Division of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, United States; Department of General Surgery, University of Cape Town, Cape Town, South Africa.
Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States.
J Gastrointest Surg. 2024 Aug;28(8):1330-1338. doi: 10.1016/j.gassur.2024.05.019. Epub 2024 May 31.
Surgery is essential for gastrointestinal (GI) cancer treatment. Many patients lack access to surgical care that optimizes outcomes. Scarce availability and/or low accessibility of appropriate resources may be the reason for this, especially in economically disadvantaged areas. This study aimed to investigate providers' and survivors' perspectives on barriers and facilitators to the availability and accessibility of surgical care.
Semistructured interviews informed by surgical disparities and access-to-care conceptual frameworks with purposively selected GI cancer providers and survivors in Alabama and Mississippi were conducted. Survivors were within 3 years of diagnosis of stage I to III esophageal, pancreatic, or colorectal cancer. Transcripts were analyzed using inductive thematic and content analysis techniques. Intercoder agreement was reached at 90 %.
The 27 providers included surgeons (n = 11), medical oncologists (n = 2), radiation oncologists (n = 2), a primary care physician (n = 1), nurses (n = 8), and patient navigators (n = 3). This study included 36 survivors with ages ranging from 44 to 87 years. Of the 36 survivors, 21 (58.3 %) were male, and 11 (30.6 %) identified as Black. Responses were grouped into 3 broad categories: (i) transportation/geographic location, (ii) specialized care/testing, and (iii) patient-/provider-related factors. The barriers included lack and cost of transportation, reluctance to travel because of uneasiness with urban centers, low availability of specialized care, overburdened referral centers, provider-related referral biases, and low health literacy. Facilitators included availability of charitable aid, centralizing multidisciplinary care, and efficient appointment scheduling.
In the Deep South, barriers and facilitators to the availability and accessibility of GI surgical cancer care were identified at the health system, provider, and patient levels, especially for rural residents. Our data suggest targets for improving the use of surgery in GI cancer care.
手术是治疗胃肠道（GI）癌症的重要手段。许多患者无法获得优化治疗效果的手术护理。造成这种情况的原因可能是适当资源的稀缺性和/或可及性较低，尤其是在经济落后地区。本研究旨在调查提供者和幸存者对获取和可及手术护理的障碍和促进因素的看法。
我们对阿拉巴马州和密西西比州的 GI 癌症提供者和幸存者进行了基于手术差异和获取护理概念框架的半结构化访谈。幸存者在确诊为 I 期至 III 期食管、胰腺或结直肠癌后 3 年内。使用归纳主题和内容分析技术对转录本进行分析。达到了 90%的编码者一致性。
27 名提供者包括外科医生（n=11）、肿瘤内科医生（n=2）、放射肿瘤学家（n=2）、初级保健医生（n=1）、护士（n=8）和患者导航员（n=3）。本研究包括 36 名年龄在 44 岁至 87 岁之间的幸存者。在 36 名幸存者中，21 名（58.3%）为男性，11 名（30.6%）为黑人。受访者的回答分为 3 个广泛的类别：（i）交通/地理位置，（ii）专科护理/检查，和（iii）患者/提供者相关因素。障碍包括缺乏和交通成本、因对城市中心感到不适而不愿旅行、专科护理的可用性低、转诊中心负担过重、提供者相关转诊偏见和低健康素养。促进因素包括慈善援助的可用性、集中多学科护理以及高效的预约安排。
在南部腹地，在卫生系统、提供者和患者层面都发现了影响 GI 外科癌症护理的可及性和可及性的障碍和促进因素，特别是对农村居民而言。我们的数据表明，有针对性地改善 GI 癌症护理中手术的应用。
