四个欧洲国家中无家可归者获得癌症预防护理的情况及项目考量：一项探索性定性研究
Access to cancer preventive care and program considerations for people experiencing homelessness across four European countries: an exploratory qualitative study.
作者信息
Schiffler Tobias, Carmichael Christina, Smith Lee, Doñate-Martínez Ascensión, Alhambra-Borrás Tamara, Varadé Miguel Rico, Barrio Cortes Jaime, Kouvari Matina, Karnaki Pania, Moudatsou Maria, Tabaki Ioanna, Gil-Salmeron Alejandro, Grabovac Igor
机构信息
Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Vienna, Austria.
Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK.
出版信息
EClinicalMedicine. 2023 Jul 20;62:102095. doi: 10.1016/j.eclinm.2023.102095. eCollection 2023 Aug.
BACKGROUND
People experiencing homelessness (PEH) have a higher prevalence of adverse health outcomes and premature mortality compared to the non-homeless population. These include a higher burden of cancer and cancer-specific morbidity and mortality-outcomes that may be a consequence of significant barriers to accessing primary and secondary prevention and community health services. This study aimed to better comprehend the health needs and barriers to accessing preventive cancer care for PEH across four European countries as well as necessary considerations for developing interventions around cancer prevention for this population.
METHODS
In this exploratory qualitative study, 69 semi-structured interviews were conducted across Austria, Greece, Spain, and the UK, with a sample comprising 15 professionals working in homelessness support services, 19 health professionals, and 35 PEH. Interviews took place between August 1 and October 31, 2021, and data were analysed inductively and iteratively following a thematic approach.
FINDINGS
Findings were organised into two overarching themes: (1) Experiences and understanding of cancer prevention and treatment and (2) Considerations for program interventions. While cancer was a significant worry among PEH across all settings, they generally had minimal knowledge and understanding of cancer symptoms and prevention. Specific programs for cancer prevention for PEH were described as almost non-existent. Health professionals in some settings indicated that cancer in PEH was often missed in the early stages and instead diagnosed when the severity of symptoms intensified.
INTERPRETATION
Overall, our findings indicate many commonalities in the health needs of PEH and the barriers they face when they seek access to cancer-specific healthcare services in the European context.
FUNDING
This study received funding from the European Union's Horizon 2020 Research and Innovation Programme under GA 965351.
背景
与无家可归者相比，经历无家可归的人群（PEH）出现不良健康结果和过早死亡的患病率更高。这些不良健康结果包括更高的癌症负担、特定癌症的发病率和死亡率，而这些结果可能是由于获得一级和二级预防以及社区卫生服务存在重大障碍所致。本研究旨在更好地理解四个欧洲国家中PEH的健康需求以及获得预防性癌症护理的障碍，以及针对该人群制定癌症预防干预措施的必要考虑因素。
方法
在这项探索性定性研究中，在奥地利、希腊、西班牙和英国进行了69次半结构化访谈，样本包括15名从事无家可归者支持服务的专业人员、19名卫生专业人员和35名PEH。访谈于2021年8月1日至10月31日进行，数据采用主题分析法进行归纳和迭代分析。
结果
研究结果分为两个总体主题：（1）对癌症预防和治疗的体验与理解；（2）项目干预的考虑因素。虽然在所有环境中，癌症都是PEH非常担忧的问题，但他们对癌症症状和预防的知识和理解普遍很少。几乎没有针对PEH的癌症预防特定项目。一些环境中的卫生专业人员表示，PEH的癌症在早期往往被漏诊，而是在症状严重时才被诊断出来。
解读
总体而言，我们的研究结果表明，在欧洲背景下，PEH的健康需求以及他们在寻求获得特定癌症医疗服务时面临的障碍存在许多共性。
资金来源
本研究获得了欧盟“地平线2020研究与创新计划”（编号965351）的资助。
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