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Comparing pathways to diagnosis and treatment for rural and urban patients with colorectal or breast cancer: A qualitative study

journal contribution
posted on 2020-09-01, 00:00 authored by Rebecca J Bergin, Jon D Emery, Ruth Bollard, Vicki WhiteVicki White
Purpose Colorectal cancer patients living in rural areas have poorer outcomes than urban counterparts, but such disparities are not found for breast cancer. Although time to care may contribute to rural‐urban disparities, few studies examine patient experiences to understand how and why delays may occur. We compared rural and urban patient experiences of pathways to colorectal or breast cancer diagnosis and treatment in Victoria, Australia. Methods Semistructured telephone interviews were conducted with 43 patients (49% colorectal; 60% rural, median 7 months postdiagnosis). A framework analysis was applied using the Model of Pathways to Treatment. Findings Rural and urban patients expressed similar attitudes and reasons for prolonged symptom appraisal and help‐seeking triggers. However, some rural patients reported long waiting times to see a Primary Care Practitioner (PCP) and perceived greater gatekeeping to diagnostic services. Patient perceptions of the urgency of PCP referral could impact behavior, such as waiting longer to book appointments. Colorectal cancer patients reported more variable types of symptoms, interpretation, and coping strategies, as well as diverse presentation routes and reduced sense of urgency, compared to breast cancer patients. Waiting time for colonoscopy could be long, particularly in the public health system, but mammograms were quickly arranged. Conclusions Pathway variation was more evident by cancer type than residential location. However, access to primary care and diagnostic services for rural patients with colorectal cancer may be important policy targets. Future research should investigate the impact of diagnostic service accessibility on PCP referral behavior to further understand rural‐urban disparities.

History

Journal

Journal of Rural Health

Volume

36

Season

Autumn 2020

Pagination

517-535

Location

Hoboken, N.J.

ISSN

0890-765X

eISSN

1748-0361

Language

eng

Publication classification

C1 Refereed article in a scholarly journal

Copyright notice

2020, National Rural Health Association

Issue

4

Publisher

Wiley-Blackwell Publishing