一项关于长途旅行对妇科癌症治疗影响的定性研究。
A qualitative study on the impact of long-distance travel for gynecologic cancer care.
作者信息
Mujumdar Vaidehi, Butler Timberly R, Shalowitz David I
机构信息
Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA, United States.
Department of Obstetrics and Gynecology, Wake Forest School of Medicine, Winston-Salem, NC, United States.
出版信息
Gynecol Oncol Rep. 2021 Sep 25;38:100868. doi: 10.1016/j.gore.2021.100868. eCollection 2021 Nov.
BACKGROUND
Women with gynecologic malignancies experience improved clinical outcomes when they are treated by gynecologic oncologists and in high-volume cancer centers. However, geography is a major barrier to high-volume care for patients. This qualitative study was undertaken to identify facilitators and barriers to patients traveling long distances for gynecologic cancer care.
METHODS
Semi-structured interviews were conducted with 19 women with gynecologic malignancies traveling >50 miles for treatment at Wake Forest Comprehensive Cancer Center. Eight interviews included caregivers. Four interview domains focused on personal challenges and coping strategies related to accessing cancer care.
RESULTS
Mean distance traveled for care was 87 miles (range: 54-218). Most participants reported that recommendations from physicians, friends, and family motivated travel. 10/19 participants were aware of closer sites for cancer care; 5 had unfavorable experiences elsewhere. Barriers to travel included time, cost, childcare, difficulty navigating, and physical discomfort. Social support was an important facilitator of travel for care; some patients utilized loaned money or vehicles. Participants reported significant energy expenditure scheduling travel, coordinating time off work, and arranging overnight stays near the cancer center. Suggestions for care improvement included travel vouchers, transportation assistance, signage and personnel to help with navigation, and appointments later in the day. Participants supported in-person oncologist outreach to rural areas and appointments via telemedicine; few preferred the current infrastructure.
CONCLUSION
Patients who travel long distances for gynecologic cancer care encounter significant burdens and rely heavily on social and financial support. Interventions should be developed and evaluated to reduce the burden of long-distance travel and develop efficient methods of outreach, including telemedicine.
背景
患有妇科恶性肿瘤的女性在由妇科肿瘤学家治疗并在高容量癌症中心接受治疗时，临床结局会得到改善。然而，地理位置是患者获得高容量医疗服务的主要障碍。本定性研究旨在确定患者长途跋涉接受妇科癌症治疗的促进因素和障碍。
方法
对19名前往维克森林综合癌症中心接受治疗、行程超过50英里的妇科恶性肿瘤女性进行了半结构化访谈。其中8次访谈包括护理人员。四个访谈领域聚焦于与获得癌症治疗相关的个人挑战和应对策略。
结果
接受治疗的平均行程为87英里（范围：54 - 218英里）。大多数参与者表示，医生、朋友和家人的推荐促使她们前来就医。19名参与者中有10人知道距离更近的癌症治疗地点；5人在其他地方有过不愉快的经历。出行障碍包括时间、费用、儿童照料、导航困难和身体不适。社会支持是就医出行的重要促进因素；一些患者使用了借款或借用的车辆。参与者报告说，安排行程、协调请假以及在癌症中心附近安排过夜住宿消耗了大量精力。改善医疗服务的建议包括提供旅行代金券、交通援助、帮助导航的标识和人员，以及安排在当天晚些时候的预约。参与者支持肿瘤学家亲自到农村地区进行宣传，并通过远程医疗进行预约；很少有人喜欢现有的医疗服务体系。
结论
长途跋涉接受妇科癌症治疗的患者面临巨大负担，严重依赖社会和经济支持。应制定和评估干预措施，以减轻长途旅行的负担，并开发高效的宣传方法，包括远程医疗。
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