An international study of clinical, demographic and competence-related determinants of communication with professionals

An international study of clinical, demographic and competence-related determinants of communication with professionals | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article An international study of clinical, demographic and competence-related determinants of communication with professionals Juan Ignacio Arraras, Johannes Giesinger, Omar Shamieh, Iqbal Bahar, and 18 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4456065/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 05 Dec, 2024 Read the published version in Supportive Care in Cancer → Version 1 posted 8 You are reading this latest preprint version Abstract Purpose: This study aims to identify the clinical and demographic determinants of patients’ communication with professionals in an international sample of cancer patients. Methods: Cancer patients completed EORTC communication questionnaire QLQ-COMU26 to assess ten areas of communication with their doctor or nurses plus another item to assess how competent they felt when communicating with professionals. Bivariable analyses and multivariable linear regression models were performed separately for each QLQ-COMU26 area. Results: 988 patients from 15 centres in 13 countries (five cultural areas) were included in the study. Higher age was related to higher level of communication in eight QLQ-COMU26 areas. Males reported higher level of communication in three areas. Lower levels of studies and a higher level of perceived competence when communicating with professionals were related to higher level of communication in the ten QLQ-COMU26 areas. Communication was of a higher level with nurses than with doctors in four areas. Having received previous treatment with the same doctor or group of nurses was related to higher communication levels in seven areas. Lack of comorbidity was related to higher communication levels in two areas. Various differences in determinants were found among tumour sites Conclusion Our regression model has shown several relationships between communication and the demographic and clinical variables that may help to identify patients at risk of poor communication. Future studies could focus on communication at diagnosis and in follow-up, and on areas such as assessing the particularities of communication between patient and professionals in relation to each cancer type. Communication cancer determinants EORTC. INTRODUCTION Communication between patients and health professionals is a crucial element of the support provided to cancer patients [ 1 , 2 ]. Carlson et al. [ 3 ] presented two aims of communication based on Feldman-Stewart’s theoretical framework for communication between patient and professional [ 4 ]: primary aims, which are directly linked to the communication process, such as offering support, providing better information, and enhancing patient education and understanding; and secondary aims, which are indirect consequences of effective communication, such as psychological functioning and Quality of Life (QoL). The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group (QLG) has developed a cancer-specific communication questionnaire – the EORTC QLQ-COMU26 – which evaluates various dimensions of patients’ communication with their healthcare professionals [ 5 ]. Based on Epstein and Street’s core functions of the Patient-Centred Communication model (PCC) [ 6 ], this cancer-specific communication questionnaire assesses some of the primary goals of communication presented by Carlson et al. [ 3 ]. It was developed in a cross-cultural setting with patients from five cultural areas and is applicable across different cultures [ 7 ]. Patient communication competence, which includes skills in providing information (e.g., expressing concerns) and asking questions [ 8 – 10 ], plays a crucial role in patient-professional communication as it may have a positive effect on PCC. It may be interesting, therefore, to study in greater detail how patients perceive their medical communication competence [ 11 ]. Communication between cancer patients and professionals and finding ways to improve this communication are important fields of research [ 12 ]. Numerous studies have analysed the determinants of good communication between patients and professionals. These studies have helped to identify patient groups whose communication with professionals may be more limited and in need of further attention [ 13 ]. The majority of these studies have been conducted in just one country [ 14 ] and at one tumour site [ 15 ] or just a few sites. Clinical and demographic variables have been included in most cases, while other variables (such as patient competence) have been included in some. Studies of some determinants, such as education, have provided inconclusive results [ 16 , 17 ]. This paper studies a combination of determinants of cancer patients’ perception of their communication with health professionals (doctors and nurses), i.e., sociodemographic and clinical characteristics as well as an associated variable such as patient communication competence. Higher communication scores were expected from older patients [ 18 ], male patients [ 19 , 20 ], and patients with higher levels of education [ 17 , 21 ]. Higher scores were also expected from patients at initial disease stages [ 22 ], those without comorbidity [ 23 ], those who had previously received oncological treatment or treatment from the same doctor or group of nurses, and those with higher levels of communication competence [ 10 ]. Higher scores were also expected in communication with nurses [ 24 ]. This study was conducted with a large sample of patients from five cultural areas in Europe and Asia with different sociodemographic and clinical characteristics. We believe the size of our sample, the varied cultural, clinical and demographic characteristics of our participants, and the combination of variables under study help to provide more solid conclusions. MATERIALS AND METHODS Patients Patients were included in the study if they were aged 18 years or over, they had been diagnosed with (primary or recurrent) cancer at any cancer site, their cancer was at an initial or advanced stage, they were undergoing any treatment (e.g., radiotherapy (RT) or chemotherapy (CT), whether or not they had previously undergone surgery), at any treatment line, and they were able to understand the language of the questionnaire and to complete it. Patients were excluded if they had any concurrent malignancies or had participated in QoL trials that could interfere with the study. To ensure cross-cultural applicability, patients were enrolled from English-speaking countries, from northern, southern, and eastern European countries, and from other regions (India, Japan and Jordan) [ 7 ]. Study design The patients recruited for this prospective study were approached when they began a treatment line. Two main patient groups were created based on whether the treatment intent was 1) radical/curative, or 2) palliative/symptom-relieving (with no prospect of cure). Communication was assessed with doctors and nurses whose regular timetables for patient consultations can usually be compared. Patients evaluated one doctor or a group of nurses. Based on our experience with patients’ preferences for communication with doctors, we focused our assessment on doctor-patient communication more than on nurse-patient communication [ 5 ]. However, we also aimed to adequately represent patient communication with nurses. Patients’ assessment Patients were approached around the first day of a treatment line and asked to assess their communication with their doctor or nurses only during their first days of treatment (i.e. not at diagnosis, in follow-up or during prior treatment lines). Patients completed the EORTC QLQ-COMU26 communication questionnaire. This questionnaire evaluates cancer patients’ perspective on their communication with their healthcare professionals. It is applicable across cancer diagnoses and treatment stages (diagnosis, treatment or follow-up), and includes palliative care. Patients indicate which professional category they are evaluating, i.e. doctor(s), nurse(s), psychologist(s), or other professional(s) and which specific treatment period they are evaluating, i.e. diagnosis, treatment or follow-up. The questionnaire comprises 26 items, which are divided into six scales plus four individual items that mainly assess behaviours related to communication [ 5 ]. Scores range from 0 to 100. A high score means a high level of communication in all scales and items. The structure of the questionnaire is presented in Table 1 . Table 1 STRUCTURE OF THE EORTC-COMU26. SCORES OF THE SAMPLE SCALE AND CONTENT MEAN (S.D.) Scale 1 patient’s active role-behaviours. 82.7 (22.7) Patients have enough opportunities to talk with the professionals Feel free to ask questions Have the opportunity to express their emotions Scale 2 aspects of the clinician-patient relationship. 85.4 (21.3) Shared understanding of the disease and treatment Mutual trust between patient and professionals Professionals have spent enough time talking with patients Scale 3 professional’s qualities creating a relationship. 90.2 (16.9) Approach as an equal Show sincerity Make it easy to talk openly about concerns Treat the patient with respect Take patient’s problems seriously Scale 4 professional’s skills 90.2 (15.8) Use language patient understands Answer questions openly Look at patient Calm voice Scale 5 professional’s management of patient’s emotions 85.6 (22.6) Try to understand patient’s situation Listen when patient expresses emotions Help patient to manage their emotions Scale 6: professional’s skills related to information 81.7 (24.6) Check patient’s previous level of information. Check patient’s understanding of information Answer difficult questions Explain the aims of the treatment Individual items Professionals take into account patient’s preferences on how the information should be offered 78.4 (32.4) Professionals correct misunderstandings in information 83.8 (26.8) Enough privacy 84.6 (27.2) Satisfaction with the communication with professional 88.8 (21.3) EORTC QLQ-COMU26 is available in English and in fourteen other language versions (each version has been developed in accordance with EORTC translation procedure), including those of the participating centres [ 25 ]. The questionnaire and its scoring instructions are available from the EORTC at https://qol.eortc.org/form/#1 . An item created for this study asked patients to assess how competent they felt when communicating with their professionals (doctor and/or nurses) using a 10-point Likert scale with responses ranging from 0 (not competent at all) to 10 (very competent). Socio-demographic and clinical data were also collected at the first time point. Statistical analysis Descriptive analysis was performed on the demographic and clinical variables, the QLQ-COMU26, and the item on competence when communicating with professionals. As a first step, the scores on the QLQ-COMU26 scales and items were compared using T-tests or ANOVA for independent samples of differences between