Knowledge, attitude, and practice of monitoring early gastric cancer after endoscopic submucosal dissection

Table 1 Participant’ demographics and knowledge, attitude, and practice scores regarding gastric cancer recurrence after endoscopic submucosal dissection

Characteristic	Number of participants	Knowledge score		Attitude score		Practice score
		mean ± SD	P	mean ± SD	P	mean ± SD	P
Total	400	3.34 ± 1.42		23.76 ± 2.81		5.75 ± 2.35
Sex			0.266		0.517		0.537
Male	192	3.26 ± 1.46		23.86 ± 3.04		5.83 ± 2.46
Female	208	3.42 ± 1.38		23.68 ± 2.58		5.68 ± 2.25
Age in yr			0.063		0.930		0.689
≤ 40	35	3.57 ± 1.12		23.83 ± 2.47		5.31 ± 1.94
41-50	56	3.57 ± 1.28		23.88 ± 2.34		5.73 ± 2.39
51-60	117	3.49 ± 1.36		23.62 ± 2.72		5.75 ± 2.45
> 60	192	3.15 ± 1.52		23.81 ± 3.05		5.84 ± 2.35
Residency			0.001		0.425		0.510
Rural areas	333	3.25 ± 1.46		23.71 ± 2.88		5.72 ± 2.34
Urban areas	67	3.79 ± 1.10		24.01 ± 2.40		5.93 ± 2.40
Education			0.001		0.418		0.737
Junior middle school or lower	297	3.20 ± 1.48		23.66 ± 2.90		5.72 ± 2.33
Senior middle school/technical secondary school	55	3.71 ± 1.13		24.04 ± 2.50		5.69 ± 2.27
Junior college/college or higher	48	3.81 ± 1.10		24.13 ± 2.59		6.00 ± 2.59
Occupation			0.000		0.512		0.407
General staff or relevant personnel	77	3.70 ± 1.15		23.95 ± 2.45		5.92 ± 2.45
Professional and technical staff	10	4.50 ± 0.53		24.60 ± 2.95		6.80 ± 2.97
Others	313	3.22 ± 1.47		23.69 ± 2.89		5.68 ± 2.30
Medical insurance			0.125		0.128		0.013
Yes	384	3.32 ± 1.43		23.72 ± 2.69		5.69 ± 2.35
No	16	3.88 ± 1.03		24.81 ± 5.01		7.19 ± 2.07
Family income in Yuan			0.002		0.116		0.977
< 2000	51	2.92 ± 1.59		23.12 ± 2.30		5.69 ± 2.08
2000-5000	247	3.29 ± 1.47		23.89 ± 2.91		5.77 ± 2.37
> 5000	102	3.69 ± 1.09		23.79 ± 2.79		5.75 ± 2.45
The time since last ESD in mo			0.001		0.000		0.000
≤ 12	193	3.10 ± 1.41		23.17 ± 2.86		4.92 ± 1.92
13-24	121	3.40 ± 1.44		24.24 ± 2.72		6.13 ± 2.53
≥ 25	86	3.80 ± 1.28		24.44 ± 2.56		7.09 ± 2.24
Family history			0.215		0.479		0.639
Yes	19	3.74 ± 1.05		24.21 ± 2.72		6.00 ± 1.97
No	381	3.32 ± 1.43		23.74 ± 2.82		5.74 ± 2.37
Infection with Helicobacter pylori in the past or present			0.984		0.295		0.886
Yes	59	3.34 ± 1.17		24.12 ± 2.34		5.71 ± 2.11
No/unclear	341	3.34 ± 1.46		23.70 ± 2.89		5.76 ± 2.39
Smoking history			0.000		0.181		0.053
Yes	53	2.53 ± 1.67		23.28 ± 2.57		5.17 ± 2.35
No	347	3.47 ± 1.34		23.84 ± 2.84		5.84 ± 2.34
Drinking alcohol			0.000		0.001		0.000
Yes	70	2.57 ± 1.53		22.71 ± 3.04		4.71 ± 2.16
No	330	3.51 ± 1.34		23.99 ± 2.71		5.97 ± 2.33
Pathological confirmation of early tumors after ESD			0.033		0.611		0.031
Yes	357	3.39 ± 1.40		23.79 ± 2.82		5.84 ± 2.33
No/not detected	43	2.91 ± 1.49		23.56 ± 2.80		5.02 ± 2.41

ESD: Endoscopic submucosal dissection; SD: Standard deviation.

