronic viral hepatitis. The rate of patient delay was high in these patients with older age, lower income, less education, place of residence (countryside or small towns), new rural insurance, lack of the knowledge about follow-up examination for chronic viral hepatitis. Multivariate analysis showed that age and lack of the knowledge about follow-up examination for chronic viral hepatitis were significantly independent predictors for patient delay. Their OR (odd ratio) and 95%CI (confidence interval) were 2.770 and 1.424-5.388, 7.867 and 1.669-37.092, respectively. According to place of residence, the univariate analysis demonstrated that significant influencing factors for patient delay included marital status, age, economic status, and knowledge about follow-up examination for chronic viral hepatitis in the countryside or small towns. Multivariate analysis also further showed that age and lack of the knowledge about follow-up examination for chronic viral hepatitis were significantly independent predictors for patient delay. Their OR and 95% CI were 3.812 and 1.550-9.373, 15.400 and 1.793-132.245, respectively. Patient delay of HCC patients in county seat and city was not significantly associated with all of above mentioned influencing factors. Conclusions Patient delay of the patients with advanced HCC in countryside or small towns was comparatively common. To early find high risk factors of HCC, government should be intensified screening to chronic hepatitis B, hepatitis C in the middle and elderly population. To reduce the rate of patient delay in advanced HCC and improve results of treatment for advanced HCC, health care workers should popularize medicine-associated knowledge, especially about chronic hepatitis and its complications.
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Objective We aimed to investigate the role of McMaster model of family therapy in improving family function of patients with advanced hepatocellular carcinoma (HCC).Methods Patients who had advanced HCC and received transarterial embolization (TAE) or transarterial chemoembolization (TACE) from Department of Hepatobiliary Ⅰ,Eastern Hepatobiliary Surgery Hospital between October 1,2012 and June 25,2013 were randomly divided into two groups:the experimental group (51 patients) and the control group (49 patients).The control group received routine family support education.The experimental group not only executed routine family support education,but also was given McMaster model of family therapy according to evaluation results of family assessment device (FAD) on the second and third day of hospitalization.The status of family function of all patients were assessed by FAD on the fnrst day of hospitalization and fourth week after therapy.We compared the status of family function between the two groups.Results In age,gender,educational level,place of residence,occupation,family economic status,medical payment,liver or kidney function,HBV infection,cirrhosis and tumor burden,no statistical differences were found between the experimental group and the control group patients before TAE or TACE.Two groups were dysfunction in communication,roles,affective responsiveness,affective involvement,behavior control,and general function in addition to problem solving before TAE or TACE.No statistical differences were found between two groups.After the therapy,compared with the control group,those patients in the experimental group had a lower level scoring in communication,roles,affective responsiveness,affective involvement,behavior control,and general function in addition to problem solving on the fourth week after the therapy,t value was-2.544,-3.767,-3.904,-2.848,-4.950 and-4.953,the difference had statistical significance.Conclusions McMaster model of family therapy may help to improve family function of patients with advanced HCC.