Analisam a autonomia e o papel dos governos estaduais nas políticas sociais de assistência social, educação e saúde, com foco na provisão dos serviços. Os autores mostram que o processo de municipalização não retirou os estados dessas políticas; há um compartilhamento da provisão com municípios, especialmente nos serviços de média e alta complexidade na assistência social e na saúde, além dos anos finais do ensino fundamental na educação. A análise dos serviços ofertados pelos estados em cada uma dessas três áreas setoriais revela que há um enorme espaço para que os estados avancem na provisão desses serviços e na sua atuação como coordenadores regionais.
Background
Advanced stage and high mortality are characteristics of cervical cancer in developing countries. Comprehension of the diagnosis itinerary is one of the main strategies to control the disease impact.
Objectives
To identify reasons for the delay in diagnosing symptomatic cervical cancer according to the patient's perspectives reported in qualitative studies. We searched four databases (PubMed, Embase, CINAHL, and Web of Science).
Selection criteria
We included qualitative studies of women with advanced cervical cancer that explored their experiences before treatment. We excluded unoriginal, non‐qualitative, and duplicated studies.
Data collection and analysis
We selected 39 articles for a full‐text reading and included 15 in the present review. We chose the Consolidated Criteria for Reporting Qualitative Research (COREQ) for quality assessment and The Model of Pathways to Treatment to guide the codifying process.
Main results
Four main themes emerged from the synthesis: (1) Health‐seeking motivators; (2) Obstacles to seeking medical care; (3) Diagnosis delay; and (4) Coping with the disease. These themes were derived from patients' personal knowledge and beliefs, social relationships, socioeconomic status, and healthcare system characteristics.
Conclusions
Individual behavior, social factors, and healthcare organization contribute to the delay in diagnosing advanced cervical cancer.
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