Barreras y facilitadores del diagnóstico temprano del cáncer desde la perspectiva de los pacientes en redes públicas de servicios de salud de Cundinamarca : El cáncer no da tiempo
Thesis
Background: Cancer is one of the leading causes of mortality worldwide. Despite advances in early detection, in low- and middle-income countries, barriers persist that lead to diagnostic confirmation in advanced stages. In Colombia, one of the geographical areas with the highest cancer mortality rates is the department of Cundinamarca. Objective: Characterize the barriers and facilitators of access to early cancer diagnosis, from the perspective of patients and their caregivers in public health service networks in the department of Cundinamarca, Colombia. Methods: Qualitative, descriptive-interpretative study, based on a phenomenological approach. 17 semi-structured interviews were conducted with patients over 18 years of age, with a confirmed cancer diagnosis in the last year, treated in institutions that provide public health services in the Sabana Centro, Sur and Soacha de Cundinamarca Health Regions. A thematic analysis of the content of the interviews was carried out. Results: In the identification of symptoms and the search for care, barriers related to the socioeconomic and cultural characteristics of the patients stand out, which influence the late search for care. In access to low complexity, barriers related to professionals predominate, such as dismissal of symptoms and late referral to specialists, while, from the characteristics of the Health System, the delimitation of benefits by levels of complexity stands out, which limit the resolution capacity of the general practitioner. The geographical barriers associated with the area of residence of the patients is another limitation of access to low complexity. In accessing medium and high complexity, the barriers imposed by insurers stand out, mainly the existence of procedures and delays in the authorization of diagnostic tests and appointments with specialists, short duration of contracts with providers, as well as the purchase fragmented and outside the territory of residence of the patient. Regarding the providers, the deficit of specialists and the delays in assigning appointments stand out. These difficulties are magnified in patients who live in rural areas, who have economic difficulties and are in charge of the care of third parties, mostly women. Finally, once the patient is referred to oncology providers, it stands out as facilitators, at the organizational level, in one of the cases, the existence of a professional who acts as a liaison in communication with insurers and other providers, which that favored the reduction of paperwork and the assignment of appointments for the start of treatment and from the health professionals, the interest in the health conditions of the patient. Conclusions: The results of the study reflect the existence of multiple barriers from the search for care to the diagnostic confirmation of cancer. While in low complexity the inherent failures of professionals and the health system stand out, it is in access to medium and high complexity services where the greatest problems are concentrated, which are associated with the barriers imposed by insurers, the organizational characteristics of the services and the socioeconomic conditions of the population, which as a whole lead to late diagnoses of cancer.
