School of Medicine, University of South Carolina, Columbia, South Carolina, USA.
Department of Surgery, the Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA.
Psychooncology. 2022 May;31(5):705-716. doi: 10.1002/pon.5890. Epub 2022 Feb 23.
OBJECTIVES: The objective of the current review was to synthesize the literature on intersectionality relative to disparities across the cancer care continuum. A model to support future intersectional cancer research was proposed. METHODS: Web-based discovery services and discipline-specific databases were queried for both peer-reviewed and gray literature. Study screening and data extraction were facilitated through the Covidence software platform. RESULTS: Among 497 screened studies, 28 met study inclusion criteria. Most articles were peer-reviewed empirical studies (n = 22) that focused on pre-diagnosis/screening (n = 19) and included marginalized racial/ethnic (n = 22) identities. Pre-cancer diagnosis, sexual orientation and race influenced women's screening and vaccine behaviors. Sexual minority women, particularly individuals of color, were less likely to engage in cancer prevention behaviors prior to diagnosis. Race and socioeconomic status (SES) were important factors in patient care/survivorship with worse outcomes among non-white women of low SES. Emergent themes in qualitative results emphasized the importance of patient intersectional identities, as well as feelings of marginalization, fears of discrimination, and general discomfort with providers as barriers to seeking cancer care. CONCLUSIONS: Patients with intersectional identities often experience barriers to cancer care that adversely impact screening, diagnosis, treatment, as well as survivorship. The use of an "intersectional lens" as a future clinical and research framework will facilitate a more multidimensional and holistic approach to the care of cancer patients.
目的:本综述的目的是综合癌症护理连续体中存在差异的交叉性文献。提出了一个支持未来交叉癌症研究的模型。
方法:通过网络发现服务和学科特定数据库,查询同行评审和灰色文献。研究筛选和数据提取通过 Covidence 软件平台进行。
结果:在 497 篇筛选的研究中,有 28 篇符合研究纳入标准。大多数文章是同行评审的实证研究(n=22),主要集中在诊断前/筛查(n=19),并纳入边缘化的种族/族裔(n=22)身份。癌症前诊断、性取向和种族影响了女性的筛查和疫苗接种行为。性少数群体女性,尤其是有色人种,在诊断前不太可能采取癌症预防行为。种族和社会经济地位(SES)是患者护理/生存的重要因素,SES 较低的非白人女性的预后较差。定性结果中的新兴主题强调了患者交叉身份的重要性,以及边缘化、对歧视的恐惧以及对提供者的普遍不适等感受,这些都是寻求癌症护理的障碍。
结论:具有交叉身份的患者在接受癌症护理时经常面临障碍,这对筛查、诊断、治疗以及生存产生不利影响。使用“交叉视角”作为未来的临床和研究框架将促进更全面、更全面的癌症患者护理方法。
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