Fractured and delayed: A qualitative analysis of disruptions in care for gynecologic malignancies during incarceration.
Fractured and delayed: A qualitative analysis of disruptions in care for gynecologic malignancies during incarceration.
复制标题
骨折和延迟：对监禁期间妇科恶性肿瘤护理中断的定性分析。
DOI：
10.1016/j.ygyno.2023.06.017
复制
发表时间：
2023
影响因子：
4.7
通讯作者：
Knittel,AndreaK
中科院分区：
文献类型：
--
作者：
Burkett,WesleyC;Iwai,Yoshiko;Gehrig,PaolaA;Knittel,AndreaK
女性的监禁率正以两倍于男性的速度增长。此外，到本十年结束时，三分之一的人将超过55岁。被监禁的妇女患妇科恶性肿瘤的几率更高，疾病的分期也更高，这可能是导致癌症死亡率高于年龄调整后的美国人口的原因。指导方针推荐的筛查和预防途径有限以及矫正设施的资源限制可能导致妇科癌症的差异。监狱中妇科癌症治疗延迟的原因仍未得到充分探讨。因此，我们试图在经历监禁的女性中确定延迟妇科癌症治疗的因素。方法：在2014-2021年期间，在美国东南部单一三级中心被监禁并被诊断患有妇科癌症的女性在电子病历中被识别。提取注释文本，并使用RADaR方法识别和分类造成延迟的贡献者。采用描述性统计对定量数据进行评估。结果通过14879篇文献摘要共识别出14例患者。进行数据缩减以确定与中心研究问题相关的摘录，从而产生175个相关的注释摘录。三级保健访问之前的延误包括患者和机构捐助者。从三级中心过渡到监狱期间的延误包括出院计划和监禁期间/之后的随访缺失。运输、授权和限制是具体的因素。摘要贡献因素包括沟通和患者的情感体验。结论：我们发现了许多导致监禁女性延迟或骨折妇科癌症治疗的因素。这些问题的影响值得进一步研究和干预，以改善护理。
ObjectiveWomen are experiencing growing rates of incarceration at twice the pace of that for men. Additionally, one-third will be older than 55 years of age by the end of the decade. Women who are incarcerated experience a higher prevalence of gynecologic malignancies and present with higher stage disease, which may be contributing to the greater mortality from cancer than the age-adjusted US population. Limited access to guideline-recommended screening and prevention and resource limitations across correctional facilities may result in gynecologic cancer disparities. Reasons for delayed gynecologic cancer care in prisons remain underexplored. Therefore, we sought to identify contributors to delayed gynecologic cancer care among women experiencing incarceration.MethodsWomen at a single tertiary center in the Southeastern U.S. who were incarcerated and were diagnosed with a gynecologic cancer during 2014–2021 were identified in the electronic medical record. Note text was extracted and contributors to delay were identified and categorized using the RADaR method. Descriptive statistics were used to assess quantitative data.Results14 patients were identified with a total of 14,879 text excerpts. Data reduction was performed to identify excerpts that were relevant to the central research question resulting in 175 relevant note excerpts. Delays prior to the tertiary care visit included patient and institutional contributors. Delays during transition from the tertiary center to prison included discharge planning and loss to follow-up during/after incarceration. Transportation, authorization, and restraints were concrete contributors. Abstract contributors included communication, and the patient's emotional experience.ConclusionsWe identify myriad contributors to delayed or fractured gynecologic cancer care in women experiencing incarceration. The impact of these issues warrants further study and intervention to improve care.