patient groups defined by (1) the demographic variables: age (≤ 50, 50–70, > 70 years), gender, education level, and professional assessed (doctor, nurse); (2) the clinical variables: anatomical location of the primary tumour, current disease stage; presence of co-morbidity (other serious medical conditions, yes or no); and any previous oncological treatment (yes or no); and (3) the other variables: the patient had received previous treatment with the same doctor or group of nurses; and the patient’s perceived level of competence when communicating with their professionals (< 7/ 7–8 / 8–10 / 10) (P < 0.05). All determinants that were significant in the bivariable analyses were included in the multivariable linear regression models separately for each QLQ-COMU26 area. Determinants that were not significant in the multivariable model were removed (backward elimination P < 0.10) to obtain the final model for predicting the QLQ-COMU26 scales. Age and gender were included as adjustment variables in the analyses of all QLQ-COMU26 areas. Anatomical location of the primary tumour was divided into the following four tumour locations: lung, head and neck (reference); colorectal, oesophageal and stomach; breast; and other. RESULTS Characteristics of the sample A total of 988 patients from 15 centres in 13 countries participated in this study. Their demographic and clinical characteristics are shown in Table 2 . Table 2 DEMOGRAPHIC AND CLINICAL CHARACTERISTICS OF THE SAMPLE. All (n = 988) Country, n (%) Austria (Innsbruck & Graz) 61 (6.2%) Japan (Kobe & Kyoto) 31 (3.1%) Jordan (Amman) 244 (24.7%) Greece (Athens) 15 (1.5%) France (Paris) 52 (5.3%) Spain (Pamplona) 205 (20.7%) Portugal (Ponta Delgada) 30 (3.0%) United Kingdom (Poole) 18 (1.8%) Germany (Regensburg) 53 (5.4%) Croatia (Rijeka) 33 (3.3%) Italy (Rome) 33 (3.3%) Poland (Rzeszów) 13 (1.3%) India (Silchar) 200 (20.2%) SOCIODEMOGRAPHIC Age, mean (SD) 60.7 (13.8) ≤ 50 years 220 (22.3%) 50–70 years 510 (51.8%) > 70 years 255 (25.9%) Missing 3 Gender, n (%) Male 487 (50.0%) Female 487 (50.0%) Missings 14 Highest level of education, n (%) Less than compulsory school education 171 (17.6%) Compulsory school education 301 (30.9%) Post compulsory education below university level 248 (25.5%) University level 253 (26.0%) Missings 15 Cohabitation, n (%) Living alone 96 (9.8%) Living with partner 280 (28.7%) Living with family 577 (59.2%) Living with other adults 22 (2.3%) Missings 13 INFORMATION RELATED TO PROFESSIONALS AT STUDY ENTRY Professional assessed, n (%) Doctor 570 (58.1%) Nurse 411 (41.9%) Missings 7 CLINICAL INFORMATION AT STUDY ENTRY Anatomical location of the primary tumour, n (%) Lung 134 (13.6%) Colorectal 129 (13.1%) Breast 235 (23.9%) Gynecologic system (ovarian. endometrium. cervix) 67 (6.8%) Head and neck 113 (11.5%) Prostate 38 (3.9%) Other genito-urinary (kidney. ureter. bladder. testis) 37 (3.8%) Oesophageal. stomach 51 (5.2%) Brain 21 (2.1%) Hematologic 36 (3.7%) Other 122 (12.4%) Missings 5 Known current Disease stage, n (%) Initial 504 (51.4%) Advanced 477 (48.6%) Missings 7 Metastases, n (%) Yes 378 (38.5%) No 605 (61.5%) Missings 5 Co-morbidity (other serious medical conditions), n (%) Yes 196 (20.1%) No 780 (79.9%) Missings 12 Patients has received previous treatment with the same doctor or group of nurses, n (%) Yes 404 (41.6%) No 568 (58.4%) Missings 16 PREVIOUS TREATMENT Any, n (%) Yes 616 (62.3%) No 372 (37.7%) ADDITIONAL QUESTIONS 1. During the consultation, I felt competent in communicating with the professional I met 8.1 (1.8) < 7 193 (19.9%) [ 7 – 8 ] 291 (30.0%) (8–10) 219 (22.6%) 10 266 (27.5%) Table 3 A. MULTIVARIABLEVARIABLE ANALYSIS OF THE RELATIONSHIPS BETWEEN HEALTH-RELATED DETERMINANTS AND SCALE 1 (ACTIVE), SCALE 2 (RELATIONSHIP) AND SCALE 3 (QUALITIES). Scale 1. Active Scale 2. Relationship Scale 3. Qualities Beta (SE) p-value 95% IC Beta (SE) p-value 95% IC Beta (SE) p-value 95% IC Intercept 52.07 (5.02) 0.000 42.22, 61.92 51.49 (4.65) 0.000 42.36, 60.62 65.39 (3.69) 0.000 58.15, 72.63 Age 0.14 (0.05) 0.005 0.04, 0.24 0.15 (0.05) 0.002 0.05, 0.24 0.06 (0.04) 0.097 -0.01, 0.14 Gender (Ref: Male) Female 0.52 (1.66) 0.754 -2.73, 3.78 0.18 (1.54) 0.905 -2.84, 3.2 -1.65 (1.22) 0.176 -4.05, 0.74 Highest level of education (Ref: Less than compulsory education) Compulsory education -5.37 (2.17) 0.014 -9.64, -1.1 -3.5 (2.01) 0.083 -7.46, 0.45 -3.59 (1.6) 0.025 -6.73, -0.46 Post-compulsory education below university level -12.03 (2.22) 0.000 -16.4, -7.67 -10.3 (2.06) 0.000 -14.34, -6.26 -8.11 (1.63) 0.000 -11.32, -4.91 University level -14.24 (2.28) 0.000 -18.73, -9.76 -12.21 (2.11) 0.000 -16.35, -8.07 -10.49 (1.67) 0.000 -13.77, -7.2 Professional assessed (Ref. Doctor) Nurse 3.42 (1.44) 0.018 0.6, 6.23 ns ns Anatomical location of the primary tumour (Ref: Lung / Head and neck) Colorectal / Oesophageal, stomach -5.42 (2.4) 0.024 -10.12, -0.72 -3.92 (2.22) 0.077 -8.27, 0.43 -1.13 (1.76) 0.522 -4.58, 2.32 Breast -4.1 (2.17) 0.059 -8.37, 0.16 -4.69 (2.01) 0.020 -8.63, -0.74 -2.38 (1.59) 0.136 -5.5, 0.75 Other 1.21 (1.88) 0.517 -2.47, 4.9 1.75 (1.73) 0.312 -1.64, 5.13 2.91 (1.37) 0.034 0.23, 5.6 Known current disease stage (Ref. Initial) Advanced ns ns ns Co-morbidity (Ref. No) Yes ns ns ns Patient has received prior treatment with the same doctor or group of nurses (Ref. No) Yes 4.9 (1.47) 0.001 2.01, 7.78 5.67 (1.36) 0.000 3, 8.33 4.22 (1.08) 0.000 2.11, 6.33 1. During the consultation, I felt competent in communicating with the professional I met 3.51 (0.39) 0.000 2.74, 4.29 3.8 (0.36) 0.000 3.09, 4.52 3.19 (0.29) 0.000 2.62, 3.75 Any prior treatment (Ref. No) Yes ns ns ns R 2 0.15 0.16 0.17 The mean age of the participants was 60.7, with the highest percentage of participants (51.8%) belonging to the 50–70 years group. The numbers of males and females were similar. Different education levels were represented, with the highest percentage of participants (30.9%) in the compulsory-education group. The percentage of patients who assessed their doctor was 58.1%, and the percentage of patients who had the disease at an initial stage was 51.4%. A variety of cancer sites (organized initially in ten categories and another ‘other tumors’ category) were represented in the sample. The percentage of patients who had limiting comorbidity was 20.1%. The percentage of patients who had received prior treatment with the same doctor or group of nurses was 41.6%, while 62.3% of the patients had received prior oncological treatment. The patients’ mean level of communicative competence was 8.1, with the highest percentage of patients (30%) scoring between 7 and 8. The scores obtained on the QLQ-COMU26 are shown in Table 1 . The results of the bivariable analysis of the relationship between the health-related determinants and the QLQ-COMU26 areas are shown in Supplementary table 1 . All determinants showed significant differences in one or more QLQ-COMU26 areas. The determinants associated with the highest number of QLQ-COMU26 areas were level of education (ten areas) and level of competence (also ten areas) and professional assessed (nine areas). The results of the multivariable analyses are shown in Tables 3 A to 3 D. Higher age was related to a higher level of communication (in all QLQ-COMU26 areas except the professional’s management of patient emotions and their correction of misunderstandings of information). Males considered their level of communication to be higher than females did in three areas (the professional’s management of patient emotions; the professional’s skills in relation to information; the professional’s consideration of their preferences in relation to information). Lower levels of studies were related to higher communication in the ten QLQ-COMU26 areas. The level of communication with nurses was considered to be higher than that with doctors in four areas (the patient’s active role-behaviours, the professional’s management of patient emotions, the professional’s skills related to information, and the professional’s consideration of patient preferences in relation to information). With regard to tumour site, lung-cancer patients showed higher communication levels than colorectal patients (in three areas) and breast-cancer patients (in four areas), while patients with other tumour sites showed a higher level of communication than lung-cancer patients in one area. Patients at initial disease stages showed a higher level of communication in one area (the professional’s consideration of patient preferences in relation to information). The presence of limiting comorbidity was related to a lower level of communication in two areas (the professional’s skills related to information; the professional’s consideration of patient preferences in relation to information). Having received previous oncological treatment was related to a lower level of communication in one area (enough privacy). Having received previous treatment with the same doctor or group of nurses was related to a higher level of communication in seven areas (the patient’s active role-behaviours; aspects of the clinician-patient relationship; the professional’s qualities when creating a relationship; the professional’s skills; the professional’s skills related to information; enough privacy; and satisfaction with the communication). A higher level of perceived competence when communicating with professionals was related to a higher level of communication in all ten QLQ-COMU26 areas. DISCUSSION This study, performed with an international sample of cancer patients, has shown that patients’ evaluation of their communication with healthcare professionals is related both to demographic factors (age, gender and level of education) and clinical factors (tumour site, disease stage, presence of limiting comorbidity, having received previous oncological treatment, the type of professional assessed, having received previous treatment with the same doctor or group of nurses, and their perceived level of communicative competence). The demographic (sex, age, and level of education) and clinical (main tumour sites and disease stages) characteristics of the sample may be considered adequate for this study. Sex, age, tumour site and stage are representative of the general population of cancer patients [ 26 ]. In this sense, the percentage of patients in the sample who were ≥ 50 years old was 77.7%, which is the range in which most new cancers are diagnosed. The different levels of education are represented in the sample. Also, patients from various cultural areas were widely represented. Scores were high in most QLQ-COMU26 areas, which indicates a good general level of communication. In line with both our hypothesis and the results of other studies [ 17 , 27 ], elderly patients evaluated their communication with healthcare professionals more highly than younger patients did. Moreover, other studies have shown that elderly patients also report a higher level of satisfaction with their communication than younger patients [ 18 , 28 ]. This difference in favour of older patients may indicate a change in patient-physician communication in recent decades: compared to previous generations of elderly patients, older cancer patients today may be willing to receive more medical