Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle.
Cierra Sisters, Seattle, Washington.
JAMA Netw Open. 2020 May 1;3(5):e204954. doi: 10.1001/jamanetworkopen.2020.4954.
Black women with endometrial cancer have a 90% higher mortality rate than white women with endometrial cancer. The advanced disease stage at which black women receive a diagnosis of endometrial cancer is a major factor in this disparity and is not explained by differences in health care access.
To describe the prediagnostic experiences of symptoms and symptom disclosure among black women with endometrial cancer.
DESIGN, SETTING, AND PARTICIPANTS: This community-engaged qualitative study developed an interview guide to collect data during semistructured interviews among a sample of 15 black women with endometrial cancer in the United States. Interviews were conducted in person or via a secure conferencing platform. An exploratory and descriptive content analysis was performed using iterative rounds of inductive coding, case summaries, and coanalysis with community input to identify emergent themes. Data were collected from October 3, 2017, to April 15, 2019, and the descriptive content analysis was performed from October 11, 2017, to May 6, 2019.
Beliefs, interpretations, and experiences of black women with endometrial cancer from symptom onset to diagnostic confirmation of cancer.
Participants included 15 women who self-identified as black or African American and ranged in age from 31 to 72 years. Eight participants lived in the Puget Sound region of Washington, 2 participants lived in California, and 1 participant each lived in Alabama, Michigan, Louisiana, Georgia, and New York. Twelve participants were receiving adjuvant therapy during the study, which indicated that they were either in a high-risk group and/or had advanced-stage disease. Thirteen participants had health insurance at the time of symptom onset, and all participants had elected to receive cancer treatment. Participants described knowledge gaps and silence about menopause, misinterpretation of vaginal bleeding, and responses by first-line health care practitioners that were not aligned with the risk of endometrial cancer among black women in the United States.
The responses of interviewed black women with endometrial cancer suggest that several mechanisms may be associated with a delay in care before diagnosis among this high-risk population and represent modifiable factors that may be useful in the development of targeted interventions to improve the rates of early diagnosis among black women with endometrial cancer.
黑人女性患有子宫内膜癌的死亡率比白人女性高出 90%。黑人女性在诊断出患有子宫内膜癌时，疾病已经处于晚期，这是造成这种差异的一个主要因素，而不是因为获得医疗保健的机会不同。
描述美国黑人女性子宫内膜癌患者在诊断前的症状体验和症状披露情况。
设计、地点和参与者：这项社区参与式定性研究开发了一个访谈指南，通过对美国 15 名黑人子宫内膜癌患者的样本进行半结构式访谈来收集数据。访谈是通过个人或安全会议平台进行的。采用迭代式归纳编码、案例总结和社区投入的协同分析进行探索性和描述性内容分析，以确定出现的主题。数据于 2017 年 10 月 3 日至 2019 年 4 月 15 日收集，描述性内容分析于 2017 年 10 月 11 日至 2019 年 5 月 6 日进行。
从症状出现到癌症确诊期间，黑人女性对自身子宫内膜癌的信念、解释和体验。
参与者包括 15 名自认为是黑人或非裔美国人的女性，年龄在 31 岁至 72 岁之间。8 名参与者居住在华盛顿州的普吉特海湾地区，2 名参与者居住在加利福尼亚州，1 名参与者分别居住在阿拉巴马州、密歇根州、路易斯安那州、佐治亚州和纽约州。12 名参与者在研究期间接受辅助治疗，这表明他们要么处于高危人群，要么患有晚期疾病。13 名参与者在症状出现时拥有健康保险，所有参与者都选择接受癌症治疗。参与者描述了知识空白和对绝经期的沉默、对阴道出血的误解，以及一线医疗保健从业者的反应，这些都与美国黑人女性患子宫内膜癌的风险不一致。
接受采访的黑人子宫内膜癌患者的反应表明，在这个高危人群中，有几种机制可能与诊断前的护理延迟有关，这些机制代表了可改变的因素，可能有助于制定针对黑人女性子宫内膜癌早期诊断的目标干预措施。
