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Estupiñán Fdez de Mesa M, Marcu A, Ream E, Whitaker KL. Understanding and tackling cancer inequities: What opportunities does intersectionality offer researchers, policymakers, and providers? A scoping review. J Psychosoc Oncol 2024:1-28. [PMID: 39120128 DOI: 10.1080/07347332.2024.2361642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
PROBLEM IDENTIFICATION We summarised the international evidence relating to the role of intersectionality in patients' lived experience of inequities along the cancer care pathway. We produced guidance to use intersectionality in future research. LITERATURE SEARCH We included 42 articles published between 1989 to 2023 that used intersectionality to guide the study and interpretation of inequities in cancer care. DATA EVALUATION/SYNTHESIS Articles predominantly comprised North American (n = 37), followed by European (n = 4) and Asian (n = 1) studies. Similar compounding effects of racism, homophobia, and discrimination across countries exacerbated inequities in cancer care experience and cancer outcomes particularly for women of color and sexual/gender minority groups. Professionals' knowledge, attitudes, and behaviors toward minoritised groups affected patient-provider relationships and influenced cancer patients' psychosocial responses. CONCLUSION Intersectionality provides a framework to assess the personal, interpersonal, and structural processes through which cancer inequities manifest within and across countries.
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Affiliation(s)
| | - Afrodita Marcu
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | - Emma Ream
- School of Health Sciences, University of Surrey, Guildford, Surrey, UK
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Crittendon DR, Brecher AC, Okere S, Hass R, Frasso R, Brawer R, Zeigler-Johnson C. Perceptions of Smoking Stigma Among African Americans: A Qualitative Study. Nicotine Tob Res 2024:ntae127. [PMID: 39009350 DOI: 10.1093/ntr/ntae127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 04/01/2024] [Accepted: 05/18/2024] [Indexed: 07/17/2024]
Abstract
INTRODUCTION African Americans/Blacks (AAB) are at increased risk for morbidity and mortality from smoking-related diseases including lung cancer (LC). Smoking stigma is believed to be a primary barrier to health care-seeking for people who smoke. Previous studies illustrate that perceptions of smoking vary across populations. However, little is known about the prevalence of smoking stigmas among AAB. The purpose of this study was to increase understanding of the perception of cigarette smoking by AAB. AIMS AND METHODS We conducted free-listing interviews in which individuals listed all-thoughts and feelings regarding smoking and health-related questions with a convenience sample of eligible AAB adults (n = 58) in the Philadelphia region. Additionally, we collected participant self-reported demographic data. Data were cleaned and the salience of each term was computed using Anthropac. Graphical methods were then used to determine salient responses across groups stratified by gender, age, education, and smoking status. RESULTS The sample had a median age of 51 years and was 67.2% female. Most participants had completed college (58.6%) and had never smoked (74.1%). Regarding their perceptions of people who smoke cigarettes, results showed that "smelly," "health hazard," and "judgment" were the most salient terms among all-participants. Overall, "smelly" and "unhealthy" were salient for both males and females. However, "dental," "dirty," "addictive," and "habit" were also salient among males. Phrases such as "unhealthy" and "addictive" were primarily salient for older participants (>51 years) versus "smelly" for younger participants. The term "smelly" was salient among all-education levels. However, "unhealthy" was also salient among those with less than a 4-year college degree. Moreover, the terms "smelly" and "annoying" were most common among people who smoke as opposed to "health hazard" among people who don't smoke. CONCLUSIONS We observed that the most stigmatizing language was primarily associated with perceptions of negative social interactions, social judgment, and health-related concerns. Future studies are needed to explore how smoking-related stigmas impact patient adherence to smoking cessation programs and LC screening protocols. IMPLICATIONS Little is known about the prevalence of smoking stigmas among AAB. This study explores the AAB perspective of cigarette smoking and related stigmas. Among AAB, smoking is represented by stigmatizing language across gender, age groups, and smoking history. It is primarily associated with negative social interactions, social judgement, and health-related concerns indicating that smoking stigma is a concern for AAB individuals who smoke. Further research is warranted.
