Abstract
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. 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. 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. 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.
Highlights
Cancer survivors are estimated to number 25 million, a population that continues to increase as survival rates for many cancers continue to improve [1,2]
Despite the estimated 20% of Canadian cancer survivors residing in rural areas 3, most cancer survivorship research has focused on people and programs in urban areas 4
The remoteness of the fn communities might explain some of the differences, but we anticipate that a lack of cultural awareness on the part of health care practitioners might explain some of the unique unmet needs described by the fn survivors
Summary
Cancer survivors are estimated to number 25 million, a population that continues to increase as survival rates for many cancers continue to improve [1,2]. Despite the estimated 20% of Canadian cancer survivors residing in rural areas 3, most cancer survivorship research has focused on people and programs in urban areas 4. A large body of literature demonstrates that individuals living in rural areas have unique challenges in accessing health care, and it is anticipated that cancer survivors living in rural locations face unique challenges [5,6,7]. The primary objective of our prospective community-based research is to identify the unmet needs of rural survivors (rss) in northern British Columbia, including psychosocial health needs as advocated by reports from the U.S Institute of Medicine [8,9]. At more than 600,000 km, northern British Columbia is roughly the size of France— more sparsely populated, with approximately 300,000 residents. 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
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