Reddy Swapna, Saxon Mary, Patel Nina, Speer Matthew, Ziegler Tiffany, Patel Nirali, Ziegler Madison, Esquivel Stephany, Mata Andrea Daniella, Devineni Asha, Paode Pooja, Thawani Nitika, Mutyala Subhakar
College of Health Solutions, Arizona State University, Phoenix, AZ.
Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ.
J Patient Cent Res Rev. 2020 Oct 23;7(4):337-342. eCollection 2020 Fall.
Despite comparable screening and incidence rates that are 26% below that of non-Hispanic Whites, Hispanic women present with breast cancer at more advanced stages of disease, representing a continuing and troubling health disparity for this population. Reducing these disparities warrant more innovative research approaches to better understand perspectives of Hispanic patients regarding barriers to treatment and how these perspectives compare to those of their providers. A pilot qualitative study was conducted at a major urban cancer center in Arizona that measured both patient and provider perspectives regarding barriers to treatment. Through a multimethod qualitative analysis, researchers surveyed patients and providers to identify perceived barriers and discordance in shared understanding. Data collection and analysis consisted of surveying patients and providers, then performing inductive qualitative analysis. Results indicated the highest concordance, or shared understanding, between patients and providers was in recognizing barriers within delivery of care, such as cost of care and insurance coverage. The greatest discordance, or gaps in shared understanding, existed in upstream barriers of the health care system, such as emotional support and trust in systems. These results underscore the gap in shared understanding between patients and providers regarding upstream barriers to care as well as the nonclinical social determinants of health Hispanic patients face in accessing breast cancer treatment. More research is warranted using this approach as a tool to reduce health disparities.
尽管西班牙裔女性的筛查率和发病率与非西班牙裔白人相当，但低于后者26%，但她们被诊断出患有乳腺癌时，疾病往往处于更晚期阶段，这表明该人群的健康差距持续存在且令人担忧。缩小这些差距需要更具创新性的研究方法，以更好地了解西班牙裔患者对治疗障碍的看法，以及这些看法与医疗服务提供者的看法有何不同。在亚利桑那州的一个主要城市癌症中心进行了一项定性研究试点，该研究测量了患者和医疗服务提供者对治疗障碍的看法。通过多方法定性分析，研究人员对患者和医疗服务提供者进行了调查，以确定他们感知到的障碍以及在共同理解方面的不一致之处。数据收集和分析包括对患者和医疗服务提供者进行调查，然后进行归纳定性分析。结果表明，患者和医疗服务提供者之间最高程度的一致性，即共同理解，在于认识到医疗服务提供过程中的障碍，如医疗费用和保险覆盖范围。最大的不一致之处，即共同理解方面的差距，存在于医疗保健系统的上游障碍中，如情感支持和对系统的信任。这些结果凸显了患者和医疗服务提供者在医疗保健上游障碍以及西班牙裔患者在获得乳腺癌治疗时面临的非临床健康社会决定因素方面的共同理解差距。有必要开展更多研究，将这种方法作为减少健康差距的工具。