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Affiliation(s)
- Denine R Crittendon
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Samantha Okere
- Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Richard Hass
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rosemary Frasso
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rickie Brawer
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Charnita Zeigler-Johnson
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
- Fox Chase Cancer Center, Philadelphia, PA, USA
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Estupiñán Fdez de Mesa M, Marcu A, Ream E, Whitaker KL. Socioeconomic inequities in care experienced by women with breast cancer in England: An intersectional cross-sectional study. Eur J Oncol Nurs 2024; 72:102648. [PMID: 39106587 DOI: 10.1016/j.ejon.2024.102648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 05/28/2024] [Accepted: 06/22/2024] [Indexed: 08/09/2024]
Abstract
PURPOSE Guided by the Intersectionality Framework, we examined the differential in breast cancer care experience across population subgroups in England. METHODS Secondary data analysis using the 2017/2018 National Cancer Patient Experience Surveys. We used disaggregated descriptive statistics (mean, standard errors, 95% confidence interval) to analyse 26,030 responses from female breast cancer patients to a question relating to overall care experience categorised by age, ethnicity, and sexual orientation in their intersection with social position. We then used logistic regression to investigate the odds (Odds Ratio (OR), 95% confidence intervals) of reporting positive care experience adjusting for patient, clinical, and Trust level factors. RESULTS Poorer care experience was predominantly reported by the most deprived younger and minoritised ethnic groups. Statistically significant findings were observed in adjusted multivariable analyses. Compared to patients aged 65-74 years, younger respondents were less likely to rate their care favourably (16-34 years old ORadj. = 0.55 (0.36-0.84). Compared to White British, Asian (ORadj. = 0.51 (0.39-0.66)) and Black African women (ORadj. = 0.53 (0.33-0.88)) were less likely to rate their care favourably. The least affluent respondents were less likely to rate their care favourably (ORadj. = 0.79 (0.64-0.97)). CONCLUSION There is evidence of inequity in overall cancer care experience among female breast cancer patients in England, particularly among women living at the specific intersection of age, ethnicity, and socioeconomic position. Future research is necessary to understand the mechanisms underlying breast cancer inequities. Policymakers, commissioners, and providers should consider the existence of multiple forms of marginalisation to inform improvement initiatives targeting patients at higher risk of vulnerability.
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Affiliation(s)
| | - Afrodita Marcu
- School of Health Sciences, University of Surrey, Research Park, Guildford, Surrey, GU2 7YH, UK
| | - Emma Ream
- School of Health Sciences, University of Surrey, Research Park, Guildford, Surrey, GU2 7YH, UK
| | - Katriina L Whitaker
- School of Health Sciences, University of Surrey, Research Park, Guildford, Surrey, GU2 7YH, UK
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Santos Salas A, Watanabe SM, Sinnarajah A, Bassah N, Huang F, Turner J, Alcalde Castro J, O'Rourke HM, Camargo-Plazas P, Salami B, Santana M, Campbell K, Abdel-Rahman O, Wildeman T, Vaughn L, Judge H, Ahmed S, Adewale B, Iyiola I. Increasing access to palliative care for patients with advanced cancer of African and Latin American descent: a patient-oriented community-based study protocol. BMC Palliat Care 2023; 22:204. [PMID: 38115105 PMCID: PMC10731745 DOI: 10.1186/s12904-023-01323-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Cancer disparities are a major public health concern in Canada, affecting racialized communities of Latin American and African descent, among others. This is evident in lower screening rates, lower access to curative, and palliative-intent treatments, higher rates of late cancer diagnoses and lower survival rates than the general Canadian population. We will develop an Access to Palliative Care Strategy informed by health equity and patient-oriented research principles to accelerate care improvements for patients with advanced cancer of African and Latin American descent. METHODS This is a community-based participatory research study that will take place in two Canadian provinces. Patients and community members representatives have been engaged as partners in the planning and design of the study. We have formed a patient advisory council (PAC) with patient partners to guide the development of the Access to Palliative Care Strategy for people of African and Latin American descent. We will engage100 participants consisting of advanced cancer patients, families, and community members of African and Latin American descent, and health care providers. We will conduct in-depth interviews to delineate participants' experiences of access to palliative care. We will explore the intersections of race, gender, socioeconomic status, language barriers, and other social categorizations to elucidate their role in diverse access experiences. These findings will inform the development of an action plan to increase access to palliative care that is tailored to our study population. We will then organize conversation series to examine together with community partners and healthcare providers the appropriateness, effectiveness, risks, requirements, and convenience of the strategy. At the end of the study, we will hold knowledge exchange gatherings to share findings with the community. DISCUSSION This study will improve our understanding of how patients with advanced cancer from racialized communities in Canada access palliative care. Elements to address gaps in access to palliative care and reduce inequities in these communities will be identified. Based on the study findings a strategy to increase access to palliative care for this population will be developed. This study will inform ways to improve access to palliative care for racialized communities in other parts of Canada and globally.
