Equitable access to cancer services - A review of barriers to quality care

BACKGROUND. Barriers to cancer care have been documented in nearly all sett ings and populations; such barriers represent potentially avoidable morbidi ty or mortality. A conceptual framework was used to describe patient, provi der, and system barriers to cancer services. METHODS. A review of the English language literature on cancer care from 19 80-1998 was conducted; key research was summarized for each domain in the c onceptual model. RESULTS. Key patient barriers are related to old age, minority race, and lo w socioeconomic class; the common pathways by which these sociodemographic factors appear to mediate cancer outcomes include social class and race-rel ated or class-related attitudes. Providers are often ill-prepared to commun icate the complexities of cancer care to their diverse patient populations; constraints of the medical care system also can impede the delivery of car e. To the authors' knowledge the impact of the rapid growth in managed care organizations (MCOs) on access to care has yet to be evaluated fully. Alth ough MCOs historically have provided high levels of cancer screening in hea lthy populations, to the authors knowledge there are fewer data regarding o utcomes for elderly and poor populations and for treatment services. CONCLUSIONS. Additional research is needed to develop and test intervention s to overcome barriers to care and evaluate the impact of the growth Of man aged care on access to cancer care for diverse populations. (C) 1999 Americ an Cancer Society.