Provider Perspectives on Factors Influencing Breast and Cervical Cancer Treatment among Georgia's Women's Health Medicaid Enrollees Open Access

Abstract

Background: Breast and cervical cancer are the second and fourteenth leading causes of cancer death among women in the United States, respectively. Despite nationwide implementation of a Medicaid expansion program for breast and cervical cancer treatment, differences in treatment among low-income and ethnic minority women persist that cannot be explained by clinical differences alone.

Objective: The objective of this study was to understand, from the perspective of providers serving low-income, uninsured and underinsured women, what factors influence treatment patterns among these populations. Comparisons across clinical and allied health care providers were also of interest.

Methods: The data consisted of 18 interviews with providers actively serving patients with breast and/or cervical cancer who were enrolled in the Georgia Women's Health Medicaid Program. The transcripts were coded using MAXqda 11 software, and descriptive and comparative analyses were performed for the factors that providers noted influenced patients' treatment decisions and behaviors.

Results: Three primary factors emerged as influencing patients' cancer treatment behaviors: 1) Patients' socioeconomic conditions, 2) Patients' knowledge, attitudes and beliefs, and 3) The availability of institutional-level support and resources. There were greater variations among clinical and allied health providers' perspectives relative to the first factor, with both groups conveying similar responses relative to the second and third factor.

Discussion: The study's findings point to the need to address economic barriers to treatment faced by low-income patients. The findings also call for a more holistic approach to cancer care that offers mental health and psychosocial support and linkages to resources across the cancer care continuum.

Table of Contents

I. INTRODUCTION .....................................................................1

A. Background and Problem Statement.........................................1

B. Study Objective.......................................................................2

C. Study Aims .............................................................................3

D. Study Significance ..................................................................3

II. LITERATURE REVIEW ............................................................4

A. Breast and Cervical Cancer Facts and Statistics ........................4

B. Available Free Screening and Treatment Services ......................6

C. Treatment Disparities and Barriers ..........................................8

III. METHODOLOGY ................................................................13

A. Introduction.........................................................................13

B. Population and Sample .........................................................14

C. Research Design ...................................................................15

D. Procedures & Instruments ....................................................15

E. Data Preparation and Analysis ...............................................17

F. Ethical Considerations...........................................................18

IV. RESULTS .............................................................................19

A. Introduction.........................................................................19

B. Findings ..............................................................................19

Influence of patients' socioeconomic conditions .........................19

Influences of patients' knowledge, attitudes and beliefs...............24

Influence of institutional resources and support..........................29

V. DISCUSSION ........................................................................34

A. Recommendations ...............................................................34

B. Study Limitations .................................................................40

VI. APPENDICES.......................................................................41

A. Appendix A: Informed Consent Form (Standard)......................42

B. Appendix B: Informed Consent Form (Grady Health System)...........44

C. Appendix C: Allied Health Interview Guide..............................46

D. Appendix D: Physician Interview Guide...................................49

VII. REFERENCES ......................................................................52

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Qualitative Research Medicaid Breast Cancer Cervical Cancer Women's Health
Committee Chair / Thesis Advisor	Andes, Karen, Emory University

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