破裂和延误：监禁期间妇科恶性肿瘤护理中断的定性分析。
Fractured and delayed: A qualitative analysis of disruptions in care for gynecologic malignancies during incarceration.
机构信息
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America.
出版信息
Gynecol Oncol. 2023 Sep;176:1-9. doi: 10.1016/j.ygyno.2023.06.017. Epub 2023 Jun 30.
OBJECTIVE
Women are experiencing growing rates of incarceration at twice the pace of that for men. Additionally, one-third will be older than 55 years of age by the end of the decade. Women who are incarcerated experience a higher prevalence of gynecologic malignancies and present with higher stage disease, which may be contributing to the greater mortality from cancer than the age-adjusted US population. Limited access to guideline-recommended screening and prevention and resource limitations across correctional facilities may result in gynecologic cancer disparities. Reasons for delayed gynecologic cancer care in prisons remain underexplored. Therefore, we sought to identify contributors to delayed gynecologic cancer care among women experiencing incarceration.
METHODS
Women at a single tertiary center in the Southeastern U.S. who were incarcerated and were diagnosed with a gynecologic cancer during 2014-2021 were identified in the electronic medical record. Note text was extracted and contributors to delay were identified and categorized using the RADaR method. Descriptive statistics were used to assess quantitative data.
RESULTS
14 patients were identified with a total of 14,879 text excerpts. Data reduction was performed to identify excerpts that were relevant to the central research question resulting in 175 relevant note excerpts. Delays prior to the tertiary care visit included patient and institutional contributors. Delays during transition from the tertiary center to prison included discharge planning and loss to follow-up during/after incarceration. Transportation, authorization, and restraints were concrete contributors. Abstract contributors included communication, and the patient's emotional experience.
CONCLUSIONS
We identify myriad contributors to delayed or fractured gynecologic cancer care in women experiencing incarceration. The impact of these issues warrants further study and intervention to improve care.
目的
女性被监禁的比例正以男性的两倍速度增长。此外，到本十年末，三分之一的女性将超过 55 岁。被监禁的女性患有妇科恶性肿瘤的比例更高，且疾病处于更晚期，这可能导致癌症死亡率高于美国人口年龄调整死亡率。在监狱中，由于获得指南推荐的筛查和预防的机会有限以及监狱资源有限，可能导致妇科癌症存在差异。监狱中延迟妇科癌症护理的原因仍未得到充分探索。因此，我们试图确定监禁女性中导致延迟妇科癌症护理的因素。
方法
在美国东南部的一家三级中心，我们在电子病历中确定了在 2014 年至 2021 年期间被监禁且被诊断患有妇科癌症的女性。提取注释文本，并使用 RADaR 方法确定延迟的原因并进行分类。使用描述性统计评估定量数据。
结果
共确定了 14 名患者，总共有 14879 个文本摘录。为了确定与中心研究问题相关的摘录，进行了数据缩减，结果得到 175 个相关注释摘录。在前往三级医疗机构就诊之前的延迟包括患者和机构因素。从三级中心到监狱的过渡期间的延迟包括在监禁期间/之后的出院计划和失访。交通、授权和限制是具体的延迟原因。抽象的原因包括沟通和患者的情绪体验。
结论
我们确定了在监禁的女性中导致妇科癌症护理延迟或中断的诸多因素。这些问题的影响需要进一步研究和干预，以改善护理。
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