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Understanding the health system drivers of delayed cancer diagnosis in public healthcare networks of Chile, Colombia and Ecuador

2025-01Artigo científico Acesso aberto
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dc.contributor.authorVargas, Ingrid
dc.contributor.authorMogollón-Pérez, Amparo Susana
dc.contributor.authorEguiguren, Pamela
dc.contributor.authorTorres, Ana Lucía
dc.contributor.authorPeralta, Andrés
dc.contributor.authorRubio-Valera, Maria
dc.contributor.authorJervelund, Signe Smith
dc.contributor.authorBorras, Josep M.
dc.contributor.authorDias, Sónia
dc.contributor.authorVázquez, María Luisa
dc.contributor.authorVazquez, M. L.
dc.contributor.authorOliver, Aida
dc.contributor.authorEspinel, Verónica
dc.contributor.authorFernández, Zahara
dc.contributor.authorAznar-Lou, Ignacio
dc.contributor.authorArroyo-Uriarte, Paula
dc.contributor.authorGil-Girbau, Montserrat
dc.contributor.authorSerrano-Blanco, Antoni
dc.contributor.authorGarmendia, María Luisa
dc.contributor.authorOyarce, Ana María
dc.contributor.authorBass, Camilo
dc.contributor.authorGuzmán, Isabel
dc.contributor.authorAlvarez, Andrea
dc.contributor.authorGonzález, Paola
dc.contributor.authorAbarca, Isabel
dc.contributor.authorStock, Rodney
dc.contributor.authorCerda, Berta
dc.contributor.authorHartwig, Guillermo
dc.contributor.authorTabilo, Cristopher
dc.contributor.authorAravena, Carmen
dc.contributor.authorStephens, Gloria
dc.contributor.authorGarcia, Virginia
dc.contributor.authorRestrepo, Ana Maria
dc.contributor.authorPinzón, Angela
dc.contributor.authorCardozo, Carol
dc.contributor.authorRangel, María Camila
dc.contributor.authorCristancho, Pablo
dc.contributor.authorArellano, Ana María
dc.contributor.authorCala, Lilian Gabriela
dc.contributor.authorMerchán, Juan Gabriel
dc.contributor.authorVelandia, Omar
dc.contributor.authorTorres, Rafael
dc.contributor.authorO'Byrne, Mauricio
dc.contributor.authorLancheros, Liliana
dc.contributor.authorDuarte, Oscar
dc.contributor.authorPereira, Hugo
dc.contributor.authorPerelman, Julian
dc.contributor.authorGama, Ana
dc.contributor.authorMarques, Patricia
dc.contributor.authorFronteira, Inês
dc.contributor.authorFor EquityCancer-LA
dc.contributor.institutionEscola Nacional de Saúde Pública (ENSP)
dc.contributor.institutionLaboratório Associado de Translacção e Inovação para a Saúde Global - LA Real (Pólo ENSP)
dc.contributor.institutionComprehensive Health Research Centre (CHRC) - Pólo ENSP
dc.contributor.institutionCentro de Investigação em Saúde Pública (CISP/PHRC)
dc.contributor.pblElsevier
dc.date.accessioned2025-07-10T21:16:42Z
dc.date.available2025-07-10T21:16:42Z
dc.date.issued2025-01
dc.descriptionFunding Information: This study has received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 965226 on the call topic SC1-BHC-17-2020, Global Alliance for Chronic Diseases - Prevention and/or early diagnosis of cancer. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Funding Information: This study has received funding from the European Union\u2019s Horizon 2020 research and innovation programme under grant agreement No 965226 on the call topic SC1-BHC-17-2020, Global Alliance for Chronic Diseases - Prevention and/or early diagnosis of cancer. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: © 2024 The Authors
dc.description.abstractAlthough the greatest delays in cancer diagnosis in Latin America occur in the provider interval little is known about the related factors. This study aims to analyze factors influencing access to cancer diagnosis -from initial contact with health services to confirmation- from institutional stakeholders' perspective in public healthcare networks of Chile, Colombia, and Ecuador. A qualitative, descriptive-interpretative study was conducted in two networks per country, using semi-structured individual interviews (n = 118; 23 to 58, per country) with a criterion sample of health professionals and administrative personnel from primary care (PC) (n = 41) and secondary/tertiary care hospitals (n = 47), network managers and policymakers (n = 30). The final sample size was reached through saturation. Thematic content analysis was performed, segmented by country. The analysis reveals interacting factors that cause cumulative delays throughout the patient's diagnostic pathway within healthcare networks, with differences between countries. In all three, informants identify similar characteristics of the networks: structural (deficits in diagnostic resources; geographical accessibility), organizational factors (long waiting times, especially after referral), and the limited knowledge and experience of PC doctors, which all lead to delayed diagnosis. In Chile and Colombia, health policy barriers related to care rationing/prioritization policies that hampered access to tests, and in Chile, increased delays for non-prioritized conditions. Country-specific barriers related to the organization of healthcare system also emerge: in Chile, private services subcontracting and the voucher system for using them; in Colombia, the management of care by insurers (care authorizations; fragmented and short-term contracting of providers); and in Ecuador, underfunding of the system. The barriers most affect the elderly, those with low socioeconomic status, with limited support networks, and rural areas residents. The results reveal relevant barriers in access to timely cancer diagnosis which can and should be addressed with specific cancer diagnosis policies and general measures that strengthen public healthcare systems and networks.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent4822875
dc.identifier.doi10.1016/j.socscimed.2024.117499
dc.identifier.issn0277-9536
dc.identifier.otherPURE: 121542255
dc.identifier.otherPURE UUID: ef6fe2b1-6b0d-47a1-be1d-e1c276ca4162
dc.identifier.otherScopus: 85210774295
dc.identifier.otherPubMed: 39626381
dc.identifier.otherWOS: 001390332900001
dc.identifier.otherORCID: /0000-0001-5085-0685/work/187716425
dc.identifier.otherORCID: /0000-0003-1406-4585/work/187717047
dc.identifier.urihttp://hdl.handle.net/10362/185054
dc.identifier.urlhttps://www.scopus.com/pages/publications/85210774295
dc.language.isoeng
dc.peerreviewedyes
dc.subjectAccess to healthcare
dc.subjectEarly diagnosis of cancer
dc.subjectHealth inequities
dc.subjectHealth services research
dc.subjectLatin America
dc.subjectQualitative research
dc.subjectHealth(social science)
dc.subjectHistory and Philosophy of Science
dc.subjectSDG 3 - Good Health and Well-being
dc.titleUnderstanding the health system drivers of delayed cancer diagnosis in public healthcare networks of Chile, Colombia and Ecuadoren
dc.title.subtitlea qualitative study with health professionals, managers and policymakersen
dc.typejournal article
degois.publication.titleSocial Science and Medicine
degois.publication.volume365
dspace.entity.typePublication
rcaap.rightsopenAccess

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