Blum Alex C, Tessema Rachael, Nussbaum Lauren, Hidalgo Cristina, Ríos López E Jennifer, Meza-Sánchez Graciela, Morse Rachel, Brown Joanna, Reategui Reyles Rios, Wong Lucía, Córdova Luis Díaz, Diaz Karina Gonzales, Liñán Renso López, Vásquez Javier Vásquez, Tracy J Kathleen, Paz-Soldan Valerie A
Tulane School of Medicine.
Tulane University School of Public Health and Tropical Medicine.
Res Sq. 2024 Dec 13:rs.3.rs-5059371. doi: 10.21203/rs.3.rs-5059371/v1.
The objective of this study was to investigate the barriers to follow-up of women with cervical lesions suspicious of cancer who were ineligible for primary-level treatment and needed, but did not receive, hospital-level care in Loreto, Peru.
In-depth, semi-structured interviews were conducted with 18 HPV-positive women requiring hospital-level follow-up care for cervical lesions suspicious of cancer but for whom there was no documentation of completion of treatment. After thematically analyzing these patient interviews, interview findings were presented to seven doctors and five nurse-midwives at both the hospital and the primary levels for comments and suggestions regarding barriers to treatment. Finally, all findings were presented at a group model building workshop with 19 health authorities and professionals, where action items were discussed to elicit suggestions for systems-level changes.
Interviewed patients and healthcare professionals expressed the need to improve communication between levels of care, as well as the need to implement a patient navigation program. Interviewees also discussed the barriers patients encountered in obtaining hospital-level follow-up that ultimately affected their continuum of care. Patient-identified barriers to hospital care were grouped into three main themes: (1) limited patient understanding of treatment steps, (2) the need for multiple trips to the hospital to obtain care, and (3) lack of provider follow-up, leading to their suggestion for (4) the need for patient navigators. The healthcare professionals concurred with the barriers identified by the patients, but further elucidated suggestions for change such as (1) prioritizing patients with a high risk of cancer when referring to the hospital, and (2) increasing communication between the different levels of care. The group model building workshop served as a space to discuss findings and action items that could potentially make these changes possible.
Despite an overall increase in follow-up for HPV-positive women since the implementation of the new HPV-based screen-and-treat program, women at high risk of developing cervical cancer are still being lost to follow-up after being referred to the hospital for care. The challenges faced by both providers and patients are complex and require systems-level improvements.
本研究的目的是调查秘鲁洛雷托地区患有疑似癌症宫颈病变、不符合初级治疗条件且需要但未接受医院级护理的女性在后续治疗中所面临的障碍。
对18名HPV阳性女性进行了深入的半结构化访谈，这些女性因疑似癌症的宫颈病变需要医院级别的后续护理，但没有治疗完成的记录。在对这些患者访谈进行主题分析后，将访谈结果呈现给医院和初级医疗机构的7名医生和5名助产士，征求他们对治疗障碍的意见和建议。最后，所有结果都在一个有19名卫生当局人员和专业人员参加的小组模型构建研讨会上进行了展示，会上讨论了行动项目，以征求有关系统层面变革的建议。
接受访谈的患者和医疗保健专业人员表示，需要改善不同护理层面之间的沟通，以及实施患者导航计划的必要性。受访者还讨论了患者在获得医院级后续治疗时遇到的障碍，这些障碍最终影响了她们的连续护理。患者确定的医院护理障碍主要分为三个主题：（1）患者对治疗步骤的理解有限；（2）需要多次前往医院接受治疗；（3）缺乏医护人员的后续跟进，因此她们建议（4）需要患者导航员。医疗保健专业人员认同患者确定的障碍，但进一步阐明了变革建议，例如（1）在转诊到医院时优先考虑癌症高风险患者；（2）加强不同护理层面之间的沟通。小组模型构建研讨会为讨论可能促成这些变革的结果和行动项目提供了一个平台。
尽管自实施新的基于HPV的筛查和治疗计划以来，HPV阳性女性的后续治疗总体有所增加，但被转诊到医院接受治疗的宫颈癌高风险女性仍在后续治疗中失访。医护人员和患者面临的挑战很复杂，需要在系统层面进行改进。
