Noel Lailea, Connors Shahnjayla K, Goodman Melody S, Gehlert Sarah
George Warren Brown School of Social Work, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA.
Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave., St. Louis, MO, 63110, USA.
Breast Cancer Res Treat. 2015 Nov;154(1):5-12. doi: 10.1007/s10549-015-3584-z. Epub 2015 Sep 26.
A mixed methods, community-based research study was conducted to understand how provider-level factors contribute to the African-American and white disparity in breast cancer mortality in a lower socioeconomic status area of North St. Louis. This study used mixed methods including: (1) secondary analysis of Missouri Cancer Registry data on all 885 African-American women diagnosed with breast cancer from 2000 to 2008 while living in the geographic area of focus; (2) qualitative interviews with a subset of these women; (3) analysis of data from electronic medical records of the women interviewed; and (4) focus group interviews with community residents, patient navigators, and other health care professionals. 565 women diagnosed with breast cancer from 2000 to 2008 in the geographic area were alive at the time of secondary data analysis; we interviewed (n = 96; 17 %) of these women. Provider-level obstacles to completion of prescribed treatment included fragmented navigation (separate navigators at Federally Qualified Health Centers, surgical oncology, and medical oncology, and no navigation services in surgical oncology). Perhaps related to the latter, women described radiation as optional, often in the same words as they described breast reconstruction. Discontinuous and fragmented patient navigation leads to failure to associate radiation therapy with vital treatment recommendations. Better integrated navigation that continues throughout treatment will increase treatment completion with the potential to improve outcomes in African Americans and decrease the disparity in mortality.
开展了一项基于社区的混合方法研究,以了解在北圣路易斯一个社会经济地位较低的地区,医疗服务提供者层面的因素如何导致非裔美国人和白人在乳腺癌死亡率上的差异。本研究采用了混合方法,包括:(1)对密苏里癌症登记处的数据进行二次分析,这些数据涉及2000年至2008年期间居住在重点地理区域内被诊断为乳腺癌的所有885名非裔美国女性;(2)对这些女性中的一部分进行定性访谈;(3)分析接受访谈女性的电子病历数据;(4)对社区居民、患者导航员和其他医疗保健专业人员进行焦点小组访谈。在二次数据分析时,2000年至2008年在该地理区域被诊断为乳腺癌的565名女性仍然存活;我们对其中96名女性(17%)进行了访谈。完成规定治疗在医疗服务提供者层面存在的障碍包括导航碎片化(联邦合格健康中心、外科肿瘤学和内科肿瘤学有各自独立的导航员,而外科肿瘤学没有导航服务)。可能与此相关的是,女性将放疗描述为可选项,她们描述放疗的用词常常与描述乳房重建的用词相同。不连续且碎片化的患者导航导致无法将放射治疗与重要的治疗建议联系起来。在整个治疗过程中更好地整合导航将提高治疗完成率,有可能改善非裔美国人的治疗效果并减少死亡率差异。