Immigrant women cancer survivors’ perceptions of healthcare services in Canada: A phenomenological study

Abstract

Middle Eastern immigrant women (MEIW) living in Canada have significantly increased. However, this group of women is under-represented in health research, and there is a gap in knowledge about their experiences when they access healthcare services for cancer care in Canada. This qualitative approach was conducted to uncover the meaning of the lived experiences of MEIW with healthcare services in Canada during their cancer survivorship (CS). Data were collected through unstructured interviews and one written description from three MEIW. Data were analyzed using a descriptive phenomenological approach developed by Giorgi. Four themes emerged to represent the essence (or meaning) of the participants’ lived experiences. Their healthcare was accompanied with delays and unmet needs. Yet, they found it helpful when they were provided with knowledge and information. The ability to communicate in English was equal to empowerment for each of them, while they faced cultural stigmatization of mental health issues. Thus, healthcare professionals need to identify immigrant women’s unmet support needs and psychosocial responses during their cancer survivorship. Language-specific and culturally competent cancer-care intervention programs must be developed within the Canadian healthcare system.

Keywords

Lived experience / Immigrant women / Qualitative approach / Cancer / Middle Eastern / Healthcare

References

[1] Hudon T.Immigrant women ( 89-503-X ). ( Women in Canada: A gender-based statistical report, Issue. G. o. Canada. 2015. Available from: http://www.statcan.gc.ca/pub/89-503-x/2015001/article/14217-eng.pdf

[2] Ashing-Giwa KT, Padilla G, Tejero J, et al. Understanding the breast cancer experience of women: a qualitative study of African American, Asian American, Latina and Caucasian cancer survivors. Psycho-oncology. 2004; 13(6): 408-428. PMid:15188447. https://doi.org/10.1002/pon.750

[3] Beckett M. The borders that remain: Prevention of cervical cancer in refugee and immigrant women in Canada. Le journal Médical Etudiant de l’Université d’Ottawa: Public Health. 2016; 6(2): 6.https://doi.org/10.18192/uojm.v6i2.1811

[4] Booth C, Li G, Zhang-Salomons J, et al. The impact of socioeconomic status on stage of cancer at diagnosis and survival. Cancer. 2010; 116(17): 4160-4167. PMid:20681012. https://doi.org/10.1002/cncr.25427

[5] Ashing-Giwa KT, Lim JW. Examining the impact of socioeconomic status and socioecologic stress on physical and mental health quality of life among breast cancer survivors. Oncology Nursing Forum. 2009; 36(1): 79-88. PMid:19136341. https://doi.org/10.1188/09.ONF.79-88

[6] Vahabi M, Lofters A, Kumar M, et al. Breast cancer screening disparities among immigrant women by world region of origin: a populationbased study in Ontario, Canada. Cancer Medicine. 2016; 5(7): 1670-1686. PMid:27105926. https://doi.org/10.1002/cam4.700

[7] Donnelly TT, Al Khater AH, Al Kuwari MG, et al. Addressing factors associated with Arab women’s socioeconomic status may reduce breast cancer mortality: Report from a well resourced Middle Eastern country. Asian Pacific Journal of Cancer Preventioan. 2015; 16(15):6303-6309. PMid:26434834. https://doi.org/10.7314/APJCP.2015.16.15.6303

[8] Hwang JJ, Donnelly TT, Ewashen C, et al. Sociocultural influences on Arab women’s participation in breast cancer screening in Qatar. Qualitative Health Research. 2017; 27(5): 714-726. PMid:26631675.https://doi.org/10.1177/1049732315619373

[9] Lofters A, McBride ML, Li D, et al. Disparities in breast cancer diagnosis for immigrant women in Ontario and BC: results from the CanIMPACT study. BMC Cancer. 2019; 19(1): 42. PMid:30626375. https://doi.org/10.1186/s12885-018-5201-0

[10] Shuldiner J, Liu Y, Lofters A.Incidence of breast and colorectal cancer among immigrants in Ontario, Canada: a retrospective cohort study from2004-2014. BMC Cancer. 2018; 18(1): 537. PMid:29739346. https://doi.org/10.1186/s12885-018-4444-0

[11] Esses VM, Medianu S. Integration barriers and information as a solution:Report based on literature covering 2005-2011 Inclusive Welcoming Communities Initiative, Issue. 2012. Available from: canada. ca/files/2012/08/Integration-Barriers-and-Infomation-as-a-Solution.pdf

[12] Vahabi M, Lofters A. Muslim immigrant women’s views on cervical cancer screening and HPV self-sampling in Ontario, Canada. BMC Public Health. 2016; 16(1): 868. PMid:27557928. https://doi.org/10.1186/s12889-016-3564-1

[13] Weerasinghe S, Mitchell T. Connection between the meaning of health and interaction with health professionals: caring for immigrant women. Health Care for Women International. 2007; 28(4):309-328. PMid:17454180. https://doi.org/10.1080/07399330601179794

[14] Moadel AB, Morgan C, Dutcher J. Psychosocial needs assessment among an underserved, ethnically diverse cancer patient population. Cancer. 2007; 109(2 Suppl): 446-454. PMid:17123273.https://doi.org/10.1002/cncr.22357

[15] Redwood-Campbell L, Fowler N, Laryea S, et al. ‘Before you teach me, I cannot know’: Immigrant women’s barriers and enablers with regard to cervical cancer screening among different ethnolinguistic groups in Canada. Cancer Journal of Public Health. 2011; 102(3):230-234. PMid:21714325. https://doi.org/10.1007/BF03404903

[16] Shah BR, Hwee J, Anand SS, et al. Family physician ethnicity influences quality of diabetes care for Chinese but not South Asian patients. Primary Care Diabetes. 2015; 9(6): 432-438. PMid:25759306.https://doi.org/10.1016/j.pcd.2015.02.002

[17] Hulme J, Moravac C, Ahmad F, et al. “I want to save my life”: Conceptions of cervical and breast cancer screening among urban immigrant women of South Asian and Chinese origin. BMC Public Health. 2016; 16(1): 1077. PMid:27733161. https://doi.org/10.1186/s12889-016-3709-2

[18] Giorgi A.Psychology as a human science: A phenomenologically based approach. Harper & Row. 1970.

[19] Giorgi A, Giorgi B, Morley J. The descriptive phenomenological psychological method. In C. Willig& W. S. Eds.).Rogers (The Sage handbook of qualitative research in psychology (2nd ed., pp.176-192). Sage Publication Ltd. 2017. https://doi.org/10.4135/9781526405555.n11

[20] Giorgi A. The descriptive phenomenological method in psychology:A modified Husserlian approach. Duquesne University Press. 2009.

[21] Creswell JW, Poth CN.Qualitative inquiry and research design:Choosing among five approaches (4th ed.). SAGE Publications. 2017.Available from: https://books.google.ca/books?id=bOLFDQAAQBAJ

[22] Russell RC, Aquino-Russell CE. Living and working between two worlds:Using qualitative phenomenological findings to enhance understanding of lived experiences. In M.M. Mariano& Q. Eds.). Emerald Publishing.Mohiuddin (The Role of expatriates in MNCs knowledge mobilization(Vol. 27, pp. 177). 2011. https://doi.org/10.1108/S1876-066X(2011)0000027012

[23] Bowden C, Galindo-Gonzalez S. Interviewing when you’re not faceto-face: The use of email interviews in a phenomenological study. International Journal of Doctoral Studies. 2015; 10(12): 79-92.https://doi.org/10.28945/2104

[24] Gordon JA. Partners’ experience of living with a person who has undergone colostomy or ileostomy surgery: A phenomenological study University of New Brunswick ]. New Brunswick. 2009.