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Affiliation(s)
- Anna Santos Salas
- Faculty of Nursing, College of Health Sciences, University of Alberta, Third Floor Edmonton, Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada.
| | - Sharon M Watanabe
- Division of Palliative Care Medicine, Department of Oncology, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, 11560 University Avenue Edmonton, Alberta, T6G 1Z2, Canada
| | - Aynharan Sinnarajah
- Department of Medicine, Queen's University, 34 Barrie Street, Kingston, ON, K7L 3N6, Canada
| | - Nahyeni Bassah
- Faculty of Nursing, College of Health Sciences, University of Alberta, Third Floor Edmonton, Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Fleur Huang
- Division of Radiation Oncology, Department of Oncology, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada
| | - Jill Turner
- Supportive Care Team Cross Cancer Institute and Division of Palliative Care Medicine, Department of Oncology, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada
| | - Jacqueline Alcalde Castro
- Department of Psychosocial Oncology and Supportive Care, Princess Margaret Cancer Centre , Department of Medicine, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Hannah M O'Rourke
- Faculty of Nursing, College of Health Sciences, University of Alberta, Third Floor Edmonton, Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | | | - Bukola Salami
- Cumming School of Medicine, University of Calgary Foothills Campus, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - María Santana
- Cumming School of Medicine, University of Calgary Foothills Campus, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
- Patient Engagement Team, Alberta SPOR SUPPORT Unit, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Katy Campbell
- Department of Women and Gender Studies, Faculty of Arts, College of Social Sciences and Humanities, 3-51 Assiniboia Hall, Edmonton, AB, T6G 2E7, Canada
| | - Omar Abdel-Rahman
- Medical Oncology Cross Cancer Institute and Department of Oncology, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, 11560 University Avenue, Edmonton, AB, T6G 1Z2, Canada
| | - Tracy Wildeman
- Faculty of Nursing, College of Health Sciences, University of Alberta, Third Floor Edmonton, Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Lisa Vaughn
- Faculty of Nursing, College of Health Sciences, University of Alberta, Third Floor Edmonton, Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Harkeert Judge
- Faculty of Nursing, College of Health Sciences, University of Alberta, Third Floor Edmonton, Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Sadia Ahmed
- Patient Engagement Team, Alberta SPOR SUPPORT Unit, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada
| | - Bisi Adewale
- Faculty of Nursing, College of Health Sciences, University of Alberta, Third Floor Edmonton, Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Iqmat Iyiola
- Faculty of Nursing, College of Health Sciences, University of Alberta, Third Floor Edmonton, Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
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Siira E, Linden K, Wallström S, Björkman I. Intersectionality in nursing research: A systematic review. Nurs Open 2023; 10:7509-7527. [PMID: 37798952 PMCID: PMC10643838 DOI: 10.1002/nop2.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/14/2023] [Accepted: 09/17/2023] [Indexed: 10/07/2023] Open
Abstract
AIM This systematic literature review aimed to identify, appraise and synthesize available research studies that apply intersectionality in nursing research. DESIGN Systematic review. DATA SOURCES Empirical and theoretical nursing studies published before February 2022 were identified from the PubMed and CINAHL databases. Studies were eligible for inclusion if they substantially covered the topics of intersectionality and nursing, had undergone peer-review, and were written in English. REVIEW METHODS The PRISMA 2020 statement for reporting systematic reviews was used to report findings. The Joanna Briggs Institute Critical Appraisal tools were used to assess the quality of the included research studies. RESULTS Out of 331 identified studies, 60 studies were substantially about nursing and intersectionality, and were included in the review. There are a myriad of ways that the concept of intersectionality has been adopted in nursing research. Furthermore, there was great heterogeneity in the definition and application of the concept of intersectionality, and only a few studies were empirical. CONCLUSION There is a need for robust and clear framing of how the concept of intersectionality is defined and understood in nursing research. There is also a need for more empirical research effectively adopting the concept of intersectionality to enhance our understanding of how health inequities operate within the field of nursing. NO PATIENT OR PUBLIC CONTRIBUTION No patients, service users, caregivers or members of the public were involved in this work.