information and to play a more active role in their care [8,KOP]. However, there is no conclusive answer in relation to age since other studies have found no age-related differences with regard to communication [ 29 , 30 ] (both of these studies comprised patients with a variety of ages). Further studies are therefore needed to clarify this issue. Males reported higher communication scores in most areas than females did. These results are in line with those from a study on communication in cancer patients with pain [ 23 ]. Other studies have found higher levels of general satisfaction among males in relation to communication with their physician [ 20 ], while still others have found higher levels of satisfaction among males in relation to information provision and the interpersonal skills of doctors and nurses [ 19 ]. These gender differences have been related to factors such as differences in communication preferences [ 31 ]. Some studies have found that if patients and professionals have the same gender, there may be an effect on communication with regard to issues such as female urinary incontinence [ 32 , 33 ]. It would be interesting to conduct more studies with professionals and patients of the same gender. Contrary to expectations, a lower level of education was related to a higher level of communication with healthcare professionals. This result may be considered positive since a lower level of education has been associated with a greater need for information among patients [ 34 ] and a greater influence of the doctor’s communication style on patient’s trust in their physician [ 15 ]. In line with our results, other studies have found that increasing levels of education are associated with lower scores for communication with professionals [ 16 ] and with lower satisfaction with communication (doctor availability) [ 24 ]. Several studies may help explain our results. For example, a higher education level has been associated with a lower frequency of disclosure in certain information areas (information about procedures) [ 16 ] and with fewer questions asked by physicians to patients [ 21 ]. However, other studies have found higher communication scores among patients with higher levels of education [ 17 ]. Communication with nurses showed higher scores than communication with doctors. Nurses are considered to play a key role in the areas of our study where they showed higher scores than doctors. These include providing emotional support or conducting the information-disclosure process [ 35 ], including clarifying or checking the patient’s understanding of information [ 36 ]. Similar results have been found in other studies [ 37 ]. For example, cancer patients treated at a day hospital showed a greater level of satisfaction with their communication with nurses than with doctors when it comes to interpersonal skills, availability, and information provision [ 24 ]. These differences notwithstanding, high scores were observed in both professional groups. Numerous clinical factors have been related to communication in our study. Differences between pairs of tumour sites (e.g. lung or head/neck compared with colorectal or oesophageal cancer) appeared in several areas of the questionnaire, and directions. Differences among tumour sites have also appeared in other studies and, as in our case, the areas of communication where the differences appeared, as well as the directions of the relationships, have been inconsistent [ 38 ]. Some confounding variables that were not included in our study may have influenced these results. Our study suggests that communication is better in one area (i.e. professionals take into account patient preferences on how the information should be offered ) in patients who are at the initial disease stage. Discrepancies between the information provided by professionals and the preferences of patients at advanced disease stages (despite this being a key area of communication) have been raised in various studies [ 39 ]. The lack of other significant differences between the two disease stages groups and the high scores found in most communication areas may be considered positive since communication is a key factor in the support offered to palliative patients [ 40 ]. Importantly, having been given prior treatment by the same doctor or group of nurses was related to higher levels of communication in seven areas. This may be due to positive aspects such as greater levels of trust with these professionals and more knowledge of the patient’s characteristics. A patient’s perceived higher level of communicative competence has been associated with higher communication scores in all QLQ-COMU26 areas. These results are in line with other studies that show that a patient’s communication skills exert a positive influence on the physician’s communicative behaviour [ 10 ]. For example, patients who actively participate in medical interviews have been shown to encourage physicians to adopt a more patient-centred style of communication [ 41 ]. Patients who report higher self-efficacy when interacting with a physician tend to seek more information from their professional [ 42 ]. Communication has been shown to improve as a result of training received by professionals [ 43 ]. It is also suggested that patients can increase their own communication competence if they also receive communication skills training [ 9 ]. STRENGTHS AND LIMITATIONS One strength of this study is that it was conducted with a large international sample of unselected participants from different cultures. Moreover, patients with different demographic and clinical characteristics were represented. As a result, we were able to reflect the usual clinical practice in countries from different cultural areas. Also, multivariable analyses were performed and a specific cancer questionnaire was administered to evaluate different communication dimensions. Both these aspects help provide more solid results. This study also has several limitations . Professionals’ assessment of their communication has not been recorded and interaction between patients and professionals has not been observed. These aspects may have helped analyse the communication between them in greater detail. Our analysis has, therefore, been more explorative regarding certain variables, since lack of evidence did not allow us to formulate detailed hypotheses or to perform confirmatory analyses. CONCLUSIONS Our regression model has identified several relationships between communication and demographic and clinical variables that may help identify patients at risk of poor communication. Future studies could focus, for example, on assessing the particularities of patient-professional communication in relation to each cancer type [ 44 ]. They could also examine coordination between professionals (e.g. the oncologist, the psychologist and the nurses) when communicating with patients [ 45 ] and study in greater detail the role played by the patients’ level of education in communications with their professionals. It would also be interesting to conduct future studies with patients who assess their communication at diagnosis and during follow-up, as well as their communication with other medical professionals such as psychologists and RT technicians. Declarations Author contributions All authors made substantial contributions to the conception and design of this study. JI Arraras, O Shamieh, I Bahar, M Koller, A Bredart, K Kuljanic, A Costantini, E Greimel, M Sztankay, LM Wintner, M Carreiro, H Ishiki, M Kontogianni, M Wolan, Y Kikawa, A Lanceley, I Gioulbasanis, A Harle and Uxue Zarandona contributed to acquisition of the data. JI Arraras and J Giesinger coordinated the analysis and interpretation of the data and wrote the first draft of the manuscript. All authors critically reviewed, revised and approved the final text. Funding: This study was supported by a grant from the EORTC Quality of Life Group: grant number 003‐2016. Acknowledgments We would like to thank Angels Pont for her work on the psychometric analyses. Ethics approval and consent to participate : This study was performed according to the rules of the Helsinki declaration. The protocol was approved by national or local ethical committees (for Spain, the Clinical Research Ethics Committee of Navarra under project 2015/72). 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Arraras JI, Illarramendi JJ, Viudez A, Ibáñez B, Lecumberri MJ, de la Cruz S et al (2013) Determinants of patient satisfaction with care in a Spanish oncology day hospital and its relationship with quality of life. Psychooncol 22:2454–2461. https://doi.org/10.1002/pon.3307 . Kuliś D, Bottomley A, Velikova G, Greimel E, Koller M (2017). EORTC Quality of Life Group translation procedure. 4th ed. EORTC QL Group: Brussels. Cancer Stat Facts: Cancer of Any Site. Surveillance, Epidemiology, and End Results (SEER) Program (2022). National Cancer Institute, Bethesda. Campbell JL, Ramsay J, Green J (2001) Age, gender, socioeconomic, and ethnic differences in patients' assessments of primary health care. Qual Health Care 10:90–95. https://doi.org/10.1136/qhc.10.2.90 Quintana JM, Gonzalez N, Bilbao A, Aizpuru F, Escobar A, Esteban C, et al (2006) Predictors of patient satisfaction with hospital health care. BMC Health Serv Res 16:102. https://doi.org/10.1186/1472-6963-6-102 . Nelson JE, Gay EB, Berman AR, Powell CA, Salazar-Schicchi J, Wisnivesky JP (2011) Patients rate physician communication about lung cancer. Cancer 117:5212–5220. https://doi.org/10.1002/cncr.26152 . Wessels H, de Graeff A, Wynia K, de Heus M, Kruitwagen CL, Woltjer GT et al (2010) Gender-related needs and preferences in cancer care indicate the need for an individualized approach to cancer patients. Oncologist 15:648–655. https://doi.org/10.1634/theoncologist.2009-0337 . Fletcher K, Prigerson HG, Paulk E, Temel J, Finlay E, Marr L et al (2013) Gender differences in the evolution of illness understanding among patients with advanced cancer. J Support Oncol 11:126–132. https://doi.org/10.12788/j.suponc.0007 . Elsner S, Juergensen M, Faust E, Niesel A, Pedersen LS, Rudnicki PM et al (2020) Urinary incontinence in women: treatment barriers and significance for Danish and German GPs. Fam Pract 37:367–373. https://doi.org/10.1093/fampra/cmz077 . Siu JY (2015) Communicating under medical patriarchy: gendered doctor-patient communication between female patients with overactive bladder and male urologists in Hong Kong. BMC Womens Health 15:44. https://doi.org/10.1186/s12905-015-0203-4 . Matsuyama RK, Wilson-Genderson M, Kuhn L, Moghanaki D, Vachhani H, Paasche-Orlow M (2011) Education level, not health literacy, associated with information needs for patients with cancer. Patient Educ Couns 85:e229-236. https://doi.org/10.1016/j.pec.2011.03.022 Kim S, Ham EH, Kim DY, Jang SN, Kim MK, Choi HA et al (2022) Comparing Perceptions, Determinants, and Needs of Patients, Family Members, Nurses, and Physicians When Making Life-Sustaining Treatment Decisions for Patients with Hematologic Malignancies. J Hosp Palliat Care 25:12–24. https://doi.org/10.14475/jhpc.2022.25.1.12 . Tolotti A, Pedrazzani C, Bonetti L, Bianchi M, Valcarenghi D. (2021) Patients' and Nurses' Perceptions