Healthcare Interactions of Low Income Latinas with Advanced Cancers

Background and Purpose: Cancer is one of the leading causes of death for Latinos in the United States. Multiple socioeconomic and socio-cultural factors create barriers to high-quality healthcare for Latinos. Delays in time from diagnosis to treatment as well as disparities in receipt of accurate diagnostic testing lead to late-stage diagnosis, reduced length of survival, and higher rates of deaths (Rivers & Patino, 2006). However, there is little understanding of how socio-cultural factors influence Latina's experiences with advanced stage cancers. Kleinman's Cultural Explanatory Model (EM) describes how individuals make meaning from their healthcare experiences and develop unique ways of understanding and managing their care (Kleinman, Eisenberg, & Good, 1978).

This study aimed to explore explanatory models (EM) of low-income, Spanish-speaking, Latinas with advanced, metastatic cancers to identify socio-cultural beliefs and behaviors associated with healthcare interactions.

Design and Methods: Using semi-structured interview questions adapted from Kleinman, women were asked to discuss their illness experiences to elicit cultural EMs regarding the cause, course, and cure of their advanced cancer. Questions also explored how women managed to cope with emotional distress and psychosocial and physical changes associated with illness, while seeking a cure from their providers. A purposive sample (n=24) was selected from participants enrolled in a randomized clinical trial to improve quality-of-life outcomes for co-occurring cancer and depression. The sample included Latinas with advanced gynecological and breast cancers (stage III & IV). All women, average age 52, spoke Spanish as their primary language. The majority of women had less than a sixth grade education and were mainly Catholic. Data were analyzed using a constant comparison method rooted in grounded theory and content analysis.

Results: The major themes that emerged were: 1) diagnosis and treatment delays at symptom onset, 2) interpersonal and intrapersonal effects of cancer treatment, 3) coping mechanisms with strong religious beliefs and a fighting spirit, and 4) mixed levels of comprehension regarding medical information.

Socio-cultural beliefs and behaviors influence Latinas' interactions with the healthcare system when seeking care for an advanced cancer condition. Mostly, Latina women were dissatisfied with their healthcare interactions because of language barriers, provider relational styles (rushed, too direct, uncaring), and/or systemic factors (too many different doctors, long wait times, limited provider time) which led to information gaps and misunderstanding about the severity of their illness.

Conclusions and Implications: Despite negative experiences with the medical system, most participants sought medical attention at symptom onset and continued to maintain the course of treatment throughout their illness experience. This study provides insight into socio-cultural explanatory models shaped by Latinas' illness experiences and provides support for social work interventions, culturally competent, and patient-centered care.