Department of Obstetrics and Gynecology, Montefiore Medical Center, Bronx, New York; the Alix School of Medicine and the Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota; the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and the Department of Laboratory Medicine and Pathology and the Department of Obstetrics and Gynecology, Mayo Clinic, and the University of Florida College of Medicine, Jacksonville, Florida.
Obstet Gynecol. 2023 Oct 1;142(4):967-977. doi: 10.1097/AOG.0000000000005338. Epub 2023 Sep 7.
We use the person-centered Pathway to Treatment framework to assess the scope of evidence on disparities in endometrial cancer stage at diagnosis. This report is intended to facilitate interventions, research, and advocacy that reduce disparities.
We completed a structured search of electronic databases: PubMed, EMBASE, Scopus, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials databases. Included studies were published between January 2000 and 2023 and addressed marginalized population(s) in the United States with the ability to develop endometrial cancer and addressed variable(s) outlined in the Pathway to Treatment.
Our database search strategy was designed for sensitivity to identify studies on disparate prolongation of the Pathway to Treatment for endometrial cancer, tallying 2,171. Inclusion criteria were broad, yet only 24 studies addressed this issue. All articles were independently screened by two reviewers.
TABULATION, INTEGRATION, AND RESULTS: Twenty-four studies were included: 10 on symptom appraisal, five on help seeking, five on diagnosis, and 10 on pretreatment intervals. Quality rankings were heterogeneous, between 3 and 9 (median 7.2) per the Newcastle-Ottawa Scale. We identified three qualitative, two participatory, and two intervention studies. Studies on help seeking predominantly investigate patient-driven delays. When disease factors were controlled for, delays of the pretreatment interval were independently associated with racism toward Black and Hispanic people, less education, lower socioeconomic status, and nonprivate insurance.
Evidence gaps on disparities in timeliness of endometrial cancer care reveal emphasis of patient-driven help-seeking delays, reliance on health care-derived databases, underutilization of participatory methods, and a paucity of intervention studies.
Given that PROSPERO was not accepting systematic scoping review protocols at the time this study began, this study protocol was shared a priori through Open Science Framework on January 13, 2021 (doi: 10.17605/OSF.IO/V2ZXY), and through peer review publication on April 13, 2021 (doi: https://doi.org/10.1186/s13643-021-01649-x).
我们使用以患者为中心的治疗途径框架来评估诊断时子宫内膜癌分期差异的证据范围。本报告旨在促进减少差异的干预、研究和宣传。
我们对电子数据库（PubMed、EMBASE、Scopus、ClinicalTrials.gov 和 Cochrane 对照试验中心注册数据库）进行了结构化搜索。纳入的研究发表于 2000 年 1 月至 2023 年期间，针对美国的弱势群体，这些群体有发展子宫内膜癌的能力，并针对治疗途径中概述的变量。
我们的数据库搜索策略旨在提高对不同程度延长子宫内膜癌治疗途径的研究的敏感性，共检索到 2171 项。纳入标准很广泛，但只有 24 项研究涉及这个问题。所有文章均由两位审稿人独立筛选。
列表、整合和结果：共纳入 24 项研究：10 项关于症状评估，5 项关于寻求帮助，5 项关于诊断，10 项关于治疗前间隔。质量排名因纽卡斯尔-渥太华量表而异，范围为 3 至 9（中位数为 7.2）。我们确定了 3 项定性研究、2 项参与性研究和 2 项干预研究。关于寻求帮助的研究主要调查患者驱动的延迟。当控制疾病因素时，治疗前间隔的延迟与对黑人和西班牙裔的种族主义、受教育程度较低、社会经济地位较低以及非私人保险独立相关。
子宫内膜癌护理及时性差异的证据差距表明，强调患者驱动的寻求帮助的延迟，依赖于医疗保健衍生的数据库，参与性方法利用不足，以及干预研究的缺乏。
鉴于 PROSPERO 在本研究开始时不接受系统范围审查方案，该研究方案于 2021 年 1 月 13 日通过开放科学框架提前共享（doi：10.17605/OSF.IO/V2ZXY），并于 2021 年 4 月 13 日通过同行评审出版物（doi：https://doi.org/10.1186/s13643-021-01649-x）。