of the Effectiveness of an Oral Cancer Agent Education Process: A Mixed-Methods Study. Cancer Nurs 44:E151-E162. https://doi.org/10.1097/NCC.0000000000000790 . Kleeberg UR, Feyer P, Günther W, Behrens M. Patient satisfaction in outpatient cancer care: a prospective survey using The PASQOC questionnaire (2008) Support Care Cancer 16:947–954. https://doi.org/10.1007/s00520-007-0362-4 . Sherlaw-Johnson C, Datta P, McCarthy M (2008) Hospital differences in patient satisfaction with care for breast, colorectal, lung and prostate cancers. Eur J Cancer 44:1559–1565. https://doi.org/10.1016/j.ejca.2008.03.023 . van der Velden NCA, van der Kleij MBA, Lehmann V, Smets EMA, Stouthard JML, Henselmans I et al. (2021) Communication about Prognosis during Patient-Initiated Second Opinion Consultations in Advanced Cancer Care: An Observational Qualitative Analysis. Int J Environ Res Public Health 26:5694. https://doi.org/10.3390/ijerph18115694 . Distelhorst SR, Cleary JF, Ganz PA, Bese N, Camacho-Rodriguez R, Cardoso F et al (2015) Optimisation of the continuum of supportive and palliative care for patients with breast cancer in low-income and middle-income countries: executive summary of the Breast Health Global Initiative, 2014. Lancet Oncol 16:e137-147. https://doi.org/10.1016/S1470-2045(14)70457-7 . Cegala DJ, Post DM (2009) The impact of patients' participation on physicians' patient-centered communication. Patient Educ Couns 77:202–208. https://doi.org/10.1016/j.pec.2009.03.025 . Bol N, Linn AJ, Smets EMA, Verdam MGE, van Weert JCM (2020) Tailored communication for older patients with cancer: Using cluster analysis to identify patient profiles based on information needs. J Geriatr Oncol 11:944–950. https://doi.org/10.1016/j.jgo.2020.01.004 . Fujimori M, Shirai Y, Asai M, Kubota K, Katsumata N, Uchitomi Y (2014) Effect of communication skills training program for oncologists based on patient preferences for communication when receiving bad news: a randomized controlled trial. J Clin Oncol 10:2166–2172. https://doi.org/10.1200/JCO.2013.51.2756 . Terrasson J, Rault A, Dolbeault S, Brédart A (2022) Question prompt lists to improve communication between cancer patients and healthcare professionals. Curr Opin Oncol 34:265–269. https://doi.org/10.1097/CCO.0000000000000840 . Lee CT, Doran DM, Tourangeau AE, Fleshner NE (2014) Perceived quality of interprofessional interactions between physicians and nurses in oncology outpatient clinics. Eur J Oncol Nurs 18:619–625. https://doi.org/10.1016/j.ejon.2014.06.004 . Additional Declarations No competing interests reported. Supplementary Files Supplementarytable1bivariable.docx Cite Share Download PDF Status: Published Journal Publication published 05 Dec, 2024 Read the published version in Supportive Care in Cancer → Version 1 posted Editorial decision: Revision requested 14 Aug, 2024 Reviews received at journal 22 Jul, 2024 Reviewers agreed at journal 04 Jul, 2024 Reviewers agreed at journal 02 Jul, 2024 Reviewers invited by journal 01 Jul, 2024 Editor assigned by journal 01 Jul, 2024 Submission checks completed at journal 22 May, 2024 First submitted to journal 21 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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16:17:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1218274,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4456065/v1/b6fe34f7-9dde-4d0e-88dc-13cf6217bd3c.pdf"},{"id":57676662,"identity":"778059f8-6ddf-4934-aecc-2f4358df7bea","added_by":"auto","created_at":"2024-06-04 07:51:28","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":29173,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarytable1bivariable.docx","url":"https://assets-eu.researchsquare.com/files/rs-4456065/v1/d6e79d753cdc3591284817c2.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"An international study of clinical, demographic and competence-related determinants of communication with professionals","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eCommunication between patients and health professionals is a crucial element of the support provided to cancer patients [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Carlson et al. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] presented two aims of communication based on Feldman-Stewart\u0026rsquo;s theoretical framework for communication between patient and professional [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]: primary aims, which are directly linked to the communication process, such as offering support, providing better information, and enhancing patient education and understanding; and secondary aims, which are indirect consequences of effective communication, such as psychological functioning and Quality of Life (QoL).\u003c/p\u003e \u003cp\u003eThe European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group (QLG) has developed a cancer-specific communication questionnaire \u0026ndash; the EORTC QLQ-COMU26 \u0026ndash; which evaluates various dimensions of patients\u0026rsquo; communication with their healthcare professionals [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Based on Epstein and Street\u0026rsquo;s core functions of the Patient-Centred Communication model (PCC) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], this cancer-specific communication questionnaire assesses some of the primary goals of communication presented by Carlson et al. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. It was developed in a cross-cultural setting with patients from five cultural areas and is applicable across different cultures [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePatient communication competence, which includes skills in providing information (e.g., expressing concerns) and asking questions [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], plays a crucial role in patient-professional communication as it may have a positive effect on PCC. It may be interesting, therefore, to study in greater detail how patients perceive their medical communication competence [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCommunication between cancer patients and professionals and finding ways to improve this communication are important fields of research [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNumerous studies have analysed the determinants of good communication between patients and professionals. These studies have helped to identify patient groups whose communication with professionals may be more limited and in need of further attention [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe majority of these studies have been conducted in just one country [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] and at one tumour site [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] or just a few sites. Clinical and demographic variables have been included in most cases, while other variables (such as patient competence) have been included in some. Studies of some determinants, such as education, have provided inconclusive results [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis paper studies a combination of determinants of cancer patients\u0026rsquo; perception of their communication with health professionals (doctors and nurses), i.e., sociodemographic and clinical characteristics as well as an associated variable such as patient communication competence.\u003c/p\u003e \u003cp\u003eHigher communication scores were expected from older patients [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], male patients [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], and patients with higher levels of education [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Higher scores were also expected from patients at initial disease stages [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], those without comorbidity [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], those who had previously received oncological treatment or treatment from the same doctor or group of nurses, and those with higher levels of communication competence [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Higher scores were also expected in communication with nurses [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study was conducted with a large sample of patients from five cultural areas in Europe and Asia with different sociodemographic and clinical characteristics. We believe the size of our sample, the varied cultural, clinical and demographic characteristics of our participants, and the combination of variables under study help to provide more solid conclusions.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u003c/h2\u003e \u003cp\u003ePatients were included in the study if they were aged 18 years or over, they had been diagnosed with (primary or recurrent) cancer at any cancer site, their cancer was at an initial or advanced stage, they were undergoing any treatment (e.g., radiotherapy (RT) or chemotherapy (CT), whether or not they had previously undergone surgery), at any treatment line, and they were able to understand the language of the questionnaire and to complete it. Patients were excluded if they had any concurrent malignancies or had participated in QoL trials that could interfere with the study.\u003c/p\u003e \u003cp\u003eTo ensure cross-cultural applicability, patients were enrolled from English-speaking countries, from northern, southern, and eastern European countries, and from other regions (India, Japan and Jordan) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThe patients recruited for this prospective study were approached when they began a treatment line. Two main patient groups were created based on whether the treatment intent was 1) radical/curative, or 2) palliative/symptom-relieving (with no prospect of cure).\u003c/p\u003e \u003cp\u003eCommunication was assessed with doctors and nurses whose regular timetables for patient consultations can usually be compared. Patients evaluated one doctor or a group of nurses. Based on our experience with patients\u0026rsquo; preferences for communication with doctors, we focused our assessment on doctor-patient communication more than on nurse-patient communication [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, we also aimed to adequately represent patient communication with nurses.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u0026rsquo; assessment\u003c/h2\u003e \u003cp\u003ePatients were approached around the first day of a treatment line and asked to assess their communication with their doctor or nurses only during their first days of treatment (i.e. not at diagnosis, in follow-up or during prior treatment lines).