Stigma and Social Determinants of Health Associated With Fidelity to Guideline-Concordant Therapy in Patients With Breast Cancer Living With and Without HIV in Botswana.
HIV
breast cancer
health care disparities
treatment fidelity
Journal
The oncologist
ISSN: 1549-490X
Titre abrégé: Oncologist
Pays: England
ID NLM: 9607837
Informations de publication
Date de publication:
11 Dec 2023
11 Dec 2023
Historique:
received:
07
11
2022
accepted:
01
06
2023
pubmed:
5
7
2023
medline:
5
7
2023
entrez:
5
7
2023
Statut:
ppublish
Résumé
Patients with breast cancer in sub-Saharan Africa (SSA) experience a disproportionate burden of mortality. Fidelity to treatment guidelines, defined as receiving optimal dose and frequency of prescribed treatments, improves survival. We sought to identify patient factors associated with treatment fidelity and how this may differ for people with HIV (PWH) and breast cancer. We conducted a qualitative study of women who initiated outpatient treatment for stages I-III breast cancer in Botswana, with deviance sampling of high- and low-fidelity patients. One-on-one interviews were conducted using semi-structured guides informed by the Theory of Planned Behavior. The sample size was determined by thematic saturation. Transcribed interviews were double coded with an integrated analytic approach. We enrolled 15 high- and 15 low-fidelity participants from August 25, 2020 to December 15, 2020, including 10 PWH (4 high, 6 low fidelity). Ninety-three percent had stage III disease. Barriers to treatment fidelity included stigma, social determinants of health (SDOH), and health system barriers. Acceptance and de-stigmatization, peer and other social support, increased knowledge and self-efficacy were identified as facilitators. The COVID-19 pandemic amplified existing socioeconomic stressors. Unique barriers and facilitators identified by PWH included intersectional stigma, and HIV and cancer care integration, respectively. We identified multilevel modifiable patient and health system factors associated with fidelity. The facilitators provide opportunities for leveraging existing strengths within the Botswana context to design implementation strategies to increase treatment fidelity to guideline-concordant breast cancer therapy. However, PWH experienced unique barriers, suggesting that interventions to address fidelity may need to be tailored to specific comorbidities.
Sections du résumé
BACKGROUND
BACKGROUND
Patients with breast cancer in sub-Saharan Africa (SSA) experience a disproportionate burden of mortality. Fidelity to treatment guidelines, defined as receiving optimal dose and frequency of prescribed treatments, improves survival. We sought to identify patient factors associated with treatment fidelity and how this may differ for people with HIV (PWH) and breast cancer.
METHODS
METHODS
We conducted a qualitative study of women who initiated outpatient treatment for stages I-III breast cancer in Botswana, with deviance sampling of high- and low-fidelity patients. One-on-one interviews were conducted using semi-structured guides informed by the Theory of Planned Behavior. The sample size was determined by thematic saturation. Transcribed interviews were double coded with an integrated analytic approach.
RESULTS
RESULTS
We enrolled 15 high- and 15 low-fidelity participants from August 25, 2020 to December 15, 2020, including 10 PWH (4 high, 6 low fidelity). Ninety-three percent had stage III disease. Barriers to treatment fidelity included stigma, social determinants of health (SDOH), and health system barriers. Acceptance and de-stigmatization, peer and other social support, increased knowledge and self-efficacy were identified as facilitators. The COVID-19 pandemic amplified existing socioeconomic stressors. Unique barriers and facilitators identified by PWH included intersectional stigma, and HIV and cancer care integration, respectively.
CONCLUSION
CONCLUSIONS
We identified multilevel modifiable patient and health system factors associated with fidelity. The facilitators provide opportunities for leveraging existing strengths within the Botswana context to design implementation strategies to increase treatment fidelity to guideline-concordant breast cancer therapy. However, PWH experienced unique barriers, suggesting that interventions to address fidelity may need to be tailored to specific comorbidities.
