Prospective Evaluation of Unmet Needs of Rural and Aboriginal Cancer Survivors in Northern British Columbia

Abstract

Background: The unmet needs of cancer survivors in rural, remote, and aboriginal communities are largely unexplored. We explored potential differences between rural survivors (rss) in 4 general population (gp) and 4 First Nations (fn) communities. Methods: We approached 4 gp and 4 fn rs communities to participate in a mixed-methods project. Participants completed the Hospital Anxiety and Depression Scale (hads) and the Survivor Unmet Needs Survey (suns) and provided demographic information. Each question on the suns can be scored from 0 to 4, with 0 representing “no unmet need” and 4 representing “very high unmet need.” A directed approach to content analysis of focus group and interview data was used to triangulate the hads and suns results. Results: We prospectively accrued 23 fn rss and 56 gp rss for this study. More fn rss had borderline or abnormal anxiety (5% vs. 21%, p = 0.02). Compared with gp rss, fn rss had higher unmet needs scores in all categories: Information (2.29 vs. 0.8, p < 0.001), Work and Financial (1.66 vs. 0.5, p < 0.001), Access and Continuity of Health Care (1.83 vs. 0.44, p < 0.001), Coping and Sharing (2.22 vs. 0.62, p < 0.001), and Emotional (2.12 vs. 0.63, p < 0.001). The qualitative findings provided examples and insight into the unmet needs experienced by rss. Conclusions: First Nations rss had significantly higher anxiety and unmet needs compared with their gp rs counterparts. In addition, different qualitative themes were identified in the groups. Our findings support the development of tailored approaches to survivorship for these populations.

Unmet needs in Iranian cancer patients

“…For example, So et al (2014) have demonstrated health and information had the highest frequency among unmet needs domain and the second one belonged to work and financial concerns( 17 ). Olson et al (2014) had the same findings, and in a context of rural and urban samples, the most common unmet needs had been information ( 18 ). In another study Edib et al (2016) illustrated psychological domain is the most mentioned needs, followed by physical, patient care needs, health information and the lowest was sexuality domain ( 19 ).…”

Supportive Care Needs in Females With Breast Cancer Under Chemotherapy and Radiotherapy and its Predictors

“…Similarly, in the review study on cancer sufferers (i.e., breast, lung, prostate, colorectal, and cervix) in Nigeria, Okediji et al found the highest needs in the information-health system, as well as psychological and physical-everyday life domains (20). Furthermore, Olson et al, as well as Park et al referred to the patients' need for information about their disease as the most unmet need in both urban and rural patients (21,12). Moreover, Moradi et al highlighted the information needs as the most significant need of females with breast cancer in Tabriz, Iran (22) while Uchida et al reported information-health and psychological needs as the most important needs of women with breast cancer (11).…”

Cycles of silence: First Nations women overcoming social and historical barriers in supportive cancer care

“…Participants' stories about residential schools and differential treatment within clinics suggest that there are colonial foundations to their silence and fatalism that are still in operation. For example, the remoteness of many communities in Canada, which severely limits access to health care, education, and many other forms of social support, stems directly from Canadian policies of land dispossession and displacement. Furthermore, Indigenous health continues to be impacted by ongoing neglect of federal responsibilities signed in treaties and land agreements, such as ensuring equitable access to healthcare, education, and housing…”

“…For instance, during treatment, First Nations and Métis patients face significantly higher distress scores for pain, depression, anxiety, and shortness of breath than Caucasian patients . Rural First Nations cancer survivors show significantly higher levels of anxiety and higher unmet needs in all categories of an unmet needs survey than non–First Nations rural survivors . These differences may be attributed somewhat to widespread perceptions and beliefs within First Nations communities that cancer is a death sentence .…”

“…A systematic review of American studies found that many Native Americans endure stigmatization, isolation, and poor quality of life in part because they do not have access to culturally relevant care services that recognize the importance of spirituality, local conceptualizations of disease, and family/community participation . Across the globe, common barriers to cancer treatment among Indigenous populations include cultural insensitivities; socioeconomic disadvantages; mistrust of mainstream health systems founded upon historical and ongoing marginalization; and complexities associated with healthcare systems, procedures, and services …”