\u003c/p\u003e \u003cp\u003ePatients completed the EORTC QLQ-COMU26 communication questionnaire. This questionnaire evaluates cancer patients\u0026rsquo; perspective on their communication with their healthcare professionals. It is applicable across cancer diagnoses and treatment stages (diagnosis, treatment or follow-up), and includes palliative care. Patients indicate which professional category they are evaluating, i.e. doctor(s), nurse(s), psychologist(s), or other professional(s) and which specific treatment period they are evaluating, i.e. diagnosis, treatment or follow-up. The questionnaire comprises 26 items, which are divided into six scales plus four individual items that mainly assess behaviours related to communication [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Scores range from 0 to 100. A high score means a high level of communication in all scales and items. The structure of the questionnaire is presented in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSTRUCTURE OF THE EORTC-COMU26. SCORES OF THE SAMPLE\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSCALE AND CONTENT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMEAN (S.D.)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eScale 1 patient\u0026rsquo;s active role-behaviours.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e82.7 (22.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatients have enough opportunities to talk with the professionals\u003c/p\u003e \u003cp\u003eFeel free to ask questions\u003c/p\u003e \u003cp\u003eHave the opportunity to express their emotions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eScale 2 aspects of the clinician-patient relationship.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85.4 (21.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShared understanding of the disease and treatment\u003c/p\u003e \u003cp\u003eMutual trust between patient and professionals\u003c/p\u003e \u003cp\u003eProfessionals have spent enough time talking with patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eScale 3 professional\u0026rsquo;s qualities creating a relationship.\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e90.2 (16.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApproach as an equal\u003c/p\u003e \u003cp\u003eShow sincerity\u003c/p\u003e \u003cp\u003eMake it easy to talk openly about concerns\u003c/p\u003e \u003cp\u003eTreat the patient with respect\u003c/p\u003e \u003cp\u003eTake patient\u0026rsquo;s problems seriously\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eScale 4 professional\u0026rsquo;s skills\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e90.2 (15.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse language patient understands\u003c/p\u003e \u003cp\u003eAnswer questions openly\u003c/p\u003e \u003cp\u003eLook at patient\u003c/p\u003e \u003cp\u003eCalm voice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eScale 5 professional\u0026rsquo;s management of patient\u0026rsquo;s emotions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85.6 (22.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTry to understand patient\u0026rsquo;s situation\u003c/p\u003e \u003cp\u003eListen when patient expresses emotions\u003c/p\u003e \u003cp\u003eHelp patient to manage their emotions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eScale 6: professional\u0026rsquo;s skills related to information\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e81.7 (24.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCheck patient\u0026rsquo;s previous level of information.\u003c/p\u003e \u003cp\u003eCheck patient\u0026rsquo;s understanding of information\u003c/p\u003e \u003cp\u003eAnswer difficult questions\u003c/p\u003e \u003cp\u003eExplain the aims of the treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndividual items\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfessionals take into account patient\u0026rsquo;s preferences on how the information should be offered\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e78.4 (32.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfessionals correct misunderstandings in information\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e83.8 (26.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnough privacy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e84.6 (27.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSatisfaction with the communication with professional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e88.8 (21.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eEORTC QLQ-COMU26 is available in English and in fourteen other language versions (each version has been developed in accordance with EORTC translation procedure), including those of the participating centres [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The questionnaire and its scoring instructions are available from the EORTC at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://qol.eortc.org/form/#1\u003c/span\u003e\u003cspan address=\"https://qol.eortc.org/form/#1\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eAn item created for this study asked patients to assess how competent they felt when communicating with their professionals (doctor and/or nurses) using a 10-point Likert scale with responses ranging from 0 (not competent at all) to 10 (very competent). Socio-demographic and clinical data were also collected at the first time point.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eDescriptive analysis was performed on the demographic and clinical variables, the QLQ-COMU26, and the item on competence when communicating with professionals.\u003c/p\u003e \u003cp\u003eAs a first step, the scores on the QLQ-COMU26 scales and items were compared using T-tests or ANOVA for independent samples of differences between patient groups defined by (1) the demographic variables: age (\u0026le;\u0026thinsp;50, 50\u0026ndash;70, \u0026gt; 70 years), gender, education level, and professional assessed (doctor, nurse); (2) the clinical variables: anatomical location of the primary tumour, current disease stage; presence of co-morbidity (other serious medical conditions, yes or no); and any previous oncological treatment (yes or no); and (3) the other variables: the patient had received previous treatment with the same doctor or group of nurses; and the patient\u0026rsquo;s perceived level of competence when communicating with their professionals (\u0026lt;\u0026thinsp;7/ 7\u0026ndash;8 / 8\u0026ndash;10 / 10) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eAll determinants that were significant in the bivariable analyses were included in the multivariable linear regression models separately for each QLQ-COMU26 area. Determinants that were not significant in the multivariable model were removed (backward elimination P\u0026thinsp;\u0026lt;\u0026thinsp;0.10) to obtain the final model for predicting the QLQ-COMU26 scales. Age and gender were included as adjustment variables in the analyses of all QLQ-COMU26 areas. Anatomical location of the primary tumour was divided into the following four tumour locations: lung, head and neck (reference); colorectal, oesophageal and stomach; breast; and other.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of the sample\u003c/h2\u003e \u003cp\u003eA total of 988 patients from 15 centres in 13 countries participated in this study. Their demographic and clinical characteristics are shown in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDEMOGRAPHIC AND CLINICAL CHARACTERISTICS OF THE SAMPLE.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;988)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCountry, n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAustria (Innsbruck \u0026amp; Graz)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e61 (6.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJapan (Kobe \u0026amp; Kyoto)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e31 (3.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJordan (Amman)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e244 (24.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGreece (Athens)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e15 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrance (Paris)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e52 (5.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpain (Pamplona)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e205 (20.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePortugal (Ponta Delgada)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e30 (3.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnited Kingdom (Poole)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e18 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGermany (Regensburg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e53 (5.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCroatia (Rijeka)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e33 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItaly (Rome)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e33 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoland (Rzesz\u0026oacute;w)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e13 (1.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndia (Silchar)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e200 (20.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSOCIODEMOGRAPHIC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge, mean (SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e60.7 (13.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;50 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e220 (22.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50\u0026ndash;70 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e510 (51.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;70 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e255 (25.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMissing\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e487 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e487 (50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMissings\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e\u003cem\u003e14\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHighest level of education, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than compulsory school education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e171 (17.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCompulsory school education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e301 (30.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost compulsory education below university level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e248 (25.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e253 (26.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMissings\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e\u003cem\u003e15\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCohabitation, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiving alone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e96 (9.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiving with partner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e280 (28.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiving with family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e577 (59.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiving with other adults\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e22 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMissings\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e\u003cem\u003e13\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eINFORMATION RELATED TO PROFESSIONALS AT STUDY ENTRY\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProfessional assessed, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDoctor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e570 (58.