{"paper_id":"b21d08b5-132d-4e49-8f0f-c62b9aac6e9a","body_text":"International Journal of Frontiers in Medicine \nISSN 2706-6819 V ol.4, Issue 9: 1-5, DOI: 10.25236/IJFM.2022.040901 \nPublished by Francis Academic Press, UK \n-1- \nWillingness and Influencing Factors of Long-Term \nDrug Treatment in Endometriosis Patients \nJialan Chen1, Xin Shen1, Qinfeng Liu2,*, Fan Wang1 \n1Gynecology Department, Shaanxi Provincial People's Hospital, Xi’an, China \n2Medical Equipment Management Department, Shaanxi Provincial People's Hospital, Xi’an, China \n*Corresponding author \nAbstract: Objective: To explore the  long-term drug treatment willingness and influencing factors of \nendometriosis. Method: The information was collected from 200 endometriosis patients who were \nadmitted to the gynecology clinic and ward of Shaanxi Provincial People’s Hospital from June 2019 to \nDecember 2020. Data was analyzed by univariate and multivariate logistic regression analysis. The \ninfluence of age, education level, diagnosis method, pre-treatment pain score, cyst diameter, EMs disease \ncognition and monthly treatment cost, pain relief satisfaction after treatment, drug toxicity tolerance and \ndrug use method on the willingness and duration of long-term drug treatment was investigated. Results: \nThe results of multivariate logistic regression analysis showed that diagnostic methods (OR = 0.304, 95% \nCI 0.127 - 0.728), pre -treatment pain score (OR = 1.415, 95% CI 1.237 - 1.620) and EMs disease \ncognition (OR = 1.058, 95% CI 1.030 - 1.087) were the main factors affecting the treatment willingness \nof EMs patients, and the drug use method was a  key factor affecting the treatment duration (P<0.05). \nConclusion: In the future, the adequate health education should be given to the EMs patients to promote \ntheir cognitive level of disease and recognition of diagnostic methods. At the same time, patient s’ \npreferences for treatment measures should be combined to improve their long- term drug treatment \nwillingness. \nKeywords: Endometriosis, long-term drug treatment, treatment willingness, influencing factor \n1. Introduction \nEndometriosis (EMs) is one of the comm on gynecological diseases, about 10% of women of \nchildbearing age worldwide are involved, and its incidence has been increasing in recent years [1-3]. \nAlthough EMs is a benign disease, it has tumor properties such as invasion, dissemination, metastasis \nand recurrence, and also has malignant potential[4, 5]. At present, surgery is the main treatment for EMs, \nbut conservative surgery  is usually difficult to cure. Therefore, drug therapy is an important adjuvant \ntherapy for EMs, and patients need long -term management after surgery. However, there is no mature \nand standardized long -term management plan in this regard at home and abroad.  In this study, the \ncognition of EMs and its treatment and the willingness and needs for treatment were obtained by health \neducation and questionnaire. On this basis, the willingness and influencing factors of patients for long -\nterm drug treatment were explored, which can provide the basis for future clinical practice. \n2. Object and Methods \n2.1. Object \nThe EMs patients who were admitted to the gynecological clinic and ward of Shaanxi Provincial \nPeople’s Hospital from June 2019 to December 2020 were selected as subjects. Patients who meet the \ncriteria were enrolled in this study: women in adolescence, childbearing age and perimenopause who \nwere suggested EMs cyst by B-ultrasound or MRI, with dysmenorrhea with painful nodules of posterior \nvaginal vault, or with sexual intercourse pain or post -sexual intercourse pain with painful tubercle of \nposterior vaginal dome, or EMs confirmed by laparoscopic exploration. The following patients were \nexcluded: those of pelvic lump suggested by B-ultrasound or MRI and EMs being excluded after repeated \nreexamination, those of tumor malignancy suspected with the elevation of marker CA125 and HE4, those \nwho cannot cooperate with health education and questionnaires due to various reasons. \n\nInternational Journal of Frontiers in Medicine \nISSN 2706-6819 V ol.4, Issue 9: 1-5, DOI: 10.25236/IJFM.2022.040901 \nPublished by Francis Academic Press, UK \n-2- \n2.2. Methods \nA qualitative research was conducted to enlist EMs patients diagnosed by clinical diagnosis and \npostoperative diagnosis. The patients were given health education, and the questionnaires before and \nafter the education and review after six months were  collected. After that, the relationship between the \nbasic information (including age, educational level, diagnostic methods, pre -treatment pain score, cyst \ndiameter and EMs disease cognition), monthly treatment cost, satisfaction of pain relief after treatment, \ntolerance of drug side effects, and drug use methods and patients’ treatment willingness and treatment \nduration were analyzed. Then the status of each factor in the willingness and persistence of long- term \ndrug treatment of EMs patients was evaluated.  \n2.3. Satistical Method \nThe data were processed by SPSS 25.0 software. The factors affecting treatment willingness and \ntreatment duration were screened separately by univariate logistic regression, and the variables with P < \n0.05 were included in the multiva riate logistic regression model. Then the main factors affecting \ntreatment willingness and treatment duration were analyzed by step method.  \n3. Results \n3.1. General Data \nA total of 200 EMs patients were investigated, and all of them completed the questionnaire. The data \nof patients before long-term drug treatment were analyzed, including age, educational level, diagnostic \nmethods, pre-treatment pain score, cyst diameter and EMs disease cognition, as shown in Table 1. \nTable 1: Basic information of research objects \nItem (n=200) \nage (year, x ±s) 34.15 ± 7.646 \neducational level (number, %)  \nprimary school 12 (6) \njunior high school 25 (12.5) \nhigh school 45 (22.5) \nundergraduate ( including college ) 76 (38) \nmaster 27 (13.5) \ndoctor 15 (7.5) \ndiagnostic method (number, %)  \npathological diagnosis 50 (25) \nclinical diagnosis 150 (75) \npre-treatment pain score (score, x ± s) 5.03 ± 2.703 \ncyst diameter (score, x ± s) 43.45 ± 7.204 \nEMs disease cognition (score,  x ± s) 31.62 ± 14.477 \n3.2. Logistics Regression Analysis of Factors affecting Patients’ Treatment Willingness \nTable 2: Analysis of factors influencing treatment willingness \nFactors Univariate logistic regression analysis multivariate logistic regression analysis \nOR (95% CI) P value OR (95% CI) P value \nage 1.019 (1.011-1.028) 0.000 0.980 (0.942-1.020) 0.332 \neducation level 1.231 (1.111-1.363) 0.000 0.915 (0.694-1.205) 0.527 \ndiagnosis method 1.632 (1.173-2.260) 0.004 0.304 (0.127-0.728) 0.008 \npre-treatment pain score 1.209 (1.138-1.284) 0.000 1.415 (1.237-1.620) 0.000 \ncyst diameter 1.016 (1.009-1.022) 0.000 0.981 (0.945-1.018) 0.306 \nEMs disease cognition 1.027 (1.018-1.037) 0.000 1.058 (1.030-1.087) 0.000 \nmonthly treatment cost (RMB)  0.000  0.902 \n≤300(ref) 1.000  1.000  \n300-500 2.000 (1.290-3.100) 0.002 1.051 (0.448-2.466) 0.908 \n500-1000 2.263 (1.319-3.883) 0.003 1.229 (0.474-3.188) 0.672 \n\nInternational Journal of Frontiers in Medicine \nISSN 2706-6819 V ol.4, Issue 9: 1-5, DOI: 10.25236/IJFM.2022.040901 \nPublished by Francis Academic Press, UK \n-3- \nUnivariate logistic regression analysis was performed on all the seven related factors, such as age, \neducation level, diagnosis method, pre -treatment pain score, cyst diameter, EMs disease cognition and \nmonthly treatment cost, which may affect the treatment willingn ess of the investigated objects. The \nresults showed that the seven factors included in the statistics were all related to the treatment willingness \nof EMs patients. Furthermore, multivariate logistic regression analysis was performed on the seven \nfactors, and the results showed that diagnostic methods (OR = 0.304, 95% CI 0.127 -  0.728), pre -\ntreatment pain score (OR = 1.415, 95% CI 1.237 - 1.620) and EMs disease cognition (OR = 1.058, 95% \nCI 1.030 - 1.087) were the main factors affecting the treatment willingness of EMs patients, as shown in \nTable 2. \n3.3. Logistics Regression Analysis of Factors affecting Patient Treatment Duration \nAccording to the treatment duration, the subjects were divided into persistent long -term drug \ntreatment group (≥ 3 months) and non- long-term treatment group (0 -3 months, including the patients \nwho refused drug treatment). With this as the dependent variabl e, univariate logistic regression and \nmultivariate logistic regression were performed on the 10 factors of age, education level, diagnosis \nmethod, pre-treatment pain score, cyst diameter, EMs disease cognition, monthly treatment cost, pain \nrelief satisfaction after treatment, drug toxicity tolerance and drug use method. The results showed that \nthe drug use method was a key factor affecting the treatment duration (P<0.05), while the other 9 factors \nhad no statistically significant effect on the treatment duration, as shown in Table 3. \nTable 3: Analysis of factors influencing treatment duration \nFactors Univariate logistic regression analysis multivariate logistic regression analysis \nOR (95% CI) P value OR (95% CI) P value \nage 0.988 (0.980-0.996) 0.004 1.038 (0.999-1.078) 0.058 \neducation level 0.839 (0.759-0.927) 0.001 0.894 (0.703-1.135) 0.357 \ndiagnosis method 0.630 (0.454-0.876) 0.006 1.006 (0.508-1.994) 0.986 \npre-treatment pain score 0.933 (0.888-0.981) 0.007 1.024 (0.915-1.146) 0.679 \ncyst diameter 0.989 (0.982-0.995) 0.001 0.976 (0.944-1.010) 0.164 \nEMs disease cognition 0.990 (0.982-0.998) 0.016 1.011 (0.990-1.302) 0.304 \nmonthly treatment cost (RMB)  0.042  0.218 \n≤300(ref) 1.000  1.000  \n300-500 0.920 (0.522-1.621) 0.773 1.739 (0.782-3.871) 0.175 \n500-1000 0.579 (0.377-0.889) 0.012 0.904 (0.438-1.865) 0.785 \npain relief satisfaction after \ntreatment 0.660 (0.484-0.901) 0.009 1.609 (0.722-3.584) 0.245 \ndrug toxicity tolerance 0.557 (0.358-0.805) 0.002 0.663 (0.355-1.239) 0.198 \ndrug use method  0.002  0.049 \nlong-term oral(ref) 1.000  1.000  \nintermittent oral 0.410 (0.229-0.734) 0.003 0.209 (0.070-0.626) 0.005 \nsubcutaneous injection 0.651 (0.405-1.048) 0.077 0.320 (0.110-0.928) 0.036 \nintrauterine placement 0.606 (0.348-1.056) 0.077 0.325 (0.111-0.953) 0.041 \n4. Discussion \nEMs is a chronic disease that can cause painful symptoms (such as dysmenorrhea, chronic pelvic pain) \nand infertility, and some patients even have a series of mental symptoms (such as depression and anxiety), \nwhich seriously affect the life quality of patients [6-8]. In recent years, drug maintenance in the EMs \ntreatment to control pain and prevent recurrence has been respected, and an expert consensus has been \nreached [9, 10]. Meanwhile, guidelines for the diagnosis and treatment of EMs have been issued in China \n[10]. At Present, the long -term management principle of EMs is clinical problem -oriented, patient-\ncentered, age-stage treatment and comprehensive treatment [11]. Therefore, understanding the willingness \nand influencing factors of long -term drug treatment  for EMs is conducive to the implementation of \ntargeted interventions and obtaining satisfactory treatment effects. \nIn this study, a total of 200 EMs patients were investigated. Through the logistic regression analysis \nof seven related factors that may affect the treatment willingness of the investigated objects, it was found \nthat the diagnostic method is a crucial factor affecting the willingness of patients to receive long -term \ndrug treatment. The possible reason is that the diagnostic method directly det ermines the patient’s \njudgment on the accuracy of disease diagnosis, and the higher the patient’s inner recognition of the \ndisease state is, the easier it is to accept treatment. Meanwhile, the stronger the ability to overcome \n\nInternational Journal of Frontiers in Medicine \nISSN 2706-6819 V ol.4, Issue 9: 1-5, DOI: 10.25236/IJFM.2022.040901 \nPublished by Francis Academic Press, UK \n-4- \nvarious difficulties encountered in disease treatment, the more able to adhere to long-term drug treatment.  \nThe pre-treatment pain score is another major factor affecting the treatment willingness, the possible \nreason is that the pain score is closely related to the direct feelings o f patients. And the higher the pre -\ntreatment pain score, the more intense the physical and mental distress caused by the disease, which \ndrives the patients to actively seek treatment and change passive treatment to active treatment. In addition, \nEMs disease cognition is another major factor that affecting patients’ treatment willingness. This is \nbecause the full understanding of EMs disease can enable the patients to predict in advance the serious \nconsequences that caused by non -standard and not timely trea tment, so as to understand the treatment \nadvice given by the doctor in charge. Then the patients can actively respond to the treatment plan and \nconsciously form a united front with doctors to fight against the disease.  \nFurthermore, through the statistical analysis of the data of the two groups of patients who adhere to \nthe long-term drug treatment group (≥ 3 months) and the non-long-term treatment group (0-3 months), it \nis found that the drug use method is the key factor affecting the treatment duration, and the difference is \nstatistically significant ( P < 0.05). Among them, long- term oral is the most acceptable treatment for \npatients, which is easier to adhere to for a long time, while the other three methods of intermittent oral, \nsubcutaneous injection and intrauterine placement are shorter than long -term oral. The reason may be \nthat long-term oral therapy is accurate, with mild side effects and easy to form a daily regular medication \nhabit, and it is easy to adhere to. The common drugs for intermittent oral therapy, such as pain relievers \nand traditional Chinese medicines, have relatively poor efficacy. And they are often used after patients \nwith symptoms, which may easily give patients the impression of poor efficacy, and the treatment is \neasily interrupted. The subcutaneous injection drugs are mainly GnRH -a drugs\n[12], which often have \nobvious menopause symptoms and osteoporosis, and obvious discomfort are caused. Intrauterine \nplacement of drugs (Miren a) often causes persistent spotting, which affects life and causes anxiety in \npatients.  \nUsually, the pain relief satisfaction after treatment and monthly treatment cost are also important \nfactors that affect whether patients can receive long -term treatment, but this conclusion is not reflected \nin the study. The possible reason is that the pain relief was roughly divided into two groups of satisfactory \nand unsatisfactory in the study, which affects the research precision to some extent. Moreover, regarding \nthe monthly treatment cost, patients pay more attention to the treatment effect.  \nAuthors’ contributions \nJialan Chen contributed to the data collection and manuscript writing. Qinfeng Liu contributed to the \ndata collection and data analysis. Fan Wang contributed to the data collection. Xin Shen helped perform \nthe data analysis. 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