Reconceptualising Rural Cancer Inequalities: Time for a New Research Agenda.

Christina Dobson,Linda Sharp,Greg Rubin,Sara Macdonald,Peter Murchie

doi:10.3390/ijerph17041455

Abstract

Evidence has shown for over 20 years that patients residing in rural areas face poorer outcomes for cancer. The inequalities in survival that rural cancer patients face are observed throughout the developed world, yet this issue remains under-examined and unexplained. There is evidence to suggest that rural patients are more likely to be diagnosed as a result of an emergency presentation and that rural patients may take longer to seek help for symptoms. However, research to date has been predominantly epidemiological, providing us with an understanding of what is occurring in these populations, yet failing to explain why. In this paper we outline the problems inherent in current research approaches to rural cancer inequalities, namely how ‘cancer symptoms’ are conceived of and examined, and the propensity towards a reductionist approach to rural environments and populations, which fails to account for their heterogeneity. We advocate for a revised rural cancer inequalities research agenda, built upon in-depth, community-based examinations of rural patients’ experiences across the cancer pathway, which takes into account both the micro and macro factors which exert influence on these experiences, in order to develop meaningful interventions to improve cancer outcomes for rural populations.

Highlights

Rural environments are often conceived of as places that both create and sustain healthy bodies, and in which healthy bodies can belong and flourish [1,2]
Perhaps rural General Practitioner (GP) have inherently ‘different’ relationships with their patients compared to GPs in urban areas, which may affect management in primary care and onwards referral [23]. Another possibility is that factors which occur post-diagnosis may be contributing to the poorer survival in rural populations
We argue for the need to develop and implement novel ways of examining rural cancer inequalities, by working with rural communities to understand how embodied experience, help-seeking, diagnostic experiences and experiences later in the cancer pathway are created and shaped by the rural environments in which they occur

Summary

Introduction

Rural environments are often conceived of as places that both create and sustain healthy bodies, and in which healthy bodies can belong and flourish [1,2]. Perhaps rural GPs have inherently ‘different’ relationships with their patients compared to GPs in urban areas, which may affect management in primary care and onwards referral [23] Another possibility is that factors which occur post-diagnosis may be contributing to the poorer survival in rural populations. We argue for the need to develop and implement novel ways of examining rural cancer inequalities, by working with rural communities to understand how embodied experience, help-seeking, diagnostic experiences and experiences later in the cancer pathway are created and shaped by the rural environments in which they occur This requires the research community to move beyond the quantitative studies, often of routinely-collected health service data, that have dominated this research field to develop detailed, in depth knowledge of the lived experiences of rural cancer patients and the contexts within which these take place.

Symptomatic Experience

Rural Locations

A New Research Agenda