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e411 (41.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMissings\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003e7\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCLINICAL INFORMATION AT STUDY ENTRY\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnatomical location of the primary tumour, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLung\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e134 (13.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eColorectal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e129 (13.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e235 (23.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGynecologic system (ovarian. endometrium. cervix)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e67 (6.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHead and neck\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e113 (11.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProstate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e38 (3.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther genito-urinary (kidney. ureter. bladder. testis)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e37 (3.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOesophageal. stomach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e51 (5.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e21 (2.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHematologic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e36 (3.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e122 (12.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMissings\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e\u003cem\u003e5\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKnown current Disease stage, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInitial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e504 (51.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdvanced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e477 (48.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMissings\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e\u003cem\u003e7\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMetastases, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e378 (38.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e605 (61.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMissings\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e\u003cem\u003e5\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCo-morbidity (other serious medical conditions), n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e196 (20.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e780 (79.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMissings\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e\u003cem\u003e12\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePatients has received previous treatment with the same doctor or group of nurses, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e404 (41.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e568 (58.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eMissings\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e\u003cem\u003e16\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePREVIOUS TREATMENT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAny, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e616 (62.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003e372 (37.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eADDITIONAL QUESTIONS\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1. During the consultation, I felt competent in communicating with the professional I met\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.1 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e193 (19.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e291 (30.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e(8\u0026ndash;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e219 (22.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e266 (27.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eA. MULTIVARIABLEVARIABLE ANALYSIS OF THE RELATIONSHIPS BETWEEN HEALTH-RELATED DETERMINANTS AND SCALE 1 (ACTIVE), SCALE 2 (RELATIONSHIP) AND SCALE 3 (QUALITIES).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eScale 1.\u003c/p\u003e \u003cp\u003eActive\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eScale 2.\u003c/p\u003e \u003cp\u003eRelationship\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eScale 3.\u003c/p\u003e \u003cp\u003eQualities\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBeta (SE)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% IC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBeta (SE)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95% IC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eBeta (SE)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e95% IC\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIntercept\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52.07 (5.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.22, 61.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e51.49 (4.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e42.36, 60.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e65.39 (3.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e58.15, 72.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.14 (0.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.04, 0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.15 (0.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.05, 0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.06 (0.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.097\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-0.01, 0.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender (Ref: Male)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.52 (1.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.754\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2.73, 3.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.18 (1.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.905\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-2.84, 3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-1.65 (1.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-4.05, 0.74\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHighest level of education (Ref: Less than compulsory education)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCompulsory education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-5.37 (2.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-9.64, -1.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-3.5 (2.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.083\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-7.46, 0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-3.59 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-6.73, -0.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-compulsory education below university level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-12.03 (2.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-16.4, -7.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-10.3 (2.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-14.34, -6.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-8.11 (1.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-11.32, -4.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-14.24 (2.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-18.73, -9.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-12.21 (2.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-16.35, -8.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-10.49 (1.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-13.77, -7.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProfessional assessed (Ref. Doctor)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.42 (1.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.6, 6.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ens\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ens\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnatomical location of the primary tumour (Ref: Lung / Head and neck)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eColorectal / Oesophageal, stomach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-5.42 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-10.12, -0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-3.92 (2.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.077\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-8.27, 0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-1.13 (1.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.522\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-4.58, 2.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-4.1 (2.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.059\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-8.37, 0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-4.69 (2.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-8.63, -0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-2.38 (1.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-5.5, 0.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.21 (1.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.517\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-2.47, 4.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.75 (1.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.312\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-1.64, 5.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.91 (1.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.23, 5.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eKnown current disease stage (Ref. Initial)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdvanced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ens\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ens\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ens\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCo-morbidity (Ref. No)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ens\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ens\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ens\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePatient has received prior treatment with the same doctor or group of nurses (Ref. No)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.9 (1.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.01, 7.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.67 (1.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3, 8.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.22 (1.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.11, 6.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e1. During the consultation, I felt competent in communicating with the professional I met\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.51 (0.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.74, 4.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.8 (0.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.09, 4.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.19 (0.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e2.62, 3.75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAny prior treatment (Ref. No)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ens\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ens\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ens\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe mean age of the participants was 60.7, with the highest percentage of participants (51.8%) belonging to the 50\u0026ndash;70 years group. The numbers of males and females were similar. Different education levels were represented, with the highest percentage of participants (30.9%) in the compulsory-education group.\u003c/p\u003e \u003cp\u003eThe percentage of patients who assessed their doctor was 58.1%, and the percentage of patients who had the disease at an initial stage was 51.4%. A variety of cancer sites (organized initially in ten categories and another \u0026lsquo;other tumors\u0026rsquo; category) were represented in the sample. The percentage of patients who had limiting comorbidity was 20.1%.\u003c/p\u003e \u003cp\u003eThe percentage of patients who had received prior treatment with the same doctor or group of nurses was 41.6%, while 62.3% of the patients had received prior oncological treatment. The patients\u0026rsquo; mean level of communicative competence was 8.1, with the highest percentage of patients (30%) scoring between 7 and 8. The scores obtained on the QLQ-COMU26 are shown in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eThe results of the bivariable analysis of the relationship between the health-related determinants and the QLQ-COMU26 areas are shown in Supplementary table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. All determinants showed significant differences in one or more QLQ-COMU26 areas. The determinants associated with the highest number of QLQ-COMU26 areas were level of education (ten areas) and level of competence (also ten areas) and professional assessed (nine areas). The results of the multivariable analyses are shown in Tables \u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e3\u003c/span\u003eA to \u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e3\u003c/span\u003eD.\u003c/p\u003e \u003cp\u003eHigher age was related to a higher level of communication (in all QLQ-COMU26 areas except the professional\u0026rsquo;s management of patient emotions and their correction of misunderstandings of information). Males considered their level of communication to be higher than females did in three areas (the professional\u0026rsquo;s management of patient emotions; the professional\u0026rsquo;s skills in relation to information; the professional\u0026rsquo;s consideration of their preferences in relation to information). Lower levels of studies were related to higher communication in the ten QLQ-COMU26 areas. The level of communication with nurses was considered to be higher than that with doctors in four areas (the patient\u0026rsquo;s active role-behaviours, the professional\u0026rsquo;s management of patient emotions, the professional\u0026rsquo;s skills related to information, and the professional\u0026rsquo;s consideration of patient preferences in relation to information). With regard to tumour site, lung-cancer patients showed higher communication levels than colorectal patients (in three areas) and breast-cancer patients (in four areas), while patients with other tumour sites showed a higher level of communication than lung-cancer patients in one area. Patients at initial disease stages showed a higher level of communication in one area (the professional\u0026rsquo;s consideration of patient preferences in relation to information). The presence of limiting comorbidity was related to a lower level of communication in two areas (the professional\u0026rsquo;s skills related to information; the professional\u0026rsquo;s consideration of patient preferences in relation to information). Having received previous oncological treatment was related to a lower level of communication in one area (enough privacy). Having received previous treatment with the same doctor or group of nurses was related to a higher level of communication in seven areas (the patient\u0026rsquo;s active role-behaviours; aspects of the clinician-patient relationship; the professional\u0026rsquo;s qualities when creating a relationship; the professional\u0026rsquo;s skills; the professional\u0026rsquo;s skills related to information; enough privacy; and satisfaction with the communication). A higher level of perceived competence when communicating with professionals was related to a higher level of communication in all ten QLQ-COMU26 areas.\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study, performed with an international sample of cancer patients, has shown that patients\u0026rsquo; evaluation of their communication with healthcare professionals is related both to demographic factors (age, gender and level of education) and clinical factors (tumour site, disease stage, presence of limiting comorbidity, having received previous oncological treatment, the type of professional assessed, having received previous treatment with the same doctor or group of nurses, and their perceived level of communicative competence).\u003c/p\u003e \u003cp\u003eThe demographic (sex, age, and level of education) and clinical (main tumour sites and disease stages) characteristics of the sample may be considered adequate for this study. Sex, age, tumour site and stage are representative of the general population of cancer patients [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In this sense, the percentage of patients in the sample who were \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;50 years old was 77.7%, which is the range in which most new cancers are diagnosed.\u003c/p\u003e \u003cp\u003eThe different levels of education are represented in the sample. Also, patients from various cultural areas were widely represented.\u003c/p\u003e \u003cp\u003eScores were high in most QLQ-COMU26 areas, which indicates a good general level of communication.\u003c/p\u003e \u003cp\u003eIn line with both our hypothesis and the results of other studies [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], elderly patients evaluated their communication with healthcare professionals more highly than younger patients did. Moreover, other studies have shown that elderly patients also report a higher level of satisfaction with their communication than younger patients [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis difference in favour of older patients may indicate a change in patient-physician communication in recent decades: compared to previous generations of elderly patients, older cancer patients today may be willing to receive more medical information and to play a more active role in their care [8,KOP].\u003c/p\u003e \u003cp\u003eHowever, there is no conclusive answer in relation to age since other studies have found no age-related differences with regard to communication [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] (both of these studies comprised patients with a variety of ages). Further studies are therefore needed to clarify this issue.\u003c/p\u003e \u003cp\u003eMales reported higher communication scores in most areas than females did. These results are in line with those from a study on communication in cancer patients with pain [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOther studies have found higher levels of general satisfaction among males in relation to communication with their physician [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], while still others have found higher levels of satisfaction among males in relation to information provision and the interpersonal skills of doctors and nurses [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. These gender differences have been related to factors such as differences in communication preferences [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Some studies have found that if patients and professionals have the same gender, there may be an effect on communication with regard to issues such as female urinary incontinence [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. It would be interesting to conduct more studies with professionals and patients of the same gender.\u003c/p\u003e \u003cp\u003eContrary to expectations, a lower level of education was related to a higher level of communication with healthcare professionals.\u003c/p\u003e \u003cp\u003eThis result may be considered positive since a lower level of education has been associated with a greater need for information among patients [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] and a greater influence of the doctor\u0026rsquo;s communication style on patient\u0026rsquo;s trust in their physician [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn line with our results, other studies have found that increasing levels of education are associated with lower scores for communication with professionals [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and with lower satisfaction with communication (doctor availability) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSeveral studies may help explain our results. For example, a higher education level has been associated with a lower frequency of disclosure in certain information areas (information about procedures) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and with fewer questions asked by physicians to patients [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, other studies have found higher communication scores among patients with higher levels of education [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCommunication with \u003cem\u003enurses\u003c/em\u003e showed higher scores than communication with doctors.\u003c/p\u003e \u003cp\u003eNurses are considered to play a key role in the areas of our study where they showed higher scores than doctors. These include providing emotional support or conducting the information-disclosure process [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], including clarifying or checking the patient\u0026rsquo;s understanding of information [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSimilar results have been found in other studies [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. For example, cancer patients treated at a day hospital showed a greater level of satisfaction with their communication with nurses than with doctors when it comes to interpersonal skills, availability, and information provision [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. These differences notwithstanding, high scores were observed in both professional groups.