Willingness to participate and model preference for integrated medical and elderly care among older patients with cancer in China: a cross sectional study.
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BACKGROUND: The global confluence of population aging and the growing chronicity of cancer underscores the urgent need for integrated care models worldwide. As home to the world's largest elderly population, China faces a particular challenge: older patients with cancer must navigate a critical gap between specialized cancer treatment and long-term elderly care. Although Integrated Medical and Elderly Care (IMEC) has emerged as a promising solution, the key factors associated with this group's acceptance of and preference for specific IMEC models remain unclear, thereby hindering effective policy development. OBJECTIVE: Informed by the Andersen Behavioral Model of Health Services Use, this study aimed to explore the factors associated with the willingness of older patients with cancer to adopt IMEC and their preferences among four service models (home-based, institution-based, community-based, and internet-based), in order to inform the design of targeted policies for optimizing integrated care delivery. METHODS: A cross-sectional survey was conducted among 924 older patients with cancer (aged ≥ 60 years) in hospitals in Anhui Province, China. Informed by the Andersen Behavioral Model, data were collected via a structured questionnaire covering three categories of factors: predisposing, enabling, and personal need factors. The outcome variables included IMEC participation willingness (categorized as "no," "depends," or "yes") and IMEC model preference (with internet-based IMEC as the reference group). Descriptive analysis, univariable ordered logistic regression, and multivariable stepwise ordered logistic regression were used to identify factors associated with participation willingness. Chi-square tests and multivariable logistic regression were applied to analyze model preference determinants. RESULTS: Among the 924 patients, 389 (42.1%) reported "no" to IMEC participation, 421 (45.6%) reported "depends," and 114 (12.3%) reported "yes." Multivariable ordered logistic regression identified eight independent factors associated with higher cumulative odds of being in a higher willingness category: knowledge of IMEC (heard but unfamiliar: OR = 2.099, p < 0.001; familiar: OR = 3.332, p < 0.001), gait instability (OR = 1.801, p < 0.001), primary cancer site (gynecological cancer: OR = 3.157, p < 0.001; lymphoma: OR = 0.458, p = 0.027), pension as an income source (OR = 1.473, p = 0.033), high social activity (OR = 1.753, p = 0.005), having two children (OR = 1.459, p = 0.012), access to recreation centers (OR = 1.404, p = 0.017), and life satisfaction (highly satisfied: OR = 2.036, p < 0.001). Regarding model preference, home-based IMEC was most preferred (57.5%), followed by institution-based (20.2%), community-based (18.2%), and internet-based (4.1%). Compared with internet-based IMEC, (1) familiarity with IMEC was associated with lower odds of preferring institution-based (OR = 0.282, p = 0.0309), community-based (OR = 0.331, p = 0.0599), and home-based IMEC (OR = 0.272, p = 0.0144); (2) high IMEC affordability (> 280 USD/month) was associated with higher odds of preferring community-based IMEC (OR = 5.373, p = 0.0118); (3) patients with breast cancer had lower odds of preferring community-based IMEC (OR = 0.147, p = 0.0246); and (4) patients with other cancer sites had lower odds of preferring home-based IMEC (OR = 0.193, p = 0.0086) and community-based IMEC (OR = 0.199, p = 0.0195). CONCLUSION: Knowledge of IMEC, health needs, and economic-social support were key factors associated with older cancer patients' willingness to participate in IMEC. Model preference was associated with knowledge of IMEC, affordability, and primary cancer site. Tailoring IMEC services based on these factors may help improve service acceptance and matching, thereby better meeting the holistic medical and care needs of older patients with cancer.