Breast cancer patients' experiences within and outside the safety net

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• 作者：Oluwadamilola M. Fayanju ; MD ; MPHS^a ; ^{fayanjuo@wudosis.wustl.edu" class="auth_mail} ; Donna B. Jeffe ; PhD^b ; ^c ; Leisha Elmore ; MD ; MPHS^a ; Deborah N. Ksiazek ; BS^d ; Julie A. Margenthaler ; MD ; FACS^a ; ^c
• 关键词：Breast cancer ; Delayed diagnosis ; Health disparities ; Late stage ; Qualitative methods ; Safety net ; St. Louis
• 刊名：Journal of Surgical Research
• 出版年：July 2014
• 年：2014
• 卷：190
• 期：1
• 页码：126-133
• 全文大小：244 K

文摘

Following reforms to the breast-cancer referral process for our city’s health Safety Net (SN), we compared the experiences from first abnormality to definitive diagnosis of breast-cancer patients referred to Siteman Cancer Center from SN and non-SN (NSN) providers.

Materials and methods

SN-referred patients with any stage (0–IV) and NSN-referred patients with late-stage (IIB–IV) breast cancer were prospectively identified after diagnosis during cancer center consultations conducted between September 2008 and June 2010. Interviews were taped and transcribed verbatim; transcripts were independently coded by two raters using inductive methods to identify themes.

Results

Of 82 eligible patients, 57 completed interviews (33/47 SN [70%] and 24/35 NSN [69%]). Eighteen SN-referred patients (52%) had late-stage disease at diagnosis, as did all NSN patients (by design). A higher proportion of late-stage SN patients (67%) than either early-stage SN (47%) or NSN (33%) patients reported feelings of fear and avoidance that deterred them from pursuing care for concerning breast findings. A higher proportion of SN late-stage patients than NSN patient reported behaviors concerning for poor health knowledge or behavior (33% versus 8%), but reported receipt of timely, consistent communication from health care providers once they received care (50% versus 17%). Half of late-stage SN patients reported improper clinical or administrative conduct by health care workers that delayed referral and/or diagnosis.

Conclusions

Although SN patients reported receipt of compassionate care once connected with health services, they presented with higher-than-expected rates of late-stage disease. Psychological barriers, life stressors, and provider or clinic delays affected access to and navigation of the health care system and represent opportunities for intervention.