Diagnostic experiences of Black and White patients with uterine cancer: A qualitative study.

Objective: To explore patient experiences with the diagnosis process for uterine cancer and the perceived barriers that may affect early diagnosis and racial disparities in stage at diagnosis.
Methods: We conducted semi-structured interviