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Rural Breast Cancer Surgery Programs: A Rapid Qualitative Review

Last updated: May 3, 2019
Project Number: RC1104-000
Product Line: Rapid Response
Research Type: Devices and Systems
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What are the experiences and perspectives of breast cancer patients, their caregivers and their health care providers with respect to breast cancer surgical care in rural areas? To ensure the relevance of the analysis to the objectives of the primary research question, a secondary set of research questions was explored during data extraction and analysis:a)  How do people with breast cancer, and their families, experience travelling for breast cancer surgical care?b)  What is the meaning and impact of receiving breast cancer surgical care close to home, from the perspective of patients and their families? c)  How does the need to travel for breast cancer surgical care shape patients’, their families’ and their health care providers’ experiences and perceptions of breast cancer surgical care?

Key Message

Long distances, isolation, and transportation issues represented a great challenge and a source of additional stress among rural breast cancer patients and their caregivers. When patients lacked the support of partners, family, or their health professionals, they felt vulnerable and lonely both in rural and urban settings. Physical and logistical challenges, such as transportation barriers, travel expenses, and disruption of work and family commitments intensified patients’ and caregivers’ discomfort and distress. Such conditions often exacerbated patients’ and caregivers' experience of care leading patients to seek the less stressful [treatment] pathway or to deny cancer treatment in the case of advanced cancer stage, old age or lack of support. Health care providers expressed similar feelings of frustration due to distance and their patients needing to travel.In some instances, patients’ perceptions of rurality mitigated perceived barriers to surgical care. Some patients viewed travel and travel expenses as part of rural life, and rural values of self-sufficiency and endurance likewise permeated reported experiences. Rural culture can carry a commitment to self-reliance, leading patients to opt for a treatment pathway that limited work and life disruptions and avoided relying on others. For some patients this meant choosing mastectomy over breast conserving surgery, which allowed them to avoid radiation therapy and repeated trips to the cancer centre. Rural stoicism also emerged through a general reticence to seek care, which may contribute in part to the common phenomena of delayed diagnosis among rural breast cancer patients.Shortages of health care professionals and fragmented health care services were further disadvantages in rural settings, experienced through delayed diagnoses, more trips to urban centres, shorter consultations, and limited access to medical support. For health care professionals this also meant shifting roles and delegating responsibilities across specialties and patients. Poor communication and coordination among care providers left patients confused about care professionals’ roles and responsibilities as well as feeling lost in the cracks of the health care system. Overall, travel and distance alone do not affect the experience of breast cancer surgery care. Rather patients, caregivers, and health care professionals rationalize distance and travel differently in relation to additional factors, such as rural culture, access to support, age, cancer conditions, availability of health care professionals and coordination of care. Rural patients and caregivers generally expressed high levels of satisfaction with their treatment and care, especially when compared to their urban counterparts.