结构性脆弱人群癌症治疗和护理的障碍：人种学数据分析的二次分析。
Barriers to cancer treatment and care for people experiencing structural vulnerability: a secondary analysis of ethnographic data.
机构信息
School of Nursing, University of Victoria, Institute on Aging & Lifelong Health, Stn. CSC Victoria, PO Box 1700, V8W 2Y2, Victoria, BC, Canada.
College of Nursing, University of Manitoba, 89 Curry Place Winnipeg, R3T 2N2, Victoria, MB, Canada.
出版信息
Int J Equity Health. 2023 Mar 30;22(1):58. doi: 10.1186/s12939-023-01860-3.
BACKGROUND
A key pillar of Canada's healthcare system is universal access, yet significant barriers to cancer services remain for people impacted by structural vulnerability (e.g., poverty, homelessness, racism). For this reason, cancer is diagnosed at a later stage, resulting in worse patient outcomes, a reduced quality of life, and at a higher cost to the healthcare system. Those who face significant barriers to access are under-represented in cancer control services Consequently, these inequities result in people dying from cancers that are highly treatable and preventable, however; little is known about their treatment and care course. The aim of this study was to explore barriers to accessing cancer treatment among people experiencing structural vulnerability within a Canadian context.
METHODS
We conducted a secondary analysis of ethnographic data informed by critical theoretical perspectives of equity and social justice. The original research draws from 30 months of repeated interviews (n = 147) and 300 h of observational fieldwork with people experiencing health and social inequities at the end-of-life, their support persons, and service providers.
RESULTS
Our analysis identified four themes presenting as 'modifiable' barriers to inequitable access to cancer treatment: (1) housing as a key determinant for cancer treatment (2) impact of lower health literacy (3) addressing social care needs is a pre-requisite for treatment (4) intersecting and compounding barriers reinforce exclusion from cancer care. These inter-related themes point to how people impacted by health and social inequities are at times 'dropped' out of the cancer system and therefore unable to access cancer treatment.
CONCLUSION
Findings make visible the contextual and structural factors contributing to inequitable access to cancer treatment within a publically funded healthcare system. Identifying people who experience structural vulnerability, and approaches to delivering cancer services that are explicitly equity-oriented are urgently needed.
背景
加拿大医疗体系的一个重要支柱是全民普及，然而，结构性弱势群体（如贫困、无家可归、种族主义）仍然面临着获得癌症服务的重大障碍。由于这些障碍，癌症的诊断往往处于较晚阶段，导致患者的预后更差，生活质量降低，同时也给医疗系统带来更高的成本。那些在获得癌症控制服务方面面临重大障碍的人在癌症控制服务中代表性不足。因此，这些不平等导致人们死于本可高度治疗和预防的癌症，但人们对他们的治疗和护理过程知之甚少。本研究旨在探讨加拿大背景下结构性弱势群体在获得癌症治疗方面面临的障碍。
方法
我们对基于公平和社会正义的批判理论观点的民族志数据进行了二次分析。原始研究从 30 个月的反复访谈（n=147）和 300 小时的观察性实地工作中提取信息，对象是生命末期面临健康和社会不平等的人、他们的支持人员和服务提供者。
结果
我们的分析确定了四个主题，这些主题表现为获得癌症治疗的不公平机会的“可改变”障碍：（1）住房是癌症治疗的关键决定因素；（2）较低健康素养的影响；（3）解决社会护理需求是治疗的前提；（4）交叉和叠加的障碍加剧了对癌症护理的排斥。这些相互关联的主题指出了受健康和社会不平等影响的人是如何有时被“淘汰”出癌症系统的，因此无法获得癌症治疗。
结论
研究结果揭示了在公共资助的医疗体系中，导致癌症治疗不公平的背景和结构性因素。迫切需要确定那些经历结构性脆弱性的人，并采取明确以公平为导向的方法来提供癌症服务。
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