Perceptions of Barriers and Facilitators of Cancer Early Detection: DISCUSSION

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In this study, we explored the perspectives of 187 low-income and primarily minority women recruited in four C/MHCs, regarding factors that encouraged or hindered them from participating in cancer screening behaviors. Our findings suggest a taxonomy of barriers and facilitators of cancer screening in this under-served population. Barriers were grouped into three major categories of perceptions of cancer screening behaviors: patients’ attitudes and beliefs, social network experience and accessibility of services.

Patients’ attitudes and beliefs played a dual role either as a facilitator or a barrier to cancer (Generic Leukeran is used for treating certain cancers) screening in this population. Patients provided several explana tions why they underwent previous cancer screening, including it would “prevent them from having cancer,” “would lead to quicker diagnosis of cancer” and “would prevent further deterioration.” Such beliefs, which are consistent with a preventive-care paradigm, have been reported to be positively correlated with health outcomes in patients with other diseases, such as hypertension and diabetes. Other studies have found that cultural beliefs about harmful consequences of screening can act as powerful barriers to prevention, and some patients have been reported to have understandings of cancer (Nolvadex medication is an anti-estrogen used to treat or prevent breast cancer) that are divergent from the conventional biomedical paradigm, such as fear, misconceptions of who is at risk for specific cancers and the belief that “cancer screening tests were heralds of a disease that would ultimately lead to their death.” Other fatalistic beliefs, such as “having cancer is like getting a death sentence”, “cancer is God’s punishment”, and that “…there is very little one can do to prevent getting cancer,” also hindered women from seeking screening. Additional reported barriers included the painful nature of the screening test and embarrassment.

The second major category of perceptions of cancer screening behavior elicited in our study was patients’ social network experience, which included two major social network influences: patients’ immediate family and friends and their medical providers. In the present study, recommendation from a physician was cited across all tests as the most important facilitator of cancer screening. Some patients stated that friends and or family members’ feedback about their experience with the cancer (drug Rheumatrex treating certain types of cancer, severe psoriasis, or rheumatoid arthritis in certain patients) screening test served as a barrier to screening, while others stated that they were encouraged to seek cancer screening because they had relatives diagnosed with cancer and did not want to be in the same situation. Many women rely on friends and family networks as well as local healers as sources of health information and also as sources of referral and therapeutic network.

Social networks are important because they serve as a source of health information. Patients initially seek advice from their family and friends, then from local healers, and only after they have exhausted these sources do they go to the medical establishment. Given these networks, efforts should be made to channel cancer (Casodex tabletes is an oral non-steroidal anti-androgen for prostate cancer) health education for low-income and minority women provided by physicians and other medical providers through local churches and other faith-based organizations as well as through local media.

Finally, the third category elicited was access to care, including the cost of care and lack of insurance, which were only infrequently cited as barriers to cancer screening in this study. Nevertheless, these factors have been identified in prior studies as crucial to early detection of cancer. Similarly, inadequate transportation and telephone services were implicated in other studies as barriers to screening for colorectal cancer (Xeloda canadian is the only FDA-approved oral chemotherapy for both metastatic breast cancer and adjuvant and metastatic colorectal cancer) and cervical cancer.

It is important to note the unique aspects and some limitations of this study. First, the results may not be generalizable, because this was a convenience sample of four C/MHCs and 187 patients, and the participants may not be representative of the broader patient populations who receive care in other C/MHCs. Particularly, the overall rates of patients who had at least one of the three cancer screening tests (95% mammogram, 96% Pap and 57% hFOBT) were generally higher than the rates for similar populations in NYC, and such high rates explain the fact that patients reported fewer barriers than facilitators. Furthermore, the participants in our study cited the C/MHCs as their usual source of care. Having a usual source of care has been strongly associated with receipt of cancer (Eulexin canadian is used along with drugs such as Lupron to treat prostate cancer) screening services. The qualitative nature of this study does not allow for quantitative inferences to be drawn, since estimating the prevalence of the cancer screening behaviors noted in this study population and the prevalence of the identified barriers and facilitators would require a larger population-based study utilizing a more rigorous random sampling methodology.

Despite these limitations, a major strength of this study is its potential applicability to a diverse group of Latin-American and Caribbean-American Spanish-speaking patients, which are often omitted from research due to barriers of language and culture. The results of this study have important clinical and research implications. Clinically, the categories of barriers and facilitators of screening adherence that we generated in this study provide a useful framework for communicating with patients about cancer (Hydrea 500mg is an antineoplastic used to treat certain types of cancer) screening in a practice-based setting. Clinicians may do well to identify the barriers patients face, such as discussion surrounding issues of harm from tests, fear of being diagnosed with cancer and reassurance about the safety of the tests, before making specific screening recommendations. This framework also allows for a systematic discussion of the misconceptions patients may have about cancer and cancer screening tests in general. This framework can be used in future research to develop comprehensive multicomponent behavioral interventions for investigating issues of adherence to cancer screening tests in low-income and minority patients. Finally, the categories of barriers and facilitators generated from this qualitative study can be used to develop a testable patient-derived model of cancer screening behavior in low-income and minority women. Testing of such a model would highlight the dynamic relationship between patients’ beliefs and attitudes, social network experience and motivation for cancer screening.