Washington University School of Medicine, St. Louis, MO, United States.
The University of Texas, MD Anderson Cancer Center, Houston, TX, United States.
Front Public Health. 2024 Nov 13;12:1470032. doi: 10.3389/fpubh.2024.1470032. eCollection 2024.
Mammography screening guidelines in the United States highlight the importance of informing and involving women when making their breast cancer screening decisions. However, the complexity of interpreting and applying these population-level guidelines can contribute to patient burden. Patient-centered communication strategies can alleviate patient burden, but few consider perspectives from racially and ethnically marginalized populations. We examine diverse women's perspectives on screening to characterize patient-centered experiences.
We conducted 28 focus groups with 134 non-Latina Black ( = 51), non-Latina White ( = 39), and Latina ( = 44) participants. We coded participants' discussion of their screening influences. We used deductive and inductive qualitative methods to identify common themes.
We identified three themes: (1) personal relationships with primary care providers, (2) potential impacts of cancer on families, and (3) interactions with medical systems. Most White participants described trusting physician relationships in contrast to perfunctory, surface-level relationships experienced by many Black participants; high costs of care prevented many Latina participants from accessing care (Theme 1). Diagnosis was a concern for most Black participants as it could burden family and most Latina participants as it could prevent them from maintaining family well-being (Theme 2). While many White participants had general ease in accessing and navigating healthcare, Latina participants were often held back by embarrassment-and Black participants frequently described disrespectful providers, false negatives, and unnecessary pain (Theme 3).
Cultural and structural factors appeared to influence participants' approaches to breast cancer screening. Structural barriers may counteract culturally salient beliefs, especially among Black and Latina participants. We suggest patient-centered communication interventions be culturally adjusted and paired with structural changes (e.g., policy, insurance coverage, material resources) to reflect women's nuanced values and intersectional social contexts.
美国的乳腺 X 光筛查指南强调了在做出乳腺癌筛查决策时告知和参与女性的重要性。然而，解释和应用这些人群水平指南的复杂性可能会增加患者的负担。以患者为中心的沟通策略可以减轻患者的负担，但很少考虑到来自种族和族裔边缘化人群的观点。我们研究了不同女性对筛查的看法，以描述以患者为中心的体验。
我们与 134 名非拉丁裔黑人（ = 51）、非拉丁裔白人（ = 39）和拉丁裔（ = 44）参与者进行了 28 次焦点小组。我们对参与者讨论其筛查影响的内容进行了编码。我们使用演绎和归纳定性方法来确定常见主题。
我们确定了三个主题：（1）与初级保健提供者的个人关系，（2）癌症对家庭的潜在影响，以及（3）与医疗系统的互动。大多数白人参与者描述了与医生的信任关系，而许多黑人参与者则经历了敷衍了事、表面化的关系；高昂的医疗费用使许多拉丁裔参与者无法获得医疗服务（主题 1）。大多数黑人参与者担心诊断会给家庭带来负担，而大多数拉丁裔参与者则担心诊断会阻止他们维持家庭幸福（主题 2）。虽然许多白人参与者在获取和使用医疗服务方面相对轻松，但拉丁裔参与者经常因尴尬而受阻，而黑人参与者则经常描述不尊重的提供者、假阴性和不必要的疼痛（主题 3）。
文化和结构性因素似乎影响了参与者对乳腺癌筛查的态度。结构性障碍可能会抵消具有文化意义的信念，尤其是对黑人和拉丁裔参与者而言。我们建议以患者为中心的沟通干预措施进行文化调整，并与结构性变化（如政策、保险覆盖、物质资源）相结合，以反映女性的细微价值观和交叉社会背景。
