Liapis Ioannis, Harsono Alfonsus Adrian H, Sanghera Jaspinder, West Katie, Ahmad Rida, Holland Michelle, Hearld Larry, Bhatia Smita, Mehari Krista, Heslin Martin J, Chu Daniel I, Fonseca Annabelle L
Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Psychology, University of South Alabama, Mobile, AL, USA.
Ann Surg Oncol. 2025 Jun;32(6):3900-3912. doi: 10.1245/s10434-025-17113-2. Epub 2025 Mar 4.
Many patients with foregut cancer do not receive guideline-concordant treatment (GCT). Although social determinants of health (SDOH) have been associated with differences in receipt of GCT, the underlying mechanisms that perpetuate these disparities remain unknown. This mixed-methods study explored barriers to receipt of care among patients with foregut cancer.
Patients with foregut cancers treated at a safety-net hospital in the Deep South were purposively selected. The patients completed semi-structured interviews, which were recorded, transcribed, and analyzed. Grounded theory methodology was used to generate themes through open coding, develop a thematic coding structure, and create a codebook. Intercoder agreement was above 90%. Patient sociodemographic and treatment-related variables were abstracted from the patients' medical records to produce simple descriptive statistics.
The majority of the 30 participating patients were male (n = 23, 77%), black (n = 18, 60%), and with a median age of 63 years (interquartile range, 55-67 years). Using the socioecologic model, barriers were categorized into individual, interpersonal, organizational, and policy levels. Within the individual level, the barriers were access to primary care providers, personal barriers, competing responsibilities, multifaceted financial barriers, and transportation barriers. The interpersonal barriers involved communication challenges, physician mistrust, and absence of social support. The organizational level barriers were health system mistrust, inadequate health care infrastructure, and lack of insurance coverage consequences. The policy level barriers were health care access policies and insurance policies.
The patients reported multiple barriers related to accessing and adhering to their treatments. Understanding these barriers is critical to forming the basis for developing and implementing programs to increase the delivery of GCT.
许多前肠癌症患者未接受符合指南的治疗（GCT）。尽管健康的社会决定因素（SDOH）与接受GCT的差异有关，但导致这些差异持续存在的潜在机制仍不清楚。这项混合方法研究探讨了前肠癌症患者接受治疗的障碍。
有目的地选择了在深南部一家安全网医院接受治疗的前肠癌症患者。患者完成了半结构化访谈，访谈进行了录音、转录和分析。采用扎根理论方法，通过开放编码生成主题，开发主题编码结构，并创建编码手册。编码员间一致性超过90%。从患者的病历中提取患者的社会人口统计学和治疗相关变量，以得出简单的描述性统计数据。
30名参与研究的患者中，大多数为男性（n = 23，77%），黑人（n = 18，60%），中位年龄为63岁（四分位间距，55 - 67岁）。使用社会生态模型，障碍被分为个人、人际、组织和政策层面。在个人层面，障碍包括获得初级保健提供者的机会、个人障碍、相互竞争的责任、多方面的经济障碍和交通障碍。人际障碍涉及沟通挑战、对医生的不信任以及缺乏社会支持。组织层面的障碍是对卫生系统的不信任、医疗保健基础设施不足以及缺乏保险覆盖的后果。政策层面的障碍是医疗保健获取政策和保险政策。
患者报告了与接受和坚持治疗相关的多种障碍。了解这些障碍对于为制定和实施旨在增加GCT提供的项目奠定基础至关重要。