\u003c/p\u003e \u003cp\u003eNumerous clinical factors have been related to communication in our study. Differences between pairs of tumour sites (e.g. lung or head/neck compared with colorectal or oesophageal cancer) appeared in several areas of the questionnaire, and directions.\u003c/p\u003e \u003cp\u003eDifferences among tumour sites have also appeared in other studies and, as in our case, the areas of communication where the differences appeared, as well as the directions of the relationships, have been inconsistent [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Some confounding variables that were not included in our study may have influenced these results.\u003c/p\u003e \u003cp\u003eOur study suggests that communication is better in one area (i.e. \u003cem\u003eprofessionals take into account patient preferences on how the information should be offered\u003c/em\u003e) in patients who are at the \u003cem\u003einitial disease\u003c/em\u003e stage. Discrepancies between the information provided by professionals and the preferences of patients at \u003cem\u003eadvanced disease\u003c/em\u003e stages (despite this being a key area of communication) have been raised in various studies [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. The lack of other significant differences between the two disease stages groups and the high scores found in most communication areas may be considered positive since communication is a key factor in the support offered to palliative patients [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eImportantly, having been given prior treatment by the same doctor or group of nurses was related to higher levels of communication in seven areas. This may be due to positive aspects such as greater levels of trust with these professionals and more knowledge of the patient\u0026rsquo;s characteristics.\u003c/p\u003e \u003cp\u003eA patient\u0026rsquo;s perceived higher level of communicative competence has been associated with higher communication scores in all QLQ-COMU26 areas. These results are in line with other studies that show that a patient\u0026rsquo;s communication skills exert a positive influence on the physician\u0026rsquo;s communicative behaviour [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. For example, patients who actively participate in medical interviews have been shown to encourage physicians to adopt a more patient-centred style of communication [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePatients who report higher self-efficacy when interacting with a physician tend to seek more information from their professional [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCommunication has been shown to improve as a result of training received by professionals [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. It is also suggested that patients can increase their own communication competence if they also receive communication skills training [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eSTRENGTHS AND LIMITATIONS\u003c/h2\u003e \u003cp\u003eOne \u003cem\u003estrength\u003c/em\u003e of this study is that it was conducted with a large international sample of unselected participants from different cultures. Moreover, patients with different demographic and clinical characteristics were represented. As a result, we were able to reflect the usual clinical practice in countries from different cultural areas.\u003c/p\u003e \u003cp\u003eAlso, multivariable analyses were performed and a specific cancer questionnaire was administered to evaluate different communication dimensions. Both these aspects help provide more solid results.\u003c/p\u003e \u003cp\u003eThis study also has several \u003cem\u003elimitations\u003c/em\u003e. Professionals\u0026rsquo; assessment of their communication has not been recorded and interaction between patients and professionals has not been observed. These aspects may have helped analyse the communication between them in greater detail. Our analysis has, therefore, been more explorative regarding certain variables, since lack of evidence did not allow us to formulate detailed hypotheses or to perform confirmatory analyses.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eOur regression model has identified several relationships between communication and demographic and clinical variables that may help identify patients at risk of poor communication.\u003c/p\u003e \u003cp\u003eFuture studies could focus, for example, on assessing the particularities of patient-professional communication in relation to each cancer type [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. They could also examine coordination between professionals (e.g. the oncologist, the psychologist and the nurses) when communicating with patients [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e] and study in greater detail the role played by the patients\u0026rsquo; level of education in communications with their professionals.\u003c/p\u003e \u003cp\u003eIt would also be interesting to conduct future studies with patients who assess their communication at diagnosis and during follow-up, as well as their communication with other medical professionals such as psychologists and RT technicians.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors made substantial contributions to the conception and design of this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eJI Arraras, O Shamieh, I Bahar, M Koller, A Bredart, K Kuljanic, A Costantini, E Greimel, M Sztankay, LM Wintner, M Carreiro, H Ishiki, M Kontogianni, M Wolan, Y Kikawa, A Lanceley, I Gioulbasanis, A Harle and Uxue Zarandona contributed to acquisition of the data.\u003c/p\u003e\n\u003cp\u003eJI Arraras and J Giesinger coordinated the analysis and interpretation of the data and wrote the first draft of the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll authors critically reviewed, revised and approved the final text.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This study was supported by a grant from the EORTC Quality of Life Group: grant number 003‐2016.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank Angels Pont for her work on the psychometric analyses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e: This study was performed according to the rules of the Helsinki declaration. The protocol was approved by national or local ethical committees (for Spain, the Clinical Research Ethics Committee of Navarra under project 2015/72). Eligible patients were introduced to the study, provided written information, and invited to participate. Written informed consent was obtained from each patient prior to inclusion.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e The authors declare they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFallowfield L, Starkings R, Palmieri C, Tait A, Stephen L, May S, et al (2023) Living with metastatic breast cancer (LIMBER): experiences, quality of life, gaps in information, care and support of patients in the UK. 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Eur J Oncol Nurs 18:619\u0026ndash;625. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ejon.2014.06.004\u003c/span\u003e\u003cspan address=\"10.1016/j.ejon.2014.06.004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Communication, cancer, determinants, EORTC.","lastPublishedDoi":"10.21203/rs.3.rs-4456065/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4456065/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePurpose: This study aims to identify the clinical and demographic determinants of patients’ communication with professionals in an international sample of cancer patients.\u003c/p\u003e\n\u003cp\u003eMethods: Cancer patients completed EORTC communication questionnaire QLQ-COMU26 to assess ten areas of communication with their doctor or nurses plus another item to assess how competent they felt when communicating with professionals. Bivariable analyses and multivariable linear regression models were performed separately for each QLQ-COMU26 area.\u003c/p\u003e\n\u003cp\u003eResults: 988 patients from 15 centres in 13 countries (five cultural areas) were included in the study. Higher age was related to higher level of communication in eight QLQ-COMU26 areas. Males reported higher level of communication in three areas. Lower levels of studies and a higher level of perceived competence when communicating with professionals were related to higher level of communication in the ten QLQ-COMU26 areas. Communication was of a higher level with nurses than with doctors in four areas. Having received previous treatment with the same doctor or group of nurses was related to higher communication levels in seven areas. Lack of comorbidity was related to higher communication levels in two areas. Various differences in determinants were found among tumour sites\u003c/p\u003e\n\u003cp\u003eConclusion Our regression model has shown several relationships between communication and the demographic and clinical variables that may help to identify patients at risk of poor communication. Future studies could focus on communication at diagnosis and in follow-up, and on areas such as assessing the particularities of communication between patient and professionals in relation to each cancer type.\u003c/p\u003e","manuscriptTitle":"An international study of clinical, demographic and competence-related determinants of communication with professionals","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-04 07:51:18","doi":"10.21203/rs.3.rs-4456065/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-08-14T08:30:09+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-22T09:08:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"81208612151312327061440132164861154317","date":"2024-07-04T15:33:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"180421429853951616716363249452961211810","date":"2024-07-02T08:08:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-01T14:39:26+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-01T13:54:53+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-23T03:06:42+00:00","index":"","fulltext":""},{"type":"submitted","content":"Supportive Care in Cancer","date":"2024-05-21T16:06:17+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"supportive-care-in-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jscc","sideBox":"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)","snPcode":"520","submissionUrl":"https://submission.nature.com/new-submission/520/3","title":"Supportive Care in Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"285317ce-04af-4398-a2c0-745568639eec","owner":[],"postedDate":"June 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-12-09T16:07:21+00:00","versionOfRecord":{"articleIdentity":"rs-4456065","link":"https://doi.org/10.1007/s00520-024-09000-5","journal":{"identity":"supportive-care-in-cancer","isVorOnly":false,"title":"Supportive Care in Cancer"},"publishedOn":"2024-12-05 15:58:14","publishedOnDateReadable":"December 5th, 2024"},"versionCreatedAt":"2024-06-04 07:51:18","video":"","vorDoi":"10.1007/s00520-024-09000-5","vorDoiUrl":"https://doi.org/10.1007/s00520-024-09000-5","workflowStages":[]},"version":"v1","identity":"rs-4456065","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4456065","identity":"rs-4456065","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}