QIM22-201: Experiences With Cancer Diagnosis and Treatment in Rural Nebraska: Qualitative Focus Group Analysis

Purpose: To explore rural cancer survivors’ and caregivers’ experiences with diagnosis and treatment, and to identify needed support services. Methods: This collective case study was part of a statewide cancer community health needs assessment conducted in Nebraska during 2021. We conducted three virtual 75- to 90-minute focus groups (N=20) with rural cancer survivors and caregivers, recruited from four central and western Nebraska cancer centers. Participants received $40 gift cards as compensation. Verbatim transcripts were inductively coded and analyzed using a directed content analysis approach. Results: The majority of participants were female (80%) and survivors (80%). Cancer types represented were breast, lung, bladder, multiple myeloma, lymphoma, and prostate. Cancer diagnosis followed three general patterns: 1) Preventive care and screening; 2) Treatment of symptoms not initially identified as being cancer-related; and 3) Self-identification of suspected cancer symptoms. Most participants reported timely notification of diagnostic results and referrals; negative experiences stemmed from perceived misdiagnosis with delayed cancer diagnosis, delayed notification of diagnostic results, and uncoordinated referral from primary to specialist care. One suggestion was to have mental health counseling available when notifying patients of the cancer diagnosis. Provider interpersonal skills impacted patient-provider communication and patient perceptions of care. Physician turn-over and lack of nearby alternative providers limited patients’ options. Specific barriers to care included: finances, transportation, and lack of cancer support groups. The intersectionality of rural and racial/ethnic minority status was identified as an unmet community need (language and cultural barriers), extending beyond cancer services to include general health education and greater accessibility to affordable primary care. Cancer centers and community organizations provide some supportive services (navigators, social work, financial assistance, gas cards, housekeeping assistance), but not all patients were aware of the services and not all qualified (e.g., lived outside service area). Conclusions: Study results will be used by the statewide cancer coalition and the National Cancer Institute-designated cancer center to prioritize outreach and interventions aimed to reduce rural cancer care disparities.