Petermann Victoria M, Taffe Brianna D, Biru Blen M, Leeman Jennifer, Leak Bryant Ashley, Albright Benjamin B, Wheeler Stephanie B, Bae-Jump Victoria L, Grainger Lanneau, Spees Lisa P
School of Nursing, University of Virginia, Charlottesville, Virginia, USA.
School of Nursing, University of North Carolina, Chapel Hill, North Carolina, USA.
J Rural Health. 2025 Jun;41(3):e70065. doi: 10.1111/jrh.70065.
Rural endometrial cancer (EC) patients are less likely to receive lymph node evaluation, high-quality surgical care, and adjuvant therapy compared to urban patients. Developing interventions to effectively address barriers to quality care requires understanding patient experiences across the cancer care continuum. Our objective was to understand the diagnostic and treatment experiences of rural EC patients.
We conducted semistructured interviews with 23 participants (22 patients, one caregiver) from rural counties in North Carolina. We developed a semistructured interview guide to examine the experiences of patients during diagnosis and treatment. Initial codes were derived from a multilevel conceptual framework of rural cancer control, and transcribed interviews were analyzed using thematic analysis.
We identified six themes reflecting determinants of diagnosis and seven themes for treatment of EC for rural patients. Provider knowledge of EC symptoms, patient symptom normalization, and fear were all discussed as major factors impacting delays in EC diagnosis. Participants noted that social networks influenced them to seek care for symptoms they did not otherwise see as concerning. During treatment, participants experienced financial burdens, and many reported significant challenges traveling to treatment. Social networks were critical for financial support and transportation to and from treatment. Personal health care experiences and community perceptions about rural cancer care also influenced decisions about where to seek gynecologic cancer treatment.
This study highlights the need to improve rural provider adherence to guidelines for EC detection, increase symptom knowledge among rural communities, and implement comprehensive assessments of unmet needs of rural patients during treatment.
与城市患者相比，农村子宫内膜癌（EC）患者接受淋巴结评估、高质量手术治疗和辅助治疗的可能性较小。制定有效解决优质护理障碍的干预措施需要了解癌症护理连续过程中的患者经历。我们的目标是了解农村EC患者的诊断和治疗经历。
我们对来自北卡罗来纳州农村县的23名参与者（22名患者，1名护理人员）进行了半结构化访谈。我们制定了一个半结构化访谈指南，以考察患者在诊断和治疗期间的经历。初始编码源自农村癌症控制的多层次概念框架，并使用主题分析法对转录的访谈进行分析。
我们确定了反映农村患者EC诊断决定因素的六个主题和治疗的七个主题。提供者对EC症状的了解、患者症状正常化和恐惧都被讨论为影响EC诊断延迟的主要因素。参与者指出，社交网络促使他们因一些他们原本不认为是问题的症状而去就医。在治疗期间，参与者经历了经济负担，许多人报告前往治疗有重大困难。社交网络对于经济支持以及往返治疗的交通至关重要。个人医疗保健经历和社区对农村癌症护理的看法也影响了寻求妇科癌症治疗地点的决定。
本研究强调需要提高农村医疗服务提供者对EC检测指南的依从性，增加农村社区的症状知识，并在治疗期间对农村患者未满足的需求进行全面评估。
