title: Use of cancer-specific mental health resources-is there an urban-rural divide?
abstract: OBJECTIVE
  The purpose of this study is to establish whether mental health (MH) outcomes, attitudes towards cancer-specific MH (CSMH) resources, and the availability of such resources differ between rural and urban cancer patients.
  
  
  METHODS
  Three months after surgery for colorectal cancer, patients received a questionnaire for completion at home assessing distress, depression, anxiety, acceptance, knowledge and use of CSMH resources and the doctor-patient relationship. We adjusted our sample to reference data of the Munich Cancer Registry and documented CSMH resources (e.g. cancer-specific information centres and cancer support groups) using a systematic Internet search.
  
  
  RESULTS
  Five hundred thirty-four patients participated with a mean age of 68.9 years; 44.5 % were female. Urban patients talked less with their doctor about their emotional state (65 %, p < 0.01) and showed poorer knowledge of CSMH resources (60 %, p < 0.002). A good doctor-patient relationship was associated with a better MH outcome. A significant predictor for acceptance was distress. Ninety-four percent of patients without a nearby support facility lived in rural areas (p < 0.001). There were no group differences concerning distress, MH outcomes, or acceptance of CSMH resources.
  
  
  CONCLUSIONS
  Despite a higher availability of CSMH resources, urban patients showed poorer doctor-patient relationships and less knowledge of such resources than rural patients. Overall, knowledge and use of these resources were poor. The amount of support facilities available therefore appears to be less important than establishing an efficient communication network between patients, doctors and providers of CSMH resources to achieve satisfaction with treatment of urban and rural cancer patients.
authors.affiliation: Medical Clinic and Policlinic III, Psycho-Oncology, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, Munich, Germany, Anna.Beraldi@med.uni-muenchen.de.
authors.forename: Anna
authors.initials: A
authors.lastname: Beraldi
authors.forename: Ene
authors.initials: E
authors.lastname: Kukk
authors.forename: Alexandra
authors.initials: A
authors.lastname: Nest
authors.forename: Gabriele
authors.initials: G
authors.lastname: Schubert-Fritschle
authors.forename: Jutta
authors.initials: J
authors.lastname: Engel
authors.forename: Pia
authors.initials: P
authors.lastname: Heußner
authors.forename: Peter
authors.initials: P
authors.lastname: Herschbach
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000523:psychology; D015179:Colorectal Neoplasms / Q000523:psychology*; D003142:Communication; D003863:Depression / Q000523:psychology; D004644:Emotions; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data*; D008875:Middle Aged; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D012424:Rural Population / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires