Memorial Sloan Kettering Cancer Center, New York, NY.
State University of New York Downstate Medical Center, Brooklyn, NY.
J Oncol Pract. 2019 Sep;15(9):e769-e776. doi: 10.1200/JOP.18.00741. Epub 2019 Jul 23.
Disparities exist between population subgroups in the use of gynecologic oncologists and high-volume hospitals. The objectives of this study were to explore the experiences of black women obtaining ovarian cancer (OC) care at a high-volume center (HVC) and to identify patient-, provider-, and systems-related factors affecting their access to and use of this level of care.
Twenty-one semistructured interviews were conducted as part of an institutional review board-approved protocol with women who self-identified as black or African American, treated for OC at a single HVC from January 2013 to May 2017. Recurring themes were identified in transcribed interviews through the process of independent and collaborative thematic content analysis.
Five themes were identified: (1) internal attributes contributing to black women's ability/desire to be treated at an HVC, (2) pathways to high- and low-volume centers, (3) obstacles to obtaining care, (4) potential barriers for black women interested in treatment at an HVC, and (5) suggestions for improving HVC use by black women. Study participants who successfully accessed care were comfortable navigating the health care system, understood the importance of self-advocacy, and valued the expertise of an HVC. Barriers to obtaining care at an HVC included lack of knowledge about the HVC, lack of referral, transportation difficulties, and lack of insurance coverage.
In this qualitative study, black women treated at an HVC shared attributes and experiences that helped them access care. There is a need to collaborate with black communities and establish interventions to reduce barriers, facilitate access, and disseminate information about the value of receiving care for OC at an HVC.
在妇科肿瘤学家和高容量医院的使用方面，人群亚组之间存在差异。本研究的目的是探讨黑人女性在高容量中心（HVC）获得卵巢癌（OC）治疗的经验，并确定影响其获得和使用这种治疗水平的患者、提供者和系统相关因素。
作为机构审查委员会批准的协议的一部分，从 2013 年 1 月至 2017 年 5 月，对在单个 HVC 接受 OC 治疗的自我认同为黑人或非裔美国人的 21 名女性进行了 21 次半结构化访谈。通过独立和协作的主题内容分析过程，在转录访谈中确定了反复出现的主题。
确定了五个主题：（1）有助于黑人女性在 HVC 接受治疗的内在属性，（2）通往高容量和低容量中心的途径，（3）获得护理的障碍，（4）对在 HVC 接受治疗感兴趣的黑人女性的潜在障碍，以及（5）提高黑人女性使用 HVC 的建议。成功获得护理的研究参与者能够熟练地驾驭医疗保健系统，了解自我倡导的重要性，并重视 HVC 的专业知识。在 HVC 获得护理的障碍包括对 HVC 的了解不足、缺乏转介、交通困难和缺乏保险覆盖。
在这项定性研究中，在 HVC 接受治疗的黑人女性分享了帮助他们获得护理的属性和经验。需要与黑人社区合作，制定干预措施，以减少障碍，促进获得护理，并传播在 HVC 接受 OC 治疗的价值信息。
