黑白子宫癌患者的诊断经历：一项定性研究
Diagnostic experiences of Black and White patients with uterine cancer: A qualitative study
影响因子:4.10000
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
摘要
探索患者在诊断时可能影响早期诊断和种族差异的诊断过程的经验。我们进行了半结构化的访谈，以确定11个非西班牙裔黑人（“黑色”）和11个非西班牙裔白人（“白人”）患有六个月的诊断患者的诊断旅程。所有访谈均通过主题分析进行了音频记录，专业转录和分析。在最终确定之前，向患者和社区倡导者提出了调查结果。响应年龄的中位年龄为64岁。十三阶段（59.1％）患有I期肿瘤，而9（40.9％）患有II-IV期疾病。受访者专注于症状，但不知道他们可以表明子宫癌。生殖年龄后，妇女对妇科护理的不适感和脱节的条件使情况更加复杂。受访者经常通过其他社会决定因素（包括性别，年龄和医疗保健访问）来看待诊断中的种族差异。这些重叠的社会经历，再加上受访者对康复的专注，可能会掩盖他们对系统性种族主义的看法。尽管很少有受访者在自己的评估中指出了负面的经历，导致了子宫癌的诊断，但黑人受访者经常描述以前的歧视性经历如何使医疗保健系统的警惕。公共对子宫癌的认识，性别期望的不适感，以及与早期诊断的妇科诊断的妇科护理疾病的期望。先前医疗保健的歧视经验进一步使黑人患者与医疗保健系统的参与变得复杂。
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.