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Affiliation(s)
- Elin Siira
- School of Health and WelfareHalmstad UniversityGöteborgSweden
| | - Karolina Linden
- Institute of Health and Care SciencesGothenburg UniversityGöteborgSweden
| | - Sara Wallström
- Institute of Health and Care SciencesGothenburg UniversityGöteborgSweden
- Centre for Person‐Centred Care GPCCGothenburg UniversityGöteborgSweden
| | - Ida Björkman
- Institute of Health and Care SciencesGothenburg UniversityGöteborgSweden
- Centre for Person‐Centred Care GPCCGothenburg UniversityGöteborgSweden
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Sherman AD, Febres-Cordero S, Bonds Johnson K, Clark KD, Klepper M, Duroseau B, Lin Y, Zhang W, Coleman M, Prakash D, Daniel GA, Chand AT, Kalu U, Tarter R, Allgood S, Cohen S, Kelly U, Balthazar M. Intersectionality in nursing research: A scoping review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2023; 5:100155. [PMID: 37982092 PMCID: PMC10655863 DOI: 10.1016/j.ijnsa.2023.100155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 11/21/2023] Open
Abstract
Background An intersectional approach to health research provides an analytical foundation to explain the multidimensionality of health status, resource accessibility, privilege, oppression, and current and historical context. The use of intersectionality in health research has known limitations. Its use in health-related fields too often focuses on outcomes, such as health disparities, rather than processes, such as power structures and social determinants. Objective This scoping review serves to examine how intersectionality has been implemented by nurses in the peer-reviewed literature. We offer insight into how it may be incorporated to inform future nursing research and healthcare provision. Design & Methods Systematic searches of PubMed (n = 257), SCOPUS (n = 807), EMBASE (n = 396), CINAHL (n = 224), and Health Source: Nursing and Academics (n = 491), published since the seminal publication on intersectionality (1989 - 2023), identified 131 research articles that met inclusion and exclusion criteria. Data extraction and synthesis were used to describe the breadth and depth of the literature specific to the application of intersectionality in nursing research. Results The included studies used intersectionality to examine the intersections of numerous identities, such as race, gender, and immigration status. However, most studies were descriptive/observational in nature, underreported their methods, and conducted deficit-based research instead of strength-based inquiries. Of note, the vast majority of included articles were published within the last five years. Conclusions Future researchers using intersectionality as a framework can improve their approach by reporting clear definitions and operationalization of intersectionality. Observational science dominated the included studies; future research should focus on intervention development and evaluation using an intersectional lens. Lastly, caution should be placed on research that focuses solely on deficits among marginalized communities, which places scientists at risk of perpetuating stereotypes or enhancing already-existing stigmas.
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Affiliation(s)
- Athena D. F. Sherman
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Sarah Febres-Cordero
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Kalisha Bonds Johnson
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Kristen D. Clark
- Department of Nursing, University of New Hampshire, Durham, NH, USA
| | | | | | - Yufen Lin
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Wenhui Zhang
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Mercy Coleman
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Diane Prakash
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Gaea A. Daniel
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Arzina Tabassum Chand
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Ugo Kalu
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Robin Tarter
- Oregon Health and Science University, Portland, OR, USA
| | | | - Sydney Cohen
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
| | - Ursula Kelly
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
- Atlanta VA Health Care System, Atlanta, Georgia, USA
| | - Monique Balthazar
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road Office: 310, Atlanta, GA 30322, USA
- Ross and Carol Nese College of Nursing, Pennsylvania State University, University Park, PA, USA
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Snyder CR, Mohammed SA. A Critical Race Theory Analysis of Mental Health Disparities Research. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01840-x. [PMID: 37884854 DOI: 10.1007/s40615-023-01840-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
Health disparities and the impact of racism on the mental and physical health of people of color has been well-documented. However, health research has historically approached race as a genetic and biological attribute to explain differences in health outcomes. Although more recent policies and research have begun to move toward conceptualizing race as a socially constructed category that can be thought of as a proxy for racism, the ways in which race and racism are conceptualized in mental health disparities research needs deeper analysis. Using critical race theory (CRT) and content analysis, we investigate how mental health research has examined race, racism, and mental health in PubMed articles published between 2012 and 2022. Findings suggest a need for more complex conceptualizations of race, particularly related to essentialized, monoracial framings that rarely explore how race is defined and employed. Much of the research analyzed did not position racism, discrimination, or oppression as central to contextualizing racial mental health disparities. Additionally, the role of voice was often missing, limiting understandings of racialized experiences. Results of this analysis illuminate areas the need for more racism conscious approaches to understanding racial disparities in mental health and identifying opportunities to promote health equity.