Table 2 Questions and answers of attitude assessments, n (%)

Questions	Strongly agree	Agree	Fair	Disagree	Strongly disagree
1. I am afraid of gastric cancer	0	0	28 (7.0)	219 (54.8)	153 (38.3)
2. I am satisfied with the endoscopic submucosal dissection	0	0	27 (6.8)	213 (53.3)	160 (40.0)
3. Despite receiving endoscopic submucosal dissection, I am still terrified of gastric cancer	0	0	27 (6.8)	220 (55.0)	153 (38.3)
4. I am terrified of gastric cancer recurrence	0	0	27 (6.8)	217 (54.3)	156 (39.0)
5. I do not believe reexamination is necessary after endoscopic submucosal dissection	19 (4.8)	265 (66.3)	69 (17.3)	47 (11.8)	0
6. I am willing to undergo regular reexaminations and follow-ups according to the doctor’s advice	0	0	98 (24.5)	185 (46.3)	117 (29.3)

Table 3 Questions and answers of practice assessments, n (%)

Questions	No	Yes
1. Do you have regular follow-up appointments in the Gastroenterology Outpatient Department after surgery?	161 (40.3)	239 (59.8)
2. Do you follow a low-salt diet after surgery?	66 (16.5)	334 (83.5)
3. Did you stop drinking alcohol after surgery?	63 (15.8)	337 (84.3)
4. Did you have Helicobacter pylori reexamination after surgery, such as a C-urea breath test?	309 (77.3)	91 (22.8)
5. Do you undergo regular gastroscopy reexaminations after surgery (3 mo, 6 mo, 9 mo, and 12 mo after surgery, then one gastroscopy every year afterward)?	234 (58.5)	166 (41.5)
6. Do you undergo yearly reexaminations by abdominal and chest CT scans after surgery?	286 (71.5)	114 (28.5)
7. Do you undergo yearly reexaminations of blood tumor biomarkers after surgery?	275 (68.8)	125 (31.3)
8. Do you regularly exercise after surgery?	328 (82.0)	72 (18.0)
9. Did you have significant body weight changes after surgery (more than 5 kilograms increased or decreased)?	14 (3.5)	386 (96.5)
10. Has your sleep status improved since the surgery?	296 (74.0)	104 (26.0)
11. Do you use dietary supplements or Traditional Chinese Medicine after surgery?	67 (16.8)	333 (83.3)

CT: Computed tomography.

Table 4 Pearson correlation analysis between knowledge, attitude, and practice of monitoring gastric cancer after endoscopic submucosal dissection

	Knowledge	Attitude	Practice
Knowledge	1.000	-	-
Attitude	0.405 (P < 0.001)	1.000	-
Practice	0.511 (P < 0.001)	0.458 (P < 0.001)	1

Table 5 Influencing factors of proactive practice

Factors	Univariate logistic regression		Multivariate logistic regression
	OR (95%CI)	P	OR (95%CI)	P
Knowledge score	2.528 (1.893-3.375)	< 0.001	1.916 (1.424-2.578)	< 0.001
Attitude score	1.395 (1.260-1.545)	< 0.001	1.253 (1.124-1.396)	< 0.001
Sex
M	Reference	-
F	0.943 (0.606-1.466)	0.794
Age in yr
≤ 40	Reference	-
41-50	2.289 (0.807-6.495)	0.119
51-60	1.820 (0.691-4.793)	0.226
> 60	1.795 (0.705-4.752)	0.220
Registered residence
Rural area	Reference	-
Urban area	1.085 (0.605-1.946)	0.784
Educational level
Junior middle school or lower	Reference	-
Senior middle school/technical secondary school	0.840 (0.428-1.645)	0.611
Junior college/college or higher	1.233 (0.636-2.390)	0.535
Occupation
General staff or relevant personnel	Reference	-
Professional and technical staff	1.472 (0.380-5.701)	0.576
Others	0.758 (0.440-1.308)	0.320
Medical insurance
Yes	Reference	-
No	1.659 (0.588-4.680)	0.339
Family income in Yuan
< 2000	Reference	-
2000-5000	1.066 (0.535-2.125)	0.856
> 5000	1.161 (0.542-2.490)	0.701
The time since last ESD in mo
≤ 12	Reference	-	Reference	-
13-24	3.788 (2.130-6.736)	< 0.001	3.296(1.761-6.172)	< 0.001
≥ 25	7.743 (4.220-14.208)	< 0.001	5.768(2.963-11.226)	< 0.001
Family history
Yes	Reference	-
No	1.370 (0.365-2.952)	0.945
Infection with Helicobacter pylori in the past or present
Yes	0.652 (0.331-1.282)	0.215
No/unclear	Reference	-
Smoking history
Yes	Reference	-
No	1.952 (0.918-4.148)	0.082
Alcohol drinking
Yes	Reference	-	Reference	-
No	2.534 (1.246-5.154)	0.010	1.160 (0.500-2.691)	0.729
Pathological confirmation of early tumors after ESD
Yes	Reference	-
No/not detected	0.493 (0.212-1.144)	0.099

CI: Confidence interval; ESD: Endoscopic submucosal dissection; F: Female; M: Male; OR: Odds ratio.