Britton Meredith Campbell, Izampuye Elizabeth, Clark Mitchell, Ornstein Ruth Ann, Nunez-Smith Marcella, Wright Jason D, Xu Xiao
Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, United States of America.
Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America.
Gynecol Oncol. 2024 Dec;191:67-73. doi: 10.1016/j.ygyno.2024.09.010. Epub 2024 Oct 2.
To explore patient experiences with the diagnosis process for uterine cancer and the perceived barriers that may affect early diagnosis and racial disparities in stage at diagnosis.
We conducted semi-structured interviews to ascertain the diagnostic journey of 11 non-Hispanic Black ("Black") and 11 non-Hispanic White ("White") patients who were diagnosed with uterine cancer in the past six months. All interviews were audio-recorded, professionally transcribed, and analyzed using thematic analysis. Findings were presented to patients and community advocates for critical review and feedback before being finalized.
Respondents had a median age of 64 years. Thirteen (59.1 %) had stage I tumor, whereas nine (40.9 %) had stage II-IV disease. Respondents were attentive to their symptoms but unaware that they could indicate uterine cancer. This was compounded by women's conditioned acceptance of discomfort and disconnection from gynecological care after reproductive age. Respondents often viewed racial disparities in diagnosis through other social determinants of health, including gender, age, and healthcare access. These overlapping social experiences, coupled with respondents' concentration on recovery, may mask their perceptions about systemic racism. Although few respondents noted negative experiences in their own evaluations leading to the diagnosis of uterine cancer, Black respondents often described how previous discriminatory experiences informed a wariness of healthcare systems.
Lack of public awareness of uterine cancer, gendered expectations for discomfort, and disconnection from gynecologic care all interfered with early diagnosis of uterine cancer. Discriminatory experiences in prior healthcare further complicate Black patients' engagement with the healthcare system.
探讨子宫癌患者的诊断过程体验以及可能影响早期诊断和诊断时分期种族差异的感知障碍。
我们进行了半结构化访谈，以确定11名非西班牙裔黑人（“黑人”）和11名非西班牙裔白人（“白人”）患者在过去六个月内被诊断为子宫癌的诊断过程。所有访谈均进行了录音、专业转录，并使用主题分析法进行分析。在最终确定之前，研究结果已提交给患者和社区倡导者进行严格审查并征求反馈意见。
受访者的中位年龄为64岁。13人（59.1%）患有I期肿瘤，而9人（40.9%）患有II-IV期疾病。受访者关注自己的症状，但并未意识到这些症状可能表明患有子宫癌。生育年龄后女性对不适的习惯性接受以及与妇科护理的脱节使情况更加复杂。受访者经常通过其他健康社会决定因素，包括性别、年龄和医疗保健可及性，来审视诊断中的种族差异。这些重叠的社会经历，再加上受访者对康复的关注，可能掩盖了他们对系统性种族主义的认知。尽管很少有受访者在自己导致子宫癌诊断的评估中提到负面经历，但黑人受访者经常描述以前的歧视性经历如何使他们对医疗系统产生警惕。
公众对子宫癌缺乏认识、对不适的性别化期望以及与妇科护理的脱节均妨碍了子宫癌的早期诊断。先前医疗保健中的歧视性经历使黑人患者与医疗系统的接触更加复杂。
