Sanchez-Feliciano Abizairie, Onyewadume Louisa, Stephens Maya J, Flores Laura E, Cheatham Chesley, McClelland Shearwood
Departments of Radiation Oncology.
Department of Radiation Oncology, Duke University School of Medicine, Durham, NC.
Am J Clin Oncol. 2025 Jan 1;48(1):3-5. doi: 10.1097/COC.0000000000001137. Epub 2024 Jul 26.
Cancer accounts for 22% of all mortality and is the leading cause of death among Hispanic and/or Latinx patients in the United States. The disparities in access to radiation therapy (RT), mortality rates, and treatment outcomes among Hispanic-American breast cancer patients compared with other populations highlight the urgent need for targeted interventions. The Navigator-Assisted Hypofractionation (NAVAH) program, with its innovative patient navigation approach and culturally sensitive survey, aims to better identify the specific barriers faced by this population. This study is a report of the NAVAH program experience piloting a Spanish-language culturally sensitive survey in Hispanic-American volunteers.
Hispanic-American volunteers with fluency in Spanish were recruited to participate in survey conduction, identified from local networks. Survey information was assessed by topic category, and survey responses were amalgamated into a representative score for each category. Survey categories include acceptability (comfort and prejudice among interactions with the system), accessibility (transportation, distance to care, and health care literacy), accommodation (access to the internet, navigating transportation), affordability (financial considerations, employment, and level of education), and availability (access to a medical center, coordinating care, and overall quality of care).
A total of 6 volunteers meeting inclusion criteria completed the survey; 4 in person and 2 by telephone. The median survey completion time was 12 minutes 38 seconds. Respondents noted satisfaction and trust in their interactions with medical providers; however, responses in the acceptability category highlighted a high perception of disparities in the medical system, including a high prevalence of racial and ethnic prejudice and a high prevalence of treatment differences between high-income and low-income patients in clinical settings.
In the first Spanish-language survey of its kind, our findings indicate that this survey design is feasible in the Hispanic-American population. Implementation of this survey in breast cancer patients will provide more definitive and comprehensive answers regarding other categories in the survey, including financial challenges during treatment, access to accommodations, and perception of treatment during cancer care. The investigation involving patients actively receiving breast cancer RT is currently underway.
癌症占所有死亡人数的22%，是美国西班牙裔和/或拉丁裔患者的主要死因。与其他人群相比，西班牙裔美国乳腺癌患者在获得放射治疗（RT）、死亡率和治疗结果方面存在差异，这凸显了针对性干预措施的迫切需求。导航辅助低分割放疗（NAVAH）项目采用创新的患者导航方法和具有文化敏感性的调查，旨在更好地识别该人群面临的具体障碍。本研究报告了NAVAH项目在西班牙裔美国志愿者中试点开展具有文化敏感性的西班牙语调查的经验。
从当地网络中招募能流利使用西班牙语的西班牙裔美国志愿者参与调查实施。调查信息按主题类别进行评估，调查回复被合并为每个类别的代表性分数。调查类别包括可接受性（与系统互动中的舒适度和偏见）、可及性（交通、就医距离和医疗保健素养）、便利性（互联网接入、交通导航）、可负担性（财务考虑、就业和教育水平）以及可获得性（获得医疗中心的机会、协调护理和整体护理质量）。
共有6名符合纳入标准的志愿者完成了调查；4人亲自参与，2人通过电话参与。调查完成的中位时间为12分38秒。受访者表示对与医疗服务提供者的互动感到满意和信任；然而，可接受性类别的回复突出显示了对医疗系统中差异的高度认知，包括种族和民族偏见的高发生率以及临床环境中高收入和低收入患者治疗差异的高发生率。
在同类首次西班牙语调查中，我们的研究结果表明这种调查设计在西班牙裔美国人群中是可行的。在乳腺癌患者中实施这项调查将为调查中的其他类别提供更明确和全面的答案，包括治疗期间的财务挑战、获得便利设施的机会以及癌症护理期间对治疗的认知。目前正在对积极接受乳腺癌放疗的患者进行调查。
