Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia.
Department of General Practice and Centre for Cancer Research, University of Melbourne, Victorian Comprehensive Cancer Centre, Melbourne, Australia.
J Rural Health. 2020 Sep;36(4):517-535. doi: 10.1111/jrh.12437. Epub 2020 Jun 2.
Colorectal cancer patients living in rural areas have poorer outcomes than urban counterparts, but such disparities are not found for breast cancer. Although time to care may contribute to rural-urban disparities, few studies examine patient experiences to understand how and why delays may occur. We compared rural and urban patient experiences of pathways to colorectal or breast cancer diagnosis and treatment in Victoria, Australia.
Semistructured telephone interviews were conducted with 43 patients (49% colorectal; 60% rural, median 7 months postdiagnosis). A framework analysis was applied using the Model of Pathways to Treatment.
Rural and urban patients expressed similar attitudes and reasons for prolonged symptom appraisal and help-seeking triggers. However, some rural patients reported long waiting times to see a Primary Care Practitioner (PCP) and perceived greater gatekeeping to diagnostic services. Patient perceptions of the urgency of PCP referral could impact behavior, such as waiting longer to book appointments. Colorectal cancer patients reported more variable types of symptoms, interpretation, and coping strategies, as well as diverse presentation routes and reduced sense of urgency, compared to breast cancer patients. Waiting time for colonoscopy could be long, particularly in the public health system, but mammograms were quickly arranged.
Pathway variation was more evident by cancer type than residential location. However, access to primary care and diagnostic services for rural patients with colorectal cancer may be important policy targets. Future research should investigate the impact of diagnostic service accessibility on PCP referral behavior to further understand rural-urban disparities.
与城市患者相比，农村地区的结直肠癌患者的预后较差，但乳腺癌患者则没有这种差异。尽管治疗时间可能是造成城乡差异的原因之一，但很少有研究从患者的角度来探讨导致这种差异的原因。本研究在澳大利亚维多利亚州比较了农村和城市患者在结直肠癌或乳腺癌诊断和治疗过程中的路径体验。
对 43 名患者（49%为结直肠癌，60%为农村患者，中位数为诊断后 7 个月）进行了半结构式电话访谈。采用治疗路径模型进行框架分析。
农村和城市患者对延长症状评估和寻求帮助的触发因素的态度和原因相似。然而，一些农村患者报告说等待时间较长才能看初级保健医生，并且他们认为获得诊断服务的障碍更大。患者对初级保健医生转诊的紧迫性的看法可能会影响他们的行为，例如等待更长时间预约。与乳腺癌患者相比，结直肠癌患者报告了更多不同类型的症状、解释和应对策略，以及更多样的就诊途径和较低的紧迫感。结肠镜检查的等待时间可能很长，尤其是在公共卫生系统中，但乳房 X 光检查可以很快安排。
与居住地点相比，癌症类型对途径的差异影响更大。然而，农村地区结直肠癌患者获得初级保健和诊断服务的机会可能是政策的重要目标。未来的研究应该调查诊断服务的可及性对初级保健医生转诊行为的影响，以进一步了解城乡差异。
