Rural Primary Care Providers’ Perceptions of Their Role in the Breast Cancer Care Continuum

Abstract

Context: Rural women in the United States experience disparity in breast cancer diagnosis and treatment when compared to their urban counterparts. Given the 11% chance of lifetime occurrence of breast cancer for women overall, the continuum of breast cancer screening, diagnosis, treatment, and recovery are of legitimate concern to rural women and their primary care providers. Purpose: This analysis describes rural primary care providers' perceptions of the full spectrum of breast cancer screening, treatment, and follow-up care for women patients, and it describes the providers' desired role in the cancer care continuum. Method: Focus group interviews were conducted with primary care providers in 3 federally qualified community health centers serving a lower income, rural population. Focus group participants (N = 26) consisted of 11 physicians, 14 nurse practitioners, and 1 licensed clinical psychologist. Data were generated from audiotaped interviews transcribed verbatim and investigator field notes. Data were analyzed using constant comparison and findings were reviewed with a group of rural health professionals to judge the fit of findings with the emerging coding scheme. Findings: Provider relationships were characterized as being with women with cancer and comprised an active behind-the-scenes role in supporting their patients through treatment decisions and processes. Three themes emerged from the interview data: Knowing the Patient; Walking Through Treatment With the Patient; and Sending Them Off or Losing the Patient to the System. Conclusions: These findings should be a part of professional education for rural practitioners, and mechanisms to support this role should be implemented in practice settings.Key words breast cancer care, provider perspectives, rural primary care.Breast cancer is an illness of national concern, with more than 180,000 women diagnosed with the disease yearly in the United States.1 The continuum of breast cancer care flows from prevention and screening through diagnosis, treatment, and posttreatment follow-up.2 Advances in diagnosis and treatment options have expanded, and the emergence of highly specialized cancer treatment centers and multidisciplinary teams of specialists have played a role in increasing survival rates and maximizing positive outcomes for patients. Yet, rural women in the United States experience disparity in breast cancer diagnosis and treatment, with diagnosis occurring at a later stage than their urban counterparts.4 Rural women also have persistently lower mammography screening rates. 5,6 Lack of insurance, geographic inaccessibility of screening mammography, lack

The primary care provider (PCP)‐cancer specialist relationship: A systematic review and mixed‐methods meta‐synthesis

“…The reasons for exclusion are summarized in Figure . After complete review and data abstraction, 36 studies met all inclusion criteria . Among eligible studies, 23 (64%) were quantitative surveys, 11 (30%) were qualitative studies, and 2 (6%) used mixed methods.…”

“…Thematic analysis of the quantitative and qualitative papers revealed 6 major themes: 1) poor and delayed communication between PCPs and cancer specialists, 2) cancer specialists' endorsement of a specialist‐based model of care, 3) PCPs' belief that they play an important role in the cancer care continuum, 4) PCPs' willingness to participate in the cancer care continuum, 5) cancer specialists' and PCPs' uncertainty regarding the knowledge or training of the PCP to provide care, and 6) discrepancies between PCPs and cancer specialists regarding roles and expectations (Table ) . Importantly, these themes crossed methodologies and were consistently identified by quantitative (Table ), qualitative (Table ), and mixed‐methods studies (Table ) . Themes were incorporated into a preliminary conceptual model of the PCP‐cancer specialist relationship as it pertained to the model of cancer care (Fig.…”

Women’s health care: the experiences and behaviors of rural and urban lesbians in the USA

“…Given the documented rural-urban disparities in the USA with regards to both cervical cancer (rural women have high incidence and mortality rates 56 ) and breast cancer (diagnosed at later stage in rural women 78 ) among the general population of women, coupled with the fact that lesbians experience greater gynecological cancer risks 58 , the risks for these types of cancer is theoretically highest among rural lesbians. Consequently, in order to adequately address these discrepancies, cancer screening rates among rural lesbians need to be higher than those for their urban counterparts.…”

Navigating the Needs of Rural Women with Breast Cancer: A Breast Care Program

“…1 Increasing survival rates and improved outcomes for women with breast cancer can be attributed to advances in diagnosis and treatment, development of specialized cancer treatment centers, and collaboration by multidisciplinary teams of experts. 2 It is estimated that there are nearly 2.8 million breast cancer survivors currently living in the United States. 3 Health care organizations have a vested interest in improving patient outcomes.…”

“…It has been shown that specialized breast cancer care is associated with a significant reduction in mortality 4 and that a mutual and personal patient-provider relationship is vital to improving outcomes of all aspects of breast cancer care for rural women. 2 The BCP supports the delivery of breast cancer care through the development and application of a breast cancer patient management framework based on six key principles, including: (1) enhanced access to Breast care needs of rural women services and quality care for all breast cancer patients ranging from prevention, early detection, diagnosis, and treatment through supportive and palliative care; (2) better coordination of high quality, compassionate care with delivery in a multidisciplinary setting; (3) reduction of barriers that prevent timely care, such as transportation, insurance, communication, and financial concerns; (4) improvement of breast cancer patient outcomes and satisfaction; (5) efficient delivery of care that could result in cost savings for the health care system; and (6) enhanced relationships with the community.…”