黑白患者子宫癌诊断体验：一项质性研究

Diagnostic experiences of Black and White patients with uterine cancer: A qualitative study

GYNECOLOGIC ONCOLOGY

影响因子:4.1

分区:医学2区 Top / 妇产科学1区肿瘤学2区

发表日期:2024 Dec

作者: Meredith Campbell Britton, Elizabeth Izampuye, Mitchell Clark, Ruth Ann Ornstein, Marcella Nunez-Smith, Jason D Wright, Xiao Xu

DOI: 10.1016/j.ygyno.2024.09.010

摘要

旨在探讨患者子宫癌诊断过程中的体验及可能影响早期诊断和种族差异的障碍。我们进行了半结构化访谈，了解11名非西班牙裔黑人（“黑人”）和11名非西班牙裔白人（“白人”）患者在过去六个月内被诊断为子宫癌的诊断历程。所有访谈均录音、专业转录，并采用主题分析法进行分析。研究结果经过患者和社区倡导者的批判性审查和反馈后定稿。受访者中位年龄为64岁。13人（59.1%）为I期肿瘤，9人（40.9%）为II-IV期。受访者对症状敏感，但未意识到可能表示子宫癌。这一认知不足部分源于女性对不适的条件反应以及生育年龄后与妇科护理的断裂。受访者常将诊断中的种族差异与其他社会决定因素（如性别、年龄、医疗获得）联系在一起。这些交织的社会体验，加上对康复的关注，可能掩盖了他们对系统性种族主义的认识。虽少数受访者报告在诊断过程中有负面体验，但黑人受访者常描述以往的歧视经历影响了他们对医疗系统的警惕。公众对子宫癌认知不足、对不适的性别化期待以及与妇科护理的断裂，均妨碍了子宫癌的早期诊断。过去医疗中的歧视经历也进一步加剧了黑人患者与医疗系统的疏离感。

Abstract

To explore patient experiences with the diagnosis process for uterine cancer and the perceived barriers that may affect early diagnosis and racial disparities in stage at diagnosis.We conducted semi-structured interviews to ascertain the diagnostic journey of 11 non-Hispanic Black ("Black") and 11 non-Hispanic White ("White") patients who were diagnosed with uterine cancer in the past six months. All interviews were audio-recorded, professionally transcribed, and analyzed using thematic analysis. Findings were presented to patients and community advocates for critical review and feedback before being finalized.Respondents had a median age of 64 years. Thirteen (59.1 %) had stage I tumor, whereas nine (40.9 %) had stage II-IV disease. Respondents were attentive to their symptoms but unaware that they could indicate uterine cancer. This was compounded by women's conditioned acceptance of discomfort and disconnection from gynecological care after reproductive age. Respondents often viewed racial disparities in diagnosis through other social determinants of health, including gender, age, and healthcare access. These overlapping social experiences, coupled with respondents' concentration on recovery, may mask their perceptions about systemic racism. Although few respondents noted negative experiences in their own evaluations leading to the diagnosis of uterine cancer, Black respondents often described how previous discriminatory experiences informed a wariness of healthcare systems.Lack of public awareness of uterine cancer, gendered expectations for discomfort, and disconnection from gynecologic care all interfered with early diagnosis of uterine cancer. Discriminatory experiences in prior healthcare further complicate Black patients' engagement with the healthcare system.