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Affiliation(s)
- Cyndy R Snyder
- Department of Family Medicine, School of Medicine, University of Washington, Seattle, WA, USA.
| | - Selina A Mohammed
- School of Nursing and Health Studies, University of Washington, Bothell, WA, USA
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8
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Garza RH, Williams MY, Ntiri SO, Hampton MD, Yan AF. Intersectionality Impacts Survivorship: Identity-Informed Recommendations to Improve the Quality of Life of African American Breast Cancer Survivors in Health Promotion Programming. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912807. [PMID: 36232105 PMCID: PMC9564905 DOI: 10.3390/ijerph191912807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/28/2022] [Accepted: 10/04/2022] [Indexed: 05/31/2023]
Abstract
(1) Background: African American women breast cancer survivors face unique experiences that impact their quality of life as they transition beyond treatments. Experiences may be complicated by living at the intersection of systemically oppressed identities, including gender, race, social class, and cancer-related disability. Using the Black Feminist Thought (BFT) framework and the PEN-3 cultural model, this qualitative study sought to: (a) understand African American women breast cancer survivors' lived experiences; (b) examine how the multiple intersecting factors of race, gender, social class/socioeconomic status, and cancer-related disability impact their quality of life; and (c) inform future health promotion programming that is culturally relevant to AAWBCS to improve their quality of life. (2) Methods: Seven focus groups were conducted with 30 African American breast cancer survivors in a Midwestern metropolitan region. Focus groups were audiotaped and transcribed verbatim. Framework analyses were conducted to identify themes with NVivo qualitative analysis software. (3) Results: Four themes emerged: (a) caregiving roles provide both support and challenges for survivors, (b) the "strong Black woman" is inherent in survivor experiences, (c) intersectionality impacts survivorship, and (d) African American women resist oppression through culturally specific supports and advocacy. (4) Conclusions: The intervention point of entry should be at the peer support group level and centered on family and provide community-based support and services. Future research should move upstream to address social determinants of health, including racism, sexism, and ableism; there is a critical need to discuss how structural racism affects health care and develop interventions to address racial discrimination and racial bias in health care.
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Affiliation(s)
- Rose Hennessy Garza
- Joseph J Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI 53205, USA
| | - Michelle Y. Williams
- Division of Research, Patient Care Services, Stanford Healthcare, Palo Alto, CA 94304, USA
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA 94304, USA
| | - Shana O. Ntiri
- Department of Family & Community Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | | | - Alice F. Yan
- Division of Research, Patient Care Services, Stanford Healthcare, Palo Alto, CA 94304, USA
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9
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Kelly-Brown J, Palmer Kelly E, Obeng-Gyasi S, Chen JC, Pawlik TM. Intersectionality in cancer care: A systematic review of current research and future directions. Psychooncology 2022; 31:705-716. [PMID: 35199401 DOI: 10.1002/pon.5890] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/07/2022] [Accepted: 01/19/2022] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The objective of the current review was to synthesize the literature on intersectionality relative to disparities across the cancer care continuum. A model to support future intersectional cancer research was proposed. METHODS Web-based discovery services and discipline-specific databases were queried for both peer-reviewed and gray literature. Study screening and data extraction were facilitated through the Covidence software platform. RESULTS Among 497 screened studies, 28 met study inclusion criteria. Most articles were peer-reviewed empirical studies (n = 22) that focused on pre-diagnosis/screening (n = 19) and included marginalized racial/ethnic (n = 22) identities. Pre-cancer diagnosis, sexual orientation and race influenced women's screening and vaccine behaviors. Sexual minority women, particularly individuals of color, were less likely to engage in cancer prevention behaviors prior to diagnosis. Race and socioeconomic status (SES) were important factors in patient care/survivorship with worse outcomes among non-white women of low SES. Emergent themes in qualitative results emphasized the importance of patient intersectional identities, as well as feelings of marginalization, fears of discrimination, and general discomfort with providers as barriers to seeking cancer care. CONCLUSIONS Patients with intersectional identities often experience barriers to cancer care that adversely impact screening, diagnosis, treatment, as well as survivorship. The use of an "intersectional lens" as a future clinical and research framework will facilitate a more multidimensional and holistic approach to the care of cancer patients.
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Affiliation(s)
- Joseph Kelly-Brown
- School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Elizabeth Palmer Kelly
- Department of Surgery, the Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Samilia Obeng-Gyasi
- Department of Surgery, the Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - J C Chen
- Department of Surgery, the Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Timothy M Pawlik
- Department of Surgery, the Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
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10
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Poteat T, Adams MA, Malone J, Geffen S, Greene N, Nodzenski M, Lockhart A, Su IH, Dean LT. Delays in breast cancer care by race and sexual orientation: Results from a national survey with diverse women in the United States. Cancer 2021; 127:3514-3522. [PMID: 34287838 PMCID: PMC8684596 DOI: 10.1002/cncr.33629] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/19/2020] [Accepted: 01/19/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Despite known differences in breast cancer by both race and sexual orientation, data on the intersectional experiences of Black sexual minority women (BSMW) along the care continuum are scant. This study sought to understand delays in breast cancer care by examining the intersection of race and sexual orientation. METHODS This online, cross-sectional survey enrolled racially and sexually diverse women aged ≥ 35 years who had been diagnosed with breast cancer within the prior 10 years or had an abnormal screening in the prior 24 months. The authors calculated summary statistics by race/sexual orientation categories, and they conducted univariate and multivariable modeling by using multiple imputation for missing data. RESULTS BSMW (n = 101) had the highest prevalence of care delays with 5.17-fold increased odds of a care delay in comparison with White heterosexual women (n = 298) in multivariable models. BSMW reported higher intersectional stigma and lower social support than all other groups. In models adjusted for race, sexual orientation, and income, intersectional stigma was associated with a 2.43-fold increase in care delays, and social support was associated with a 32% decrease in the odds of a care delay. CONCLUSIONS Intersectional stigma may be an important driver of breast cancer inequities for BSMW. Reducing stigma and ensuring access to appropriate social support that addresses known barriers can be an important approach to reducing inequities in the breast cancer care continuum.
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Affiliation(s)
- Tonia Poteat
- University of North Carolina Chapel Hill, Department of Social Medicine, CB #7240, Chapel Hill, NC 27599
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N Wolfe Street, Baltimore, MD 21205
| | | | - Jowanna Malone
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N Wolfe Street, Baltimore, MD 21205
| | - Sophia Geffen
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N Wolfe Street, Baltimore, MD 21205
| | - Naomi Greene
- Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior and Society, 624 North Broadway Street, Baltimore, MD 21205
| | - Michael Nodzenski
- University of North Carolina Chapel Hill, Department of Biostatistics, CB #7420, Chapel Hill, NC 27599
| | - Alex Lockhart
- University of North Carolina Chapel Hill, Department of Biostatistics, CB #7420, Chapel Hill, NC 27599
| | - I-Hsuan Su
- University of North Carolina Chapel Hill, Department of Biostatistics, CB #7420, Chapel Hill, NC 27599
| | - Lorraine T. Dean
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N Wolfe Street, Baltimore, MD 21205
- Johns Hopkins School of Medicine, Department of Oncology, 720 Rutland Ave, Baltimore, MD 21205
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11
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Elk R. The intersection of racism, discrimination, bias, and homophobia toward African American sexual minority patients with cancer within the health care system. Cancer 2021; 127:3500-3504. [PMID: 34287834 DOI: 10.1002/cncr.33627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/02/2021] [Accepted: 04/07/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Ronit Elk
- Division of Geriatrics, Gerontology and Palliative Care, Department of Medicine, University of Alabama, Birmingham, Alabama
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