Obstacles to cancer care: focus on the economically disadvantaged.

Abstract

PURPOSE/OBJECTIVES: To provide additional documentation of the unmet cancer prevention and control needs of poor Americans. DESIGN AND SETTING: Qualitative analysis of testimony provided at American Cancer Society hearings on cancer and the poor. SAMPLE: 46 economically disadvantaged individuals with personal experiences with cancer. METHODS: Review of transcription of oral testimony and qualitative analysis for recurrent themes to identify common obstacles to cancer care. FINDINGS: Six major obstacles were identified: care was deferred because of costs; care was described as "fragmented," "impersonal," and "symptomatic;" patients were discouraged from worrying about bodily changes; patients were discouraged from seeking state-of-the-art care; poor patients experienced difficulty communicating their needs and concerns; and poverty interfered with efforts to participate in volunteer activities. CONCLUSIONS: Testimony is suggestive of the problems that poor patients with cancer face. Challenges to improve the situation include expanding and extending diagnostic, treatment, and rehabilitative services to the poor; facilitating education and prevention; and further research to document the scope of the problem. IMPLICATIONS FOR NURSING PRACTICE: Nurses should engage in the debate over healthcare reform and take advantage of the opportunities to define and participate in the development of procedures, strategies, and systems for removing obstacles to quality cancer prevention and care for the poor.