A consultation with Canadian rural women with breast cancer
Ontario Breast Cancer Community Research Initiative, Sunnybrook & Women's Health Sciences Centre, Toronto, Ontario, Canada. Health Expectations
(Impact Factor: 3.41).
04/2004; 7(1):40-50. DOI: 10.1046/j.1369-6513.2003.00248.x
Relatively little research has been carried out on the health and supportive care needs of rural women living with breast cancer. In this study, results from a Canadian focus group study are used to highlight issues of importance to rural women.
A total of 276 rural women with breast cancer divided into 17 focus groups participated in the study conducted across Canada. A standardized protocol for discussion was employed. Issues of access to information, support and services were discussed, with women describing their experiences in trying to find appropriate programmes and services.
The major theme identified through analysis of qualitative data was 'becoming aware of and/or gaining access to health care information, support and services.' Other major themes included: (1) dealing with isolation; (2) having to travel; (3) feeling the financial burden and (4) coping with changing work.
Rural women with breast cancer have supportive care challenges related to their circumstances. A series of recommendations were generated through the consultation process which are contributing to the development of a national strategy focusing on the development and extension of programmes for rural women with breast cancer. Although the research on the project was not to specified standards, and suffered from less attention than community capacity building and advocacy, it proved to be of worth and revealed potential benefits from collaborations between researchers and community organizations.
Available from: David Wiljer
- "If the initial diagnosis was made in an academic hospital or one with an affiliated cancer centre, or if a patient’s referring physician resided in a county with a cancer centre, the patient had a significantly greater likelihood of receiving RT
[19,27,33]. Tyldesley et al.
 argued that rural areas have fewer specialists with adequate knowledge of the indications for RT, and Gray et al.
 highlighted a lack of patient support modalities. Notably, patient outcomes were not different between the high-volume and low-volume institutions
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Radiation therapy (RT) is effective treatment for curing and palliating cancer, yet concern exists that not all Canadians for whom RT is indicated receive it. Many factors may contribute to suboptimal use of RT. A review of recent Canadian literature was undertaken to identify such barriers.
MEDLINE, CINAHL, and EMBase databases were used to search keywords relating to barriers to accessing or utilizing RT in Canada. Collected abstracts were reviewed independently. Barriers identified in relevant articles were categorized as relating to the health systems, patient socio-demographic, patient factors, or provider factors contexts and thematic analysis performed for each context.
535 unique abstracts were collected. 75 met inclusion criteria. 46 (61.3%) addressed multiple themes. The most cited barriers to accessing RT when indicated were patient age (n = 26, 34.7%), distance to treatment centre (n = 23, 30.7%), wait times (n = 22, 29.3%), and lack of physician understanding about the use of RT (n = 16, 21.6%).
Barriers to RT are reported in many areas. The role of provider factors and the lack of attention to patient fears and mistrust as potential barriers were unexpected findings demanding further attention. Solutions should be sought to overcome identified barriers facilitating more effective cancer care for Canadians.
Available from: Kate Collie
- "Effective patient–provider communication has been shown to be associated with more favorable medical outcomes for patients with chronic diseases (Kaplan et al., 1989), and also with lower It is important to understand what factors may promote or inhibit successful interactions with medical professionals for women with breast cancer. This issue has particular relevance for women living in rural areas, who may find it harder than their urban counterparts to get access to information they need because of social isolation , the risk of stigma in small communities, scarcity of providers, poverty, inadequate transportation , and geographic distances between patients and providers (DeLeon et al., 2003; Gray et al., 2004; Kenkel, 2003; Wilson et al., 2000). In rural northeastern California where this study was conducted, this problem is exacerbated by mountainous terrain, exceptionally sparse population, and severe winter weather. "
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ABSTRACT: This study examined self-efficacy, coping, and social support in relation to difficulties interacting with physicians and nurses among women living with breast cancer. One hundred women living in rural, mountainous communities of northeastern California were recruited, with 89 providing complete data for this study. All women completed a battery of questionnaires that included the CARES--Medical Interaction Subscale and measures of self-efficacy, coping, satisfaction with social support, and demographic and medical characteristics. In a multiple regression analysis, difficulties interacting with medical professionals were found to be greater among women who were not married, who used more behavioral disengagement or less self-distraction to cope with breast cancer, and who reported less self-efficacy for affect regulation and for seeking and understanding medical information. Emotional venting and satisfaction with social support for dealing with cancer-related stress were not, however, significantly related to difficulties in interacting with the medical team. This model accounted for an adjusted value of 42% of the variance. Further research is needed to identify possible causal relationships related to these findings and to determine what interventions might be warranted to improve medical interactions for women with breast cancer living in rural areas.
Available from: Rebecca J Schlegel
- "Second, because rural breast cancer patients are unlikely to have contact with other breast cancer patients or survivors, they may feel that they lack cancer-specific role models. Concordant with this, rural breast cancer patients regularly report the desire to meet with breast cancer survivors because this experience helps normalize their fears and offers a survivorship perspective (Gray et al., 2004; Wilson et al. 2000; Dunaway et al., 1995). Without interaction with these much needed role models, rural breast cancer patients may be likely to adopt forms of coping that are habitual and/or functional within their rural communities. "
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