[25] Canada Health Act. ( n. d).Available from: https://laws-lois.justice.gc.ca/eng/acts/C-6/page-1.html

[26] Holst-Hansson A, Idvall E, Bolmsjö I, et al. The narrow treatment road to survival: Everyday life perspectives of women with breast cancer from Iraq and the former Yugoslavia undergoing radiation therapy in Sweden. European Journal of Cancer Care. 2018; 27(2): e12825.PMid:29345023. https://doi.org/10.1111/ecc.12825

[27] Duffy L, Aquino-Russell C. The lived experience of women with cancer: Phenomenological findings expressed through poetry. Canandian Oncology Nursing Journal. 2007; 17(4): 193-205. PMid:18286992.https://doi.org/10.5737/1181912x174193198

[28] Setia MS, Quesnel-Vallee A, Abrahamowicz M, et al. Access to health-care in Canadian immigrants: a longitudinal study of the national population health survey. Health & Social Care in the Community. 2011; 19(1): 70-79. PMid:21054621. https://doi.org/10.1111/j.1365-2524.2010.00950.x

[29] Government of Canada. Interim Federal Health Program: Summary of coverage. 2019. Available from: https://www.canada.ca/en/immigration-refugees-citizenship/services/refugees/help-within-canada/health-care/interim-federal-health-program/coverage-summary.html

[30] Cheung MC, Earle CC, Fischer HD, et al. Impact of immigration status on cancer outcomes in Ontario, Canada. Journal of Oncology Practice. 2017; 13(7): e602-e612. PMid:28605254. https://doi.org/10.1200/JOP.2016.019497

[31] Nanny Angel Network. ( n. d.).Available from: https://nannyangelnetwork.com/

[32] The Kelly Shires Breast Cancer Foundation. ( n. d.). Available from: https://www.kellyshiresfoundation.org/

[33] Tudor Car L, Papachristou N, Bull A, et al. Clinician-identified problems and solutions for delayed diagnosis in primary care: a PRIORITIZE study. BMC Family Practice. 2016; 17(1): 131-131. PMid:27613564. https://doi.org/10.1186/s12875-016-0530-z

[34] Vermeir P, Vandijck D, Degroote S, et al. Communication in healthcare:a narrative review of the literature and practical recommendations. International Journal of Clinical Practice. 2015; 69(11):1257-1267. PMid:26147310. https://doi.org/10.1111/ijcp.12686

[35] Halkett GKB, Arbon P, Scutter SD, et al. The experience of making treatment decisions for women with early stage breast cancer: a diagrammatic representation. European Journal of Cancer Care. 2005; 14(3): 249-255. PMid:15952969. https://doi.org/10.1111/j.1365-2354.2005.00565.x

[36] Williams F, Jeanetta SC. Lived experiences of breast cancer survivors after diagnosis, treatment and beyond: qualitative study. Health Expectations:An International Journal of Public Participation in HealthCare and Health Policy. 2016; 19(3): 631-642. PMid:25953316.https://doi.org/10.1111/hex.12372

[37] Aery A. Facilitators to accessing primary and preventive care for immigrants and refugees in Canada: A literature review. 2018.Available from: https://www.wellesleyinstitute.com/wp-content/uploads/2018/09/Facilitators-to-accessing-primary-and-preventive-care-1.pdf

[38] Inhestern L, Bergelt C. When a mother has cancer: strains and resources of affected families from the mother’s and father’s perspective-a qualitative study. BMC Women’s Health. 2018; 18(1):72-72. PMid:29801481. https://doi.org/10.1186/s12905-018-0562-8

[39] Forrest G, Plumb C, Ziebland S, et al. Breast cancer in the family-children’s perceptions of their mother’s cancer and its initial treat-ment: qualitative study. British Medical Journal (Clinical research ed.). 2006; 332(7548): 998-1003. PMid:16613935. https://doi.org/10.1136/bmj.38793.567801.AEhttps://doi.org/10.1136/bmj.38793.567801.AE

[40] Morris JN, Martini A, Preen D. The well-being of children impacted by a parent with cancer: an integrative review. Supportive Care in Cancer. 2016; 24(7): 3235-3251. https://doi.org/10.1007/s00520-016-3214-2

[41] Canadian Cancer Society. ( n. d.).Finding support and support groups Available from: https://www.cancer.ca/en/cancer-information/cancer-type/childhood-cancer-information/finding-support-and-support-groups/?region=sk

[42] Gele AA, Qureshi SA, Kour P, et al. Barriers and facilitators to cervi-cal cancer screening among Pakistani and Somali immigrant women in Oslo: a qualitative study. International Journal of Women’s Health. 2017; 9: 487-496. PMid:28740435. https://doi.org/10.2147/IJWH.S139160

