Cancer Screening Experiences of Black Breast and Ovarian Cancer Patients and Family Members.

Black women experience disproportionate rates of advanced breast cancer diagnoses and mortality. Mammography is a proven and effective tool in early breast cancer detection and impacts patient outcomes. We interviewed Black women with a personal or family history of breast and/or ovarian cancer to understand their screening experiences and views. N = 61 individuals completed an interview. Interview transcripts were qualitatively analyzed for themes regarding clinical experiences, guideline adherence, and family sharing specific to Black women and their families. Most participants were college educated with active health insurance. Women in this cohort were knowledgeable about the benefits of mammography and described few barriers to adhering to annual mammogram guidelines. Some with first-degree family history were frustrated at insurance barriers to mammography before the age of 40. Participants were generally comfortable encouraging family and friends to receive mammograms and expressed a desire for a similar screening tool for ovarian cancer. However, they expressed concern that factors such as screening awareness and education, lack of insurance coverage, and other systematic barriers might prevent other Black women from receiving regular screening. Black women in this cohort reported high adherence to mammography guidelines, but expressed concern about cultural and financial barriers that may impact cancer screening access in the population more generally and contribute to disparities. Participants noted the importance of frank and open discussions of breast cancer screening in their families and community as a means of improving awareness.

"There's not enough studies": Views of black breast and ovarian cancer patients on research participation.

BACKGROUND: Black breast and ovarian cancer patients are underrepresented in clinical cancer trials disproportionate to the prevalence of these cancers in Black females. Historically, lower enrollment has been attributed to individualized factors, including medical mistrust, but more recently structural factors, including systemic racism, have received additional scrutiny. We interviewed Black women with a personal or family history of breast and ovarian cancer to understand their views and experiences related to research participation. METHODS: Qualitative interviews were conducted via telephone or video conference and transcribed verbatim. Transcripts were qualitatively analyzed for iterative themes related to the offer and participation in cancer clinical trials and research studies, impact on cancer care, and recommendations to increase enrollment of Black patients. RESULTS: Sixty-one Black women completed an interview. Participants expressed that Black women are underrepresented in cancer research, and that this negatively impacted their own care. Many cited past historical abuses, including the Tuskegee syphilis trial, as a potential factor for lower enrollment but suggested that lower enrollment was better understood in the context of the entirety of their healthcare experiences, including present-day examples of patient mistreatment or dismissal. Participants suggested that proactive community engagement, transparency, and increased representation of Black research team members were strategies likely to foster trust and bolster research participation. CONCLUSION(S): Medical mistrust is only a partial factor in the lower participation of Black patients in cancer research. Researchers should implement the strategies identified by our participants to promote diverse enrollment and ensure that Black patients are included in future therapeutic advances.

Medical professional dominance and client dissatisfaction - a study of doctor-patient interaction and reported dissatisfaction with medical care among female patients at four hospitals in Trinidad and Tobago - abstract

The aims of the study were to evaluate the presence of medical professional dominance displayed by physicians, and to assess the levels of satisfaction with care received, as reported by a simple random sample of 320 patients on obstetrical (236) and gynaecology (84) wards at four hospitals in Trinidad and Tobago. Professional dominance was defined entirely in relation to quality of doctor-patient interaction and was assessed by participant observation techniques in 90 patient-doctor interactions. Patient satisfaction levels were measured by a survey interview technique. The type of communication was evaluated as poor, very poor or completely absent in about 95 percent of interactions. Forty-five per cent (45 percent) were fully dissatisfied, 30 percent partly satisfied and 25 percent completely satisfied with the information received from doctors (AU)

The IMF, structural adjustment and health in the Caribbean: policy change in health care in Trinidad and Tobago

In this study, an assessment of the impact of structural adjustment policies in the 1980s on the health status of people in the Caribbean is undertaken through observation of the effects of these policies on the living conditions of employment, income education, nutrition, housing and water supply. The data show distinct patterns of decline in living conditions in the Caribbean. Reference is made to the fact that while nutrition has the greatest impact on health, all other living conditions identified significantly affect the health status of the people. Other factors point to real declines in health status through increases in morbidity among specific groups in the Caribbean. In the context of declining health status, I examine the recent changes in health policy being implemented by the government of Trinidad and Tobago to effect a virtual privatization of health services. I comment on the possible outcome of these policies in relation to access to health care using evidence from the region, and suggest modifications to these policies in order to ensure that health is enhances in the Caribbean region (AU)

Fatalism and health in the Brazilian state of Sao Paulo

The literature portrays fatalism as a behavior, expressed through inaction, based on the perceived inability of the individual or group to overcome social and economic deprivation. The attitude of fatalism was found to affect the poor in some industrial countries, and to be widely characteristic of populations in developing countries. Research on fatalism among mothers of infants in Northeastern Brazil, where infant mortality rates are very high, produced conflicting results, with some researchers reporting high levels of fatalistic attitudes, and others identifying the absence of fatalistic behaviors, due to strong socio-cultural networks of support among the poor. In this paper, using multiple regression analysis, I argue that fatalism among the adult population in Sao Paulo is relatively low due to extensive social support, and further that social support acts to prevent and/or reduce fatalistic attitudes (AU)

Modernization and health in developing countries: the case of Brazil

Improved health, declines in mortality and morbidity and extension of life expectancy have all been positively associated with 'development' in industrial countries within the last century, through improved nutrition, sanitation, better housing, improved conditions of work, income, education, public health and similiar factors. In Brazil, the modernization process of the mid 1960s to 1980s resulted in a decline in these structural factors for the vast majority of the population. Decline in living conditions in turn, affect health. Estimates indicate that mortality among some age groups may have increased. Some analysis claim that the reason for the mortality among some age groups may have increased. Some analysts claim that the reason for the mortality levels in Latin America since the 1960s has been the lack of individual responsibility in the refusal of the people to adopt behaviors which protect health; thus mortality and morbidity levels are seen as products of individual inadequacies and not of structural deficiencies. In this dissertation I examine the relative effects of structural factors and individual responsibility factors on the determination of health in Brazil, and compare their influences on two aspects of health status. This analysis shows that although the adoption of health protective behaviors does enhance health, the practice of these behaviors is itself a product of structural factors associated with socioeconomic variables. I also examine the significance of the Brazilian experience for developing countries (AU)

Impact of the health delivery system on women in Trinidad and Tobago: consequences for the year 2000 and beyond

Study examines the impact of health care delivery on women with gynaecological and obstetric problems in Trinidad and Tobago. Focuses on four major institutions - Port of Spain General Hospital, San Fernando General Hospital, Mount Hope Women's Hospital and Tobago County Hospital. The objectives were to examine the perceptions of women interviewed about their conditions, doctors and nurses and to carry on-the-spot non-participant observations of patients' interaction with doctors and nurses which would be compared and assessed against patient's statements of their perceptions of health care which was given to them. (AU)