Santos Salas Anna, Bassah Nahyeni, Pujadas Botey Anna, Robson Paula, Beranek Julia, Iyiola Iqmat, Kennedy Megan
Faculty of Nursing, College of Health Sciences, Third Floor Edmonton, Clinic Health Academy, University of Alberta, Edmonton, AB, Canada.
Cancer Strategic Clinical Network, Cancer Care Alberta, Alberta Health Services, Foothills Medical Centre, South Tower, Calgary, AB, Canada.
Oncol Rev. 2024 Nov 5;18:1427441. doi: 10.3389/or.2024.1427441. eCollection 2024.
Underserved populations both globally and in Canada face serious cancer inequities that result from systemic economic, environmental, and social conditions. These pose barriers in access to cancer care and lead to suboptimal cancer care experiences and outcomes. Knowledge of effective interventions to improve access to cancer care is needed to inform the design of tailored interventions for these populations.
To identify interventions and programs to improve access to cancer care for underserved populations in high income countries with universal health coverage (UHC) and the United States (US) throughout the cancer care continuum.
We conducted a systematic review following the PRISMA standards. We searched Medline, EMBASE, PsycINFO, CINAHL, Scopus, and the Cochrane Library. Inclusion criteria: quantitative and qualitative studies published in English in the last 10 years (2013-2023), describing interventions/programs to improve access to cancer care for underserved populations (18 years and over). We included studies in the US given the body of scholarship on equity in cancer care in that country. Screening, data extraction and analysis were undertaken by two independent reviewers.
Our search yielded 7,549 articles, and 74 met the inclusion criteria. Of these, 56 were conducted in the US, 8 in Australia, 6 in Canada, and 4 in the United Kingdom. Most (90.5%) were quantitative studies and 47.3% were published between 2020-2023. Seven types of interventions were identified: patient navigation, education and counselling, virtual health, service redesign, financial support, improving geographical accessibility and multicomponent interventions. Interventions were mainly designed to mitigate language, distance, financial, lack of knowledge and cultural barriers. Most interventions focused on access to cancer screening, targeted rural populations, racialized groups and people with low socioeconomic status, and were conducted in community-based settings. The majority of interventions or programs significantly improved access to cancer care.
Our systematic review findings suggest that interventions designed to remove specific barriers faced by underserved populations can improve access to cancer care. Few studies came from countries with UHC. Research is required to understand tailored interventions for underserved populations in countries with UHC.
全球和加拿大的医疗服务不足人群面临着严重的癌症不平等问题，这些问题源于系统性的经济、环境和社会状况。这些因素构成了获得癌症护理的障碍，并导致癌症护理体验和结果不理想。需要了解有效的干预措施以改善癌症护理的可及性，为针对这些人群设计量身定制的干预措施提供依据。
确定在具有全民健康覆盖（UHC）的高收入国家和美国，贯穿癌症护理全过程，改善医疗服务不足人群获得癌症护理机会的干预措施和项目。
我们按照PRISMA标准进行了系统综述。我们检索了Medline、EMBASE、PsycINFO、CINAHL、Scopus和Cochrane图书馆。纳入标准：过去10年（2013 - 2023年）以英文发表的定量和定性研究，描述改善医疗服务不足人群（18岁及以上）获得癌症护理机会的干预措施/项目。鉴于美国有关于癌症护理公平性的学术研究，我们纳入了美国的研究。筛选、数据提取和分析由两名独立评审员进行。
我们的检索产生了7549篇文章，74篇符合纳入标准。其中，56篇在美国进行，8篇在澳大利亚，6篇在加拿大，4篇在英国。大多数（90.5%）是定量研究，47.3%在2020 - 2023年发表。确定了七种类型的干预措施：患者导航、教育与咨询、虚拟医疗、服务重新设计、经济支持、改善地理可及性和多成分干预。干预措施主要旨在减轻语言、距离、经济、知识缺乏和文化障碍。大多数干预措施侧重于癌症筛查的可及性，针对农村人口、种族化群体和社会经济地位低的人群，并在社区环境中实施。大多数干预措施或项目显著改善了癌症护理的可及性。
我们的系统综述结果表明，旨在消除医疗服务不足人群面临的特定障碍的干预措施可以改善癌症护理的可及性。来自具有全民健康覆盖国家的研究很少。需要开展研究以了解针对具有全民健康覆盖国家医疗服务不足人群的量身定制的干预措施。
