1
|
Consequences of Structural Urbanism: Urban-Rural Differences in Cancer Patients' Use and Perceived Importance of Supportive Care Services from a 2017-2018 Midwestern Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063405. [PMID: 35329094 DOI: 10.3390/ijerph19063405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Structural inequities, in part, undergird urban-rural differences in cancer care. The current study aims to understand the potential consequences of structural inequities on rural and urban cancer patients' access to and perceived importance of supportive cancer care resources. METHODS We used data collected from November 2017 to May 2018 from a larger cross-sectional needs assessment about patients' support needs, use of services, and perceptions at a Midwestern United States cancer center. Oncology patients received a study packet during their outpatient clinic visit, and interested patients consented and completed the questionnaires. RESULTS Among the sample of 326 patients, 27% of the sample was rural. In adjusted logistic regression models, rural patients were less likely to report using any secondary support services (15% vs. 27%; OR = 0.43, 95%CI [0.22, 0.85], p = 0.02) and less likely than urban counterparts to perceive secondary support services as very important (51% vs. 64%; OR = 0.57, 95%CI [0.33, 0.94], p = 0.03). CONCLUSION Structural inequities likely have implications on the reduced access to and importance of supportive care services observed for rural cancer patients. To eliminate persistent urban-rural disparities in cancer care, rural residents must have programs and policies that address cancer care and structural inequities.
Collapse
|
2
|
Horrill TC, Martin DE, Lavoie JG, Schultz ASH. A critical exploration of nurses' perceptions of access to oncology care among Indigenous peoples: Results of a national survey. Nurs Inq 2021; 29:e12446. [PMID: 34342080 PMCID: PMC9286560 DOI: 10.1111/nin.12446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/08/2021] [Accepted: 07/11/2021] [Indexed: 11/30/2022]
Abstract
Inequities in access to oncology care among Indigenous peoples in Canada are well documented. Access to oncology care is mediated by a range of factors; however, emerging evidence suggests that healthcare providers, including nurses, play a significant role in shaping healthcare access. The purpose of this study was to critically examine access to oncology care among Indigenous peoples in Canada from the perspective of oncology nurses. Guided by postcolonial theoretical perspectives, interpretive descriptive and critical discourse analysis methodologies informed study design and data analysis. Oncology nurses were recruited from across Canada to complete an online survey (n = 78). Nurses identified a range of barriers experienced by Indigenous peoples when accessing oncology care, yet located these barriers primarily at the individual and systems levels. Nurses perceived themselves as mediators of access to oncology care; however, their efforts to facilitate access to care were constrained by the dominance of biomedicine within healthcare. Nurses' constructions of access to oncology care highlight the embedded narrative of individualism within nursing practice and the relative invisibility of racism as a determinant of equitable access to care among Indigenous peoples. This suggests a need for oncology nurses to better understand and incorporate structural determinants of health perspectives.
Collapse
Affiliation(s)
- Tara C Horrill
- Nursing & Allied Health Research and Knowledge Translation, BC Cancer, Vancouver, BC, Canada
| | - Donna E Martin
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Josée G Lavoie
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Annette S H Schultz
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| |
Collapse
|
3
|
The mediating role of unmet needs in the relationship between displacement and psychological adjustment: A study of cancer survivors from a Portuguese island region. Eur J Oncol Nurs 2021; 52:101928. [PMID: 33756420 DOI: 10.1016/j.ejon.2021.101928] [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: 07/21/2020] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE The present study aims to explore whether the association between previous displacement to mainland Portugal to perform cancer therapy and current psychological adaptation is mediated by cancer survivors' unmet needs in terms of their emotional experience, financial concerns, access and continuity of care, and relations with others. METHOD This cross-sectional study included a sample of 173 cancer survivors from the Azores archipelago (Portugal) recruited from a local oncological health unit. Participants completed a sociodemographic and clinical questionnaire and self-report measures assessing their unmet needs and psychological adaptation. Two parallel multiple mediation models were tested. RESULTS Azorean cancer survivors live with unmet needs, especially emotional needs (M = 16.68, SD = 10.78). Displacement was indirectly associated with both anxious (indirect effect = 0.58, SE = 0.27, 95% Bias Corrected and accelerated Confidence Interval = [0.05, 1.15]) and depressive symptomatology (indirect effect = 0.36, SE = 0.17, 95% Bias Corrected and accelerated Confidence Interval = [0.03, 0.84]) through unmet emotional needs. CONCLUSION Previous displacements seem to play an important role in the way cancer survivors adapt to survivorship by contributing to higher levels of unmet emotional needs. These findings can provide a scientific and clinical contribution to other isolated or island regions in the world where survivors face similar constraints.
Collapse
|
4
|
Living with leg lymphedema: developing a novel model of quality lymphedema care for cancer survivors. J Cancer Surviv 2020; 15:140-150. [PMID: 32712757 PMCID: PMC7822774 DOI: 10.1007/s11764-020-00919-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/10/2020] [Indexed: 11/03/2022]
Abstract
Purpose Lower-extremity lymphedema (LEL) is a lifelong consequence of cancer therapy and can lead to serious physical and psychosocial complications for many cancer survivors. However, clinical knowledge and treatment of LEL remain minimal. The purpose of this study was to integrate perspectives of lymphedema patients and healthcare providers (HCPs) on LEL to develop a novel model for quality lymphedema care. Methods A mixed-methods approach was implemented. Standardized questionnaires and semi-structured interviews were used to assess psychosocial well-being and experiences of LEL patients. Interviews were also used to evaluate the clinical experiences of HCPs working within tumour groups associated with cancer-related LEL. Thematic analysis was used to analyse qualitative data. Results Twenty-two patients and eleven HCPs participated in this study. Patient QOL, generalized anxiety and depressive symptom scores revealed a complex interplay between psychosocial well-being and supportive LEL care after cancer. Three themes emerged from interviews with patients (n = 19) and HCPs (n = 11): level of lymphedema knowledge, effectiveness of rehabilitation oncology services and barriers to care. Implications for Cancer Survivors We developed a novel model for quality lymphedema care that emphasizes the importance of continued physical and psychosocial support for LEL patients, while illustrating the importance of HCPs in facilitating a smooth transition for patients to LEL care after cancer treatment. Electronic supplementary material The online version of this article (10.1007/s11764-020-00919-2) contains supplementary material, which is available to authorized users.
Collapse
|
5
|
Spence W, Ghosh S, Palen M, Liska A, Ha V, Wong R, Huang F. Symptom burden among Northern Alberta radiotherapy patients with advanced cancer: mapping needs and gaps. Support Care Cancer 2020; 28:4963-4969. [PMID: 32034512 DOI: 10.1007/s00520-020-05330-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 01/28/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Patients with advanced cancer often experience symptoms including pain, nausea, anorexia, fatigue, and depression. High symptom burden can be alleviated by multidisciplinary palliative care (PC) teams practicing symptom-directed management. Patients who are unable to access such services may be at higher risk of increased symptoms and poor outcomes. METHODS A sequential exploratory mixed methods study was performed to explore the burden of symptoms experienced by Northern Alberta patients with advanced cancer. The symptom burden among patients from rural and remote communities was characterized in a retrospective review capturing basic demographic and clinicopathologic information, in addition to patient-reported outcomes. Symptom prevalence was evaluated against the nature and range of supportive care services available. Service accessibility was assessed at community level by surveying health care providers (HCPs) and performing thematic analysis on their responses. RESULTS From January 1 to December 31, 2017, 607 outpatients were seen in consultation in an integrated palliative radiotherapy clinic in Edmonton, Alberta. A total of 166 (27.3%) patients resided in Alberta communities designated as rural or remote. Patient-reported symptom prevalence and intensity of scores did not differ significantly between rural/remote and urban populations. Unmet practical needs were flagged significantly more often by patients from rural communities (p = 0.05). HCPs from rural community health centers in Northern Alberta were knowledgeable regarding PC services availability and referral processes within their communities. CONCLUSION Although the symptom burden experienced by patients living with advanced cancer in rural and remote areas of Northern Alberta does not differ significantly from their urban counterparts, and community HCPs are knowledgeable regarding PC services, unmet needs within these communities remain. Continuing support for PC services in rural communities, as well as establishing care pathways for patients from rural populations traveling to urban centers to receive treatment, will help to minimize the unmet needs these patients experience.
Collapse
Affiliation(s)
- Winter Spence
- Cross Cancer Institute, 11560 University Ave, Edmonton, Alberta, Canada.
| | - Sunita Ghosh
- Cross Cancer Institute, 11560 University Ave, Edmonton, Alberta, Canada.,University of Alberta, 8440 112 St NW, Edmonton, Alberta, Canada
| | - Megan Palen
- Cross Cancer Institute, 11560 University Ave, Edmonton, Alberta, Canada
| | - Alex Liska
- Cross Cancer Institute, 11560 University Ave, Edmonton, Alberta, Canada
| | - Vincent Ha
- Cross Cancer Institute, 11560 University Ave, Edmonton, Alberta, Canada
| | - Rebecca Wong
- Princess Margaret Cancer Centre, 610 University Ave, Toronto, Ontario, Canada.,University of Toronto, 1 King's College Circle, Toronto, Ontario, Canada
| | - Fleur Huang
- Cross Cancer Institute, 11560 University Ave, Edmonton, Alberta, Canada.,University of Alberta, 8440 112 St NW, Edmonton, Alberta, Canada
| |
Collapse
|
6
|
Access to cancer care among Indigenous peoples in Canada: A scoping review. Soc Sci Med 2019; 238:112495. [DOI: 10.1016/j.socscimed.2019.112495] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 11/20/2022]
|
7
|
Tzelepis F, Paul CL, Sanson-Fisher RW, Campbell HS, Bradstock K, Carey ML, Williamson A. Unmet supportive care needs of haematological cancer survivors: rural versus urban residents. Ann Hematol 2018. [DOI: 10.1007/s00277-018-3285-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
8
|
Dang A, Miller S, Horvat D, Klassen-Ross T, Graveline M, Collins R, Olson R. Assessing post-radiotherapy handover notes from a family physician perspective. Curr Oncol 2018; 25:49-52. [PMID: 29507483 DOI: 10.3747/co.25.3728] [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: 11/15/2022] Open
Abstract
Background Across our province, post-radiotherapy (rt) handover notes are sent to family physicians (fps) after rt. Based on previous fp feedback, we created a revised post-radiotherapy handover note with more information requested by fps. The purpose of this study was to determine whether the revised handover note improved the note as a communication aid. Methods Potential common and rare treatment side effects, oncologist contact information, and treatment intent were added to the revised handover note. Both versions were sent alongside a questionnaire to fps. Paired t-tests were carried out to compare satisfaction differences. Results There was a response rate of 37% for the questionnaires. Significantly greater clarity in the following categories was observed: responsibility for patient follow-up (mean score improvement of 1.2 on a 7-point Likert scale, p < 0.001), follow-up schedule (1.1, p < 0.001) as well as how and when to contact the oncologist (1.4, p = 0.001). Family physicians were also more content with how the institute transitioned care back to them (1.5, p = 0.012). Overall, fps were generally satisfied with the content of the revised post-rt handover note and noted improvement over the previous version. The frequency of investigations and institute supports initiated such as counselling services were suggested further additions. Conclusions The inclusion of potential treatment side effects, oncologist contact information, treatment intent and a well-laid out follow-up schedule were essential information needed by fps for an effective post-rt completion note. With these additions, the revised post-rt handover note showed significant improvement.
Collapse
Affiliation(s)
- A Dang
- University of British Columbia School of Medicine, Prince George, British Columbia
| | - S Miller
- Department of Radiation Oncology, British Columbia Cancer Agency-Centre for the North, Prince George, British Columbia.,Department of Surgery, University of British Columbia, Vancouver, British Columbia
| | - D Horvat
- University of British Columbia School of Medicine, Prince George, British Columbia.,Northern Health, Prince George, BC.,University of Northern British Columbia, Prince George, British Columbia.,Northern Partners in Care, Prince George, British Columbia
| | - T Klassen-Ross
- University of Northern British Columbia, Prince George, British Columbia
| | - M Graveline
- Northern Partners in Care, Prince George, British Columbia
| | - R Collins
- Northern Partners in Care, Prince George, British Columbia
| | - R Olson
- Department of Radiation Oncology, British Columbia Cancer Agency-Centre for the North, Prince George, British Columbia.,Department of Surgery, University of British Columbia, Vancouver, British Columbia
| |
Collapse
|
9
|
Lyford M, Haigh MM, Baxi S, Cheetham S, Shahid S, Thompson SC. An Exploration of Underrepresentation of Aboriginal Cancer Patients Attending a Regional Radiotherapy Service in Western Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E337. [PMID: 29443892 PMCID: PMC5858406 DOI: 10.3390/ijerph15020337] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 01/30/2018] [Accepted: 02/07/2018] [Indexed: 12/17/2022]
Abstract
Travel logistics impede Aboriginal patients' uptake of cancer treatments and is one reason for the poorer outcomes of Aboriginal people with cancer. This research examined benefits of a newly established rurally based radiotherapy unit in southwest Western Australia (WA), and included exploring the experience of Aboriginal patients and possible reasons for Aboriginal people's underrepresentation in treatment. Semi-structured in-depth interviews with 21 service providers involved in the treatment and care of people with cancer, and 3 Aboriginal patients with cancer who undertook radiotherapy at the Service were undertaken. Data were subject to thematic analysis involving immersion in the data for familiarization, inductive coding, investigator discussion and refining of emerging themes and triangulation of patient and provider interviews. Aboriginal cancer patients were positive about the treatment and support they had received, highlighting the often complex challenges faced by rural Aboriginal cancer patients in accessing and maintaining treatment. Service providers offered suggestions for small numbers presenting to the Service, including late presentation, potential perceptions of cultural insensitivity on the part of service providers, out-of-pocket costs and under-ascertainment of Aboriginal status. The Service has put in place practices and initiatives to support patient health and wellbeing, including making the facility more welcoming towards Aboriginal people and ensuring culturally appropriate care.
Collapse
Affiliation(s)
- Marilyn Lyford
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, Western Australia 6530, Australia.
| | - Margaret M Haigh
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, Western Australia 6530, Australia.
| | - Siddhartha Baxi
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, Western Australia 6530, Australia.
- Radiation Oncology, South West Radiation Oncology Service, South West Health Campus, Corner of Bussell Hwy & Robertson Drive, Bunbury, Western Australia 6230, Australia.
| | - Shelley Cheetham
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, Western Australia 6530, Australia.
- School of Nursing, Midwifery and Paramedicine, Curtin University, Kent Street, Perth, Western Australia 6102, Australia.
| | - Shaouli Shahid
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, Western Australia 6530, Australia.
- Centre for Aboriginal Studies, Curtin University, Kent Street, Perth, Western Australia 6102, Australia.
| | - Sandra C Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, 167 Fitzgerald Street, Geraldton, Western Australia 6530, Australia.
| |
Collapse
|
10
|
Abstract
Background: The identification and management of unmet needs is an essential component of health care for the growing cancer
patient population. Information about the prevalence of unmet need can help medical service planning/redesigning. Therefore, this
study aimed to identify unmet needs in Iranian patients suffering from cancer.
Methods: This cross-sectional correlational study was conducted on 650 cancer patients admitted to the major medical centers in
Mashhad and Neyshabur by census sampling. The data was gathered by the Survivor Unmet Needs Survey (SUNS). Data were analyzed
using ANOVA, t-test and Pearson correlation.
Results: Most of participants were female (56%, n=263) and Mashhad resident (67.1%, n=436). The most common cancers were
colorectal (17.8 %, n=116), stomach (13.6%, n=88) and lung (9.4%, n=62), respectively. The highest unmet needs score belonged to
work and financial needs (2.46 ± 0.91), and the least was the emotional domain (1.92±0.90). Among demographic factors, a significant
relationship was found between resident places (p<0.001), and cancer type (p<0.0001).
Conclusion: This is the first study addressing the unmet needs of cancer patients in Iran. It reveals that cancer patients had a relative
high number of unmet needs; this shows the necessity of including these factors in the routine assessment of all cancer patients and
planning treatment interventions based on their individual’s need.
Collapse
|
11
|
|
12
|
Hammond C, Thomas R, Gifford W, Poudrier J, Hamilton R, Brooks C, Morrison T, Scott T, Warner D. Cycles of silence: First Nations women overcoming social and historical barriers in supportive cancer care. Psychooncology 2017; 26:191-198. [DOI: 10.1002/pon.4335] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 10/26/2016] [Accepted: 11/25/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Chad Hammond
- School of Rehabilitation Sciences; University of Ottawa; Ottawa ON Canada
| | - Roanne Thomas
- School of Rehabilitation Sciences; University of Ottawa; Ottawa ON Canada
| | - Wendy Gifford
- School of Nursing; University of Ottawa; Ottawa ON Canada
| | - Jennifer Poudrier
- Department of Sociology; University of Saskatchewan; Saskatoon SK Canada
| | - Ryan Hamilton
- Department of Psychology; University of New Brunswick; Fredericton NB Canada
| | - Carolyn Brooks
- Department of Sociology; University of Saskatchewan; Saskatoon SK Canada
| | - Tricia Morrison
- School of Rehabilitation Sciences; University of Ottawa; Ottawa ON Canada
| | - Tracy Scott
- First Nations, Inuit, and Métis Program; Saint Elizabeth Health Care; Winnipeg MB Canada
| | - Doris Warner
- First Nations, Inuit, and Métis Program; Saint Elizabeth Health Care; Markham ON Canada
| |
Collapse
|