George Mathew, Smith Alexandra, Ranmuthugula Geetha, Sabesan Sabe
Department of Medical Oncology, North West Cancer Centre, Tamworth, NSW, Australia.
School of Rural Medicine, University of New England, Armidale, NSW, Australia.
Int J Gen Med. 2022 Feb 15;15:1583-1594. doi: 10.2147/IJGM.S338128. eCollection 2022.
To explore patients', caregivers', and health professionals' perspectives on barriers and challenges to accessing, commencing and completing cancer therapy, with a focus on geriatric patients and the impacts of comorbidities and rurality.
A qualitative sub-study using focus group discussions was conducted in a regional cancer center and one of its outreach clinics in rural New South Wales, Australia. Five discussions with three distinct cohorts were undertaken, including: 1) geriatric cancer patients (two discussions); 2) caregivers (two discussions); and 3) health professionals (one discussion). Each focus group comprised eight to ten participants. A question guide was used to elicit participants' experiences of receiving/providing cancer care and support during cancer treatment in a rural setting. Iterative thematic analysis was undertaken, with transcripts coded using NVivo software.
Participants identified travel to larger regional centers and/or metropolitan areas and related arrangements as primary challenges to accessing diagnostic tests, surgeries, some treatments, and follow-up tests. Financial stress, and a lack of knowledge regarding available support services and mechanisms, was also a key issue for most patients and caregivers. Differences in availability of specific testing equipment, such as PET-CT, further complicated patients' and caregivers' experience of seeking diagnosis and management of cancer. While all interview cohorts identified positive rapport between clinicians and patients as a key characteristic of their experience of cancer management in rural and regional areas, difficulty in retaining clinical staff and related staffing levels at some health services were understood to negatively impact patients' and caregivers' experiences.
Overall, the study highlights the effects of geographical, social, and informational isolation on patients' and caregivers' experience of cancer diagnosis and management, and suggests several implications for further research and practice improvement.
探讨患者、护理人员及医疗专业人员在获取、开始和完成癌症治疗方面所面临的障碍和挑战，重点关注老年患者以及合并症和农村地区的影响。
在澳大利亚新南威尔士州农村地区的一家区域癌症中心及其一家外展诊所进行了一项采用焦点小组讨论的定性子研究。与三个不同群体进行了五次讨论，包括：1）老年癌症患者（两次讨论）；2）护理人员（两次讨论）；3）医疗专业人员（一次讨论）。每个焦点小组由八至十名参与者组成。使用问题指南来了解参与者在农村环境中接受/提供癌症治疗和支持的经历。进行了迭代主题分析，使用NVivo软件对转录本进行编码。
参与者认为前往更大的区域中心和/或大都市地区以及相关安排是获取诊断测试、手术、某些治疗和后续测试的主要挑战。经济压力以及对现有支持服务和机制缺乏了解，对大多数患者和护理人员来说也是一个关键问题。特定检测设备（如PET-CT）可用性的差异，进一步使患者和护理人员寻求癌症诊断和管理的经历变得复杂。虽然所有访谈群体都认为临床医生与患者之间的良好关系是他们在农村和地区癌症管理经历的一个关键特征，但一些医疗服务机构临床工作人员留用困难及相关人员配备水平被认为对患者和护理人员的经历产生了负面影响。
总体而言，该研究突出了地理、社会和信息隔离对患者和护理人员癌症诊断和管理经历的影响，并提出了对进一步研究和实践改进的若干启示。
