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The Diagnosis and Treatment Decisions of Cancer Patients in Rural Western Australia

McConigley, Ruth PhD, RN; Holloway, Kristi BSc (Hons), RN; Smith, Jodi Grad Dip Gerontology, OT; Halkett, Georgia PhD, FIR; Keyser, Jo PGrad Dip Hlth Ed, RN, SBN; Aoun, Samar PhD; Monterosso, Leanne PhD, RN, RM, NNT, FRCNA

doi: 10.1097/NCC.0b013e3181f795e7
Articles: Online Only

Background: People living in rural areas who have a diagnosis of cancer have poorer outcomes than people living in urban centers. The reasons for this are unclear. Little is known about the impact that living in a rural area has on the diagnosis and treatment decisions of these people and how these may in turn impact on care outcomes.

Objectives: This study explored the reasons why people living in rural areas may delay diagnosis and what issues affected the decisions they made regarding their cancer treatment.

Methods: In depth, semistructured interviews were conducted with 18 participants from 3 rural Western Australian health regions. Content analysis was used to develop themes.

Results: Four themes were identified to describe the rural cancer experience. The first 3 themes, Experiences of Diagnosis and Referral, The Treatment Journey, and Managing your own Care, relate to the experiences of rural cancer patients during their journey through the health care system. The final overarching theme, Implicit Faith, described the level of confidence that rural cancer patients had in the health system, often despite delays and inconveniences.

Conclusions: There is a need to improve primary health care and care coordination for rural cancer patients living in Australia and to promote self-advocacy and consumer empowerment for rural cancer patients.

Implications for Practice: Rural patients need help and support throughout their cancer journey, including through the process of diagnosis.

Background: People living in rural areas who have a diagnosis of cancer have poorer outcomes than people living in urban centers. The reasons for this are unclear. Little is known about the impact that living in a rural area has on the diagnosis and treatment decisions of these people and how these may in turn impact on care outcomes. Objectives: This study explored the reasons why people living in rural areas may delay diagnosis and what issues affected the decisions they made regarding their cancer treatment. Methods: In depth, semistructured interviews were conducted with 18 participants from 3 rural Western Australian health regions. Content analysis was used to develop themes. Results: Four themes were identified to describe the rural cancer experience. The first 3 themes, Experiences of Diagnosis and Referral, The Treatment Journey, and Managing your own Care, relate to the experiences of rural cancer patients during their journey through the health care system. The final overarching theme, Implicit Faith, described the level of confidence that rural cancer patients had in the health system, often despite delays and inconveniences. Conclusions: There is a need to improve primary health care and care coordination for rural cancer patients living in Australia and to promote self-advocacy and consumer empowerment for rural cancer patients. Implications for Practice: Rural patients need help and support throughout their cancer journey, including through the process of diagnosis.

Author Affiliations: Western Australian Centre for Cancer and Palliative Care, Curtin Health Innovation Research Institute, Curtin University, Perth (Dr McConigley, Mss Holloway and Smith; and Drs Halkett, Aoun, and Monterosso); and Western Australian Country Health Service, Midwest and Murchison Region (Ms Keyser), Western Australia.

This project was funded by the WA Cancer and Palliative Care Network Small Grants 2009.

Correspondence: Ruth McConigley, PhD, RN, Western Australian Centre for Cancer and Palliative Care, Health Research Campus, Curtin University, GPO Box U1987, Perth, Western Australia 6845 (R.McConigley@curtin.edu.au).

Accepted for publication August 12, 2010.

© 2011 Lippincott Williams & Wilkins, Inc.