EQUAL Research Program in Palliative Care, Faculty of Nursing, University of Alberta, 3rd Floor Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.
Department of Symptom Control and Palliative Care, Cross Cancer Institute, Edmonton, AB, Canada.
Support Care Cancer. 2019 Dec;27(12):4733-4744. doi: 10.1007/s00520-019-04726-z. Epub 2019 Apr 10.
Disparities in access to palliative care services for populations with social disparities have been reported in Western countries. Studies indicate that these populations tend to report higher symptom distress than other population groups. We need to further investigate how social disparities influence symptom burden to improve symptom relief in these populations.
To examine the perspectives of specialist palliative care providers concerning the relationship between social disparities and symptom burden in populations with advanced cancer.
Two sequential qualitative studies that followed a combination of interpretive and critical methodologies. The interpretive approach was outlined by van Manen's hermeneutic phenomenology while the critical component was informed by the works of Paulo Freire. Participants involved two specialist palliative care teams from a large acute care hospital and a large cancer center in Western Canada. Participants included 11 palliative care providers including registered nurses, nurse practitioners, physicians, and pharmacists.
Participants perceived that social conditions that might aggravate symptom burden included low income, low education, lack of social support, language barriers, and rurality. The relationship between income and symptom burden reflected diverse views. Participants identified populations prone to complex symptom burden including homeless individuals, Indigenous people, people with a history of addictions, and people with mental health or psychosocial issues.
Participants perceived that social disparities may increase symptom complexity in populations with advanced cancer. Participants did not identify ethnicity and gender as influencing symptom burden. Further research is needed to examine the interactions of social disparities, patient individuality, and symptom burden.
在西方国家，已经有报道称，社会差异人群获得姑息治疗服务的机会存在差异。研究表明，这些人群往往比其他人群报告更高的症状困扰。我们需要进一步研究社会差异如何影响症状负担，以改善这些人群的症状缓解。
探讨专科姑息治疗提供者对晚期癌症人群中社会差异与症状负担之间关系的看法。
这是两项先后进行的定性研究，采用了解释学和批判学相结合的方法。解释学方法以范马南的解释现象学为基础，而批判学部分则受到保罗·弗莱雷作品的启发。参与者包括来自加拿大西部一家大型急症护理医院和一家大型癌症中心的两个专科姑息治疗团队。参与者包括 11 名姑息治疗提供者，包括注册护士、护士从业者、医生和药剂师。
参与者认为可能加重症状负担的社会状况包括低收入、低教育水平、缺乏社会支持、语言障碍和农村地区。收入与症状负担之间的关系反映了不同的观点。参与者确定了容易出现复杂症状负担的人群，包括无家可归者、原住民、有吸毒史的人以及有心理健康或心理社会问题的人。
参与者认为社会差异可能会增加晚期癌症人群的症状复杂性。参与者没有将种族和性别确定为影响症状负担的因素。需要进一步研究以探讨社会差异、患者个体差异和症状负担之间的相互作用。
