Williams Faustine, Colditz Graham A, Hovmand Peter, Gehlert Sarah
East Tennessee State University.
Washington University in St. Louis.
J Health Dispar Res Pract. 2018 Spring;11(1):160-178.
Although patterns of African American and white women breast cancer incidence and mortality in St. Louis, Missouri is consistent with those seen elsewhere in the United States, rates vary greatly across zip codes within the city of St. Louis. North St. Louis, whose neighborhoods are primarily African American, exhibits rates of breast cancer mortality that are among the highest in the city and the state as a whole. Based on information that up to 50% of women in North St. Louis with a suspicious diagnosis of breast cancer never enter treatment, we conducted three 2-hour group model building sessions with 34 community stakeholders (e.g., breast cancer survivors or family members or caregivers and community support members such as navigators) to identify the reasons why African American women do not begin or delay breast cancer treatment. Participant sessions produced a very rich and dynamic causal loop diagram of the system producing disparities in breast cancer mortality in St. Louis. The diagram includes 8 major subsystems, causal links between system factors, and feedback loops, all of which shed light on treatment delays/initiation. Our work suggests that numerous intersecting factors contribute to not seeking treatment, which in turn may contribute to African American and white disparities in mortality.
尽管密苏里州圣路易斯市非裔美国女性和白人女性乳腺癌的发病率和死亡率模式与美国其他地方一致，但圣路易斯市内不同邮政编码区域的发病率差异很大。北圣路易斯的社区主要为非裔美国人，其乳腺癌死亡率在该市乃至整个州都是最高的。基于北圣路易斯高达50%的疑似乳腺癌女性从未接受治疗这一信息，我们与34位社区利益相关者（如乳腺癌幸存者、家庭成员或护理人员以及导航员等社区支持人员）进行了三次为时两小时的小组模型构建会议，以确定非裔美国女性不开始或延迟乳腺癌治疗的原因。参与者会议产生了一个非常丰富且动态的因果循环图，该图展示了导致圣路易斯市乳腺癌死亡率存在差异的系统。该图包括8个主要子系统、系统因素之间的因果联系以及反馈回路，所有这些都有助于解释治疗延迟/开始的情况。我们的研究表明，众多相互交织的因素导致了不寻求治疗的情况，这反过来可能导致非裔美国人和白人在死亡率上的差异。