[43] Syrowatka A, Hanley JA, Weir DL, et al. Ability to predict new-onset psychological distress using routinely collected health data: A population-based cohort study of women diagnosed with breast can-cer. Journal of the National Comprehensive Cancer Network. 2018; 16(9): 1065-1073. PMid:30181418. https://doi.org/10.6004/jnccn.2018.7038

[44] Nasrabadi AN, Bahabadi AH, Hashemi F, et al. Views of Iranian patients on life with cancer: a phenomenological study. Nurs-ing & Health Sciences. 2011; 13(2): 216-220. PMid:21595817. https://doi.org/10.1111/j.1442-2018.2011.00604.x

[45] Alexander A, Kaluve R, Prabhu JS, et al. The impact of breast cancer on the patient and the family in indian perspective. Indian Journal of Palliative Care. 2019; 25(1): 66-72.

[46] Wo´zniak K, I˙zycki D. Cancer: A family at risk. Przeglad Menopauzalny = Menopause Review. 2014; 13(4): 253-261. PMid:26327863. https://doi.org/10.5114/pm.2014.45002

[47] Spiegel D, Riba MB. Managing anxiety and depression during treat-ment. The Breast Journal. 2015; 21(1): 97-103. PMid:25377647. https://doi.org/10.1111/tbj.12355

[48] Sewilam AM, Watson AMM, Kassem AM, et al. Suggested avenues to reduce the stigma of mental illness in the Middle East. International Journal of Social Psychiatry. 2014; 61(2): 111-120. PMid:24957595. https://doi.org/10.1177/0020764014537234

[49] Aery A, McKenzie K.Primary care utilization trajectories for immigrants and refugees in Ontario compared with longterm residents. 2018. Available from: https://www.wellesleyinsti tute.com/wp-content/uploads/2018/11/Primary-care-utilization-trajectories-for-immigrants-and-refugees-in-Ontario-compared-with-long-term-residents.pdf

[50] Ashing-Giwa KT, Lim JW. Examining emotional outcomes among a multiethnic cohort of breast cancer survivors. Oncology Nursing Forum. 2011; 38(3): 279-288. PMid:21531679. https://doi.org/10.1188/11.ONF.279-288

[51] Christensen S, Zachariae R, Jensen AB, et al. Prevalence and risk of depressive symptoms 3-4 months post-surgery in a nation-wide cohort study of Danish women treated for early stage breast-cancer. Breast Cancer Research and Treatment. 2009; 113(2): 339-355. PMid:18278553. https://doi.org/10.1007/s10549-008-9920-9

[52] Sammarco A, Konecny LM. Quality of life, social support, and un-certainty among Latina and Caucasian breast cancer survivors: a comparative study. Oncology Nursing Forum. 2010; 37(1): 93-99. PMid:20044344. https://doi.org/10.1188/10.ONF.93-99

[53] Sze M, Butow P, Bell M, et al. Migrant health in cancer: out-come disparities and the determinant role of migrant-specific vari-ables. The Oncologist. 2015; 20(5): 523-531. PMid:25802406. https://doi.org/10.1634/theoncologist.2014-0274

[54] Leng J, Lee T, Li Y, et al. Support needs of Chinese immigrant cancer patients. Supportive Care in Cancer. 2014; 22(1): 33-42. PMid:23982771.https://doi.org/10.1007/s00520-013-1950-0

[55] Costas-Muniz R, Leng J, Diamond L, et al. Psychosocial correlates of appointment keeping in immigrant cancer patients. Journal of Psychosocial Oncology. 2015; 33(2): 107-123. PMid:25574581. https://doi.org/10.1080/07347332.2014.992084

[56] Sheppard VB, Adams IF, Lamdan R, et al. The role of patient-provider communication for black women making decisions about breast cancer treatment. Psycho-Oncology. 2011; 20(12): 1309-1316. PMid:20941804. https://doi.org/10.1002/pon.1852

[57] Health system navigators: Band-Aid or cure? A primer with Reflec-tios from the change foundation’s panorama panel Issue. Panorama. 2013. Available from: http://www.ncmn.ca/Resources/Documents/TCF_Panorama_Navigator_final.pdf