Objectives Cervical cancer disparities persist for Black women despite targeted efforts. Reasons for this vary; one potential factor affecting screening and prevention is perceived discrimination in medical settings. The purpose of this study was to describe experiences of perceived discrimination in medical settings for Black women and to explore the impact on cervical cancer screening and prevention. Methods This paper presents mixed methods results using the Discrimination in Medical Settings (DMS) scale and qualitative interviews to understand the medical experiences of Black women. We administered the DMS scale to 48 Black women and interviewed five about their experiences engaging in the healthcare system. Results High levels of perceived discrimination were experienced by our sample, with the majority of women having experienced discrimination in the medical setting. Qualitative data contextualized these results, including the impact on the patient-provider relationship and on the development of medical mistrust. Most women reported they had been screened within the last 3 years (75%) and had seen a doctor within the past year (89.6%). Conclusions Black women are engaging in healthcare while experiencing perceived discrimination in medical settings. Future interventions should address the poor quality of medical encounters that Black women experience.
170 Background: Despite recommendations from numerous clinical bodies (e.g., ASCO), less than 20% of NCORP-affiliated practices regularly collect SOGI data. This gap compromises the ability to identify and correct care inequities experienced by sexual and gender minority (SGM) individuals. Therefore, we evaluated provider- and clinic- level barriers and facilitators to SOGI collection at NCORP practices across the US. Methods: We conducted 14 interviews across seven NCORP oncology practices via Zoom. We purposefully sampled to ensure geographic, racial, and ethnic diversity of patient populations. We interviewed one clinician (oncologist, advanced practice provider) and one clinic staff member per practice. The Consolidated Framework for Implementation Research (CFIR) informed thematic analysis that identified barriers and facilitators to SOGI data collection. Interviews were recorded, transcribed, and coded by two coders who adjudicated any discordance. Analyses were conducted in NVivo. Results: Thematic saturation occurred after interviews at six practices, with interviews at the seventh practice confirming saturation. Participants represented five geographic regions and included three Minority Underserved practices and two rural practices. Several organizational context characteristics influenced SOGI data collection: access to knowledge, information technology infrastructure, staff processes, and perceived relative priority of SOGI for an oncology visit. All oncologists expressed a low relative priority of sexual orientation data for oncology care. Gender identity had higher priority because it influences how clinicians should address patients. At the clinic level, this low relative priority coincides with a lack of processes and policies for collecting SOGI from all patients. At the oncology care team level, perceived irrelevance to oncology care was related to discomfort in asking SOGI, fear of patient discomfort, and limited awareness of SOGI in electronic health records. Suggested solutions included: normalizing asking SOGI questions, giving patients privacy to complete SOGI, and clarifying relevance of SOGI for clinical purposes. Understanding how SOGI improves patient experiences was a facilitator for collection. Conclusions: Within this NCORP practice sample, SOGI data collection barriers included clinician-perceived low relative priority for collection, and perceptions that SOGI disclosure does not influence care quality, despite most interviewees expressing a strong desire to show respect to patients and provide high quality cancer care. Oncology teams may benefit from training on culturally sensitive SOGI collection, education on SOGI data relevance to oncology practices, and support for implementing SOGI data collection policies.
Although advancements in cervical cancer prevention have helped reduce the incidence, mortality, and prevalence, access to these preventive services has not been experienced equally by all women in the United States. The purpose of this study was to learn about the factors that affect access to preventive services in a low-income, primarily Black community. Using a community-based participatory research approach, women were recruited to participate in 7 focus groups, with 6 to 8 women per group (N = 45). Participants were mainly Black (64%), with a mean age of 46 years, and 60% reporting completing at least some college. The discussions were transcribed, and text data were organized using Dedoose software. Guided by qualitative content analysis, the data were analyzed through an iterative process of coding and condensing the codes into themes. Ten types of barriers and 11 facilitators relating to cervical cancer screening access were identified and grouped into 7 themes. Participants provided suggestions for promoting cervical cancer screening in their community. On the basis of the findings of the data, the researchers conceptualized and mapped culturally and geographically appropriate interventions to promote cervical cancer screening within the community of interest.
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