Identifiants
pubmed: 37405697
pii: 7219660
doi: 10.1093/oncolo/oyad183
pmc: PMC10712728
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e1230-e1238Subventions
Organisme : NIH HHS
Pays : United States
Organisme : NIH HHS
Pays : United States
Informations de copyright
© The Author(s) 2023. Published by Oxford University Press.
Références
J Cancer Educ. 2016 Jun;31(2):413-8
pubmed: 25982550
BMC Public Health. 2021 Apr 20;21(1):758
pubmed: 33879107
World J Surg Oncol. 2018 Mar 22;16(1):63
pubmed: 29566711
J Glob Oncol. 2018 Sep;4:1-11
pubmed: 30241207
J Glob Oncol. 2018 Sep;4:1-7
pubmed: 30241141
Epidemiol Health. 2017 Feb 5;39:e2017006
pubmed: 28171715
J Int AIDS Soc. 2022 Jul;25 Suppl 1:e25918
pubmed: 35818882
J Natl Compr Canc Netw. 2019 Aug 1;17(8):957-967
pubmed: 31390594
Health Serv Res. 2007 Aug;42(4):1758-72
pubmed: 17286625
Oncologist. 2021 Dec;26(12):e2200-e2208
pubmed: 34390287
Int J Cancer. 2018 Dec 1;143(11):2732-2740
pubmed: 29992553
Lancet Glob Health. 2018 Aug;6(8):e885-e893
pubmed: 30012269
Pediatrics. 2008 Aug;122(2):e395-401
pubmed: 18676526
Breast Cancer Res Treat. 2017 Feb;162(1):105-114
pubmed: 28025716
Health Educ Behav. 2015 Oct;42(5):621-6
pubmed: 25712240
Psychooncology. 2016 Oct;25(10):1206-1211
pubmed: 27421234
Cancer Epidemiol Biomarkers Prev. 2015 Oct;24(10):1495-506
pubmed: 26359465
JCO Glob Oncol. 2022 May;8:e2200016
pubmed: 35584347
Breast Cancer Res Treat. 2018 May;169(1):175-187
pubmed: 29368311
CA Cancer J Clin. 2019 Jan;69(1):7-34
pubmed: 30620402
Implement Sci. 2007 Nov 30;2:40
pubmed: 18053122
BMC Public Health. 2014 Sep 06;14:922
pubmed: 25194567
J Glob Oncol. 2018 Sep;4:1-8
pubmed: 30241225
BMC Med. 2019 Feb 15;17(1):17
pubmed: 30764819
J Natl Compr Canc Netw. 2016 Aug;14(8):961-9
pubmed: 27496112
Prev Med Rep. 2015 Apr 14;2:270-82
pubmed: 26844083
J Glob Oncol. 2018 Dec;4:1-9
pubmed: 30532993
Gynecol Oncol Rep. 2020 Jun 22;33:100605
pubmed: 32637528
BMC Med. 2019 Feb 15;17(1):31
pubmed: 30764826
Breast J. 2010 Mar-Apr;16(2):206-7
pubmed: 20136646
Ethiop J Health Sci. 2017 May;27(3):255-262
pubmed: 29217924
Am J Public Health. 2021 Jul;111(7):1309-1317
pubmed: 34110916
Int J Behav Nutr Phys Act. 2022 Jul 30;19(1):97
pubmed: 35907867
Adm Policy Ment Health. 2015 Sep;42(5):533-44
pubmed: 24193818
Oncologist. 2018 Dec;23(12):1446-1452
pubmed: 29959283
Lancet Oncol. 2022 Jun;23(6):729-738
pubmed: 35550274
Sci Rep. 2020 Aug 6;10(1):13241
pubmed: 32764734
PLoS Med. 2014 Sep 09;11(9):e1001720
pubmed: 25202974
AIDS Res Ther. 2022 Jun 23;19(1):26
pubmed: 35739534
Psychol Health. 2011 Sep;26(9):1113-27
pubmed: 21929476
Breast Cancer Res. 2019 Aug 13;21(1):93
pubmed: 31409419
Health Educ Behav. 2006 Apr;33(2):233-51
pubmed: 16531515