Stigma, colorectal cancer knowledge and self-efficacy among colorectal cancer survivors: A cross-sectional study based on random forest analysis

Abstract

Purpose: To assess the stigma levels among colorectal cancer (CRC) survivors, identify determinants, examine correlations with CRC knowledge and self-efficacy, and quantify the relative influence of various contributing factors.

Methods: In total, 301 CRC survivors were enrolled from a tertiary oncology center in southern China. The participants completed the Social Impact Scale (SIS), Bowel Cancer Awareness Measure (Bowel CAM), General Self-Efficacy Scale (GSES), and a demographic and disease-related questionnaire. The analytical framework included multiple linear regression to identify the factors influencing stigma, LASSO regression for variable refinement, and random forest modeling to construct hierarchies of factor importance.

Results: Participants demonstrated moderate levels across all measures: stigma (54.63 ± 8.37), CRC knowledge (8.25 ± 4.74), and self-efficacy (26.81 ± 5.95). Multiple linear regression identified type of medical insurance, support from peers, unwillingness to accept colonoscopy, CRC knowledge, and self-efficacy as significant factors influencing stigma. Random forest analysis ranked factor importance by Gini index: self-efficacy (4366.41), support from peers (1618.03), CRC knowledge (1029.04), type of medical insurance (886.66), and unwillingness to accept colonoscopy (750.16).

Conclusions: Healthcare providers should pay more attention to stigma among CRC patients. Effective stigma reduction necessitates culturally-sensitive psychosocial interventions, including enhancing patients' confidence in managing their disease, strengthening professional-driven online popularization of science campaigns, and facilitating social support networks.

Keywords: Cancer survivors; Colorectal cancer; Colorectal cancer knowledge; Self-efficacy; Stigma.