Ragas Daiva M, Nonzee Narissa J, Tom Laura S, Phisuthikul Ava M, Luu Thanh Ha, Dong XinQi, Simon Melissa A
Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois.
Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois.
Womens Health Issues. 2014 Sep-Oct;24(5):511-8. doi: 10.1016/j.whi.2014.06.011.
The patient voice remains underrepresented in clinical and public health interventions. To inform interventions that strive to improve access to breast and cervical cancer screening and follow-up among low-income populations, we explored recommendations from low-income women pursuing health care in the safety net.
Semi-structured interviews were conducted among women receiving follow-up care for an abnormal breast or cervical cancer screening result or a positive cancer diagnosis in federally qualified health centers, free clinics, or an academic cancer center in the Chicago metropolitan area.
Of the 138 women interviewed in the parent study, 52 women provided recommendations for improving access to screening and follow-up care. Most were between 41 and 65 years old (62%) and African American (60%) or White (25%). Recommendations included strengthening community-based health education with more urgent messaging, strategic partnerships, and active learning experiences to increase patient engagement, which women regarded as a key driver of access. Women also suggested increasing access by way of changes to health care delivery systems and policy, including more direct patient-provider and patient-clinic communications, addressing delays caused by high patient volume, combining preventive services, expanding insurance coverage, and adjusting screening guidelines.
This exploratory study demonstrates important insights from the patient lens that may help to increase the acceptability and efficacy of community and clinical interventions aimed at improving access to breast and cervical cancer screening and follow-up. Further research is needed to identify appropriate integration of patient input into interventions, practice, and policy change.
在临床和公共卫生干预措施中，患者的声音仍然未得到充分体现。为了为旨在改善低收入人群获得乳腺癌和宫颈癌筛查及后续治疗机会的干预措施提供信息，我们探讨了在安全网医疗机构寻求医疗服务的低收入女性的建议。
在芝加哥大都市地区的联邦合格健康中心、免费诊所或学术癌症中心，对因乳腺癌或宫颈癌筛查结果异常或癌症诊断呈阳性而接受后续治疗的女性进行了半结构化访谈。
在母研究中接受访谈的138名女性中，有52名女性提供了改善筛查和后续治疗可及性的建议。大多数女性年龄在41至65岁之间（62%），非裔美国人（60%）或白人（25%）。建议包括加强基于社区的健康教育，传递更紧急的信息，建立战略伙伴关系，并提供积极的学习体验，以提高患者的参与度，女性认为这是获得医疗服务的关键驱动力。女性还建议通过改变医疗服务提供系统和政策来增加可及性，包括加强患者与提供者、患者与诊所之间更直接的沟通，解决患者数量过多导致的延误问题，整合预防服务，扩大保险覆盖范围，以及调整筛查指南。
这项探索性研究从患者的角度展示了重要见解，可能有助于提高旨在改善乳腺癌和宫颈癌筛查及后续治疗可及性的社区和临床干预措施的可接受性和有效性。需要进一步研究以确定如何将患者的意见适当地融入干预措施、实践和政策变革中。
