Fractured and delayed: A qualitative analysis of disruptions in care for gynecologic malignancies during incarceration.

Autor: Burkett WC; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America. Electronic address: wesley.burkett@unchealth.unc.edu., Iwai Y; University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States of America. Electronic address: yoshiko_iwai@med.unc.edu., Gehrig PA; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA, United States of America. Electronic address: pam7w@virginia.edu., Knittel AK; Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America. Electronic address: andrea_knittel@med.unc.edu.
Jazyk: angličtina
Zdroj: Gynecologic oncology [Gynecol Oncol] 2023 Sep; Vol. 176, pp. 1-9. Date of Electronic Publication: 2023 Jun 30.
DOI: 10.1016/j.ygyno.2023.06.017
Abstrakt: Objective: Women 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.
Methods: Women 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.
Results: 14 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.
Conclusions: We 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.
Competing Interests: Declaration of Competing Interest None.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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