Perspectives of cancer and cancer screening among homeless adults of New York City shelter-based clinics: a qualitative approach.

Abstract

Millions of homeless Americans have lower cancer screening and higher cancer mortality rates. We explored perspectives and perceptions regarding cancer and cancer screening among homeless. Using random and criteria sampling, we conducted in-depth semi-structured interviews with 50 homeless adults from New York City's (NYC) shelters and shelter-based clinics. Mean age was 51.66 years with average 2.03 years of homelessness; 33/50 were older than 50. Only a small number of participants had their recommended cancer screening. Contrary to general assumptions and despite significant barriers, the homeless were concerned about cancer, believed their risk of cancer is higher compared to the general population, and generally considered screening a high priority during homelessness. While they acknowledged several individual- and systems-level barriers, they welcomed targeted measures to address their multi-level barriers. Suggested strategies included active counseling by providers, health education or reminders via mHealth strategies or face-to-face in shelters, addressing potential providers' prejudice and biases regarding their priorities, incentives, and patient navigators or coach to help navigating the complex cancer screening process. There are gaps in effective cancer screening despite adequate attitude and perceptions among homeless. The health system needs to shift from addressing only basic care to a more equitable approach with accessible and acceptable opportunities for preventive cancer care for the homeless.