Mullens Cody L, Hernandez J Andres, Conn Mary Ellen, Kennedy-Rea Stephenie, Ueno Cristiane M
West Virginia University School of Medicine, Morgantown, W.Va.
University of Pennsylvania, Perelman School of Medicine, Center for Public Health Initiatives, Philadelphia, Pa.
Plast Reconstr Surg Glob Open. 2020 Feb 20;8(2):e2638. doi: 10.1097/GOX.0000000000002638. eCollection 2020 Feb.
Despite policies such as the Women's Health and Cancer Rights Act (WHCRA) and Breast Cancer Patient Education Act, rates for breast reconstruction vary and are especially low for some subpopulations of patients, especially rural women. In order to better understand patient perceptions, qualitative analysis using focus groups is an underutilized tool for obtaining patient perspectives regarding health-related issues and access to care. Our aim was to better understand patient perceptions using qualitative analysis.
Three focus groups were held in rural counties within West Virginia in order to better understand patient perceptions, knowledge, and beliefs regarding breast health, breast cancer, access to breast reconstruction, and how to disseminate and educate this patient population regarding their right to accessing breast reconstruction.
Major themes analyses revealed perceived barriers to care related to lacking care coordination, lack of insurance coverage and other resources, as well as issues related to transportation. Participants consistently discussed avoiding breast screening care due fear and denial in addition to pain. Few patients were aware of their right to accessing breast reconstruction per the WHCRA, and many were concerned about follow-up burden, complications, and general fear related to breast reconstruction. Themes related to dissemination of information to promote the option of breast reconstruction included social media, patient counseling by their referring physician, and other means of intervention in clinics and other points in the care coordination chain.
Rural women have important, unique viewpoints regarding access to and perceived barriers from obtaining breast reconstruction. Plastic surgeons must work diligently to educate, disseminate, and improve care coordination among this population in order to improve access to breast reconstruction among rural breast cancer patients.
尽管有《妇女健康与癌症权利法案》（WHCRA）和《乳腺癌患者教育法案》等政策，但乳房重建的比例各不相同，某些患者亚群，尤其是农村妇女的比例特别低。为了更好地理解患者的看法，使用焦点小组进行定性分析是一种未得到充分利用的工具，可用于获取患者对健康相关问题和医疗服务可及性的看法。我们的目的是通过定性分析更好地理解患者的看法。
在西弗吉尼亚州的农村县举行了三个焦点小组，以更好地了解患者对乳房健康、乳腺癌、乳房重建可及性以及如何向该患者群体宣传和教育其获得乳房重建权利的看法、知识和信念。
主要主题分析揭示了与护理协调不足、缺乏保险覆盖和其他资源以及交通问题相关的医疗服务障碍。参与者除了因疼痛外，还因恐惧和否认而一致讨论了避免乳房筛查护理的问题。很少有患者知道他们根据WHCRA获得乳房重建的权利，许多人担心后续负担、并发症以及与乳房重建相关的普遍恐惧。与传播信息以促进乳房重建选择相关的主题包括社交媒体、转诊医生对患者的咨询以及在诊所和护理协调链中的其他干预点的其他手段。
农村妇女在获得乳房重建和感知到的障碍方面有重要且独特的观点。整形外科医生必须努力对这一人群进行教育、宣传并改善护理协调，以提高农村乳腺癌患者获得乳房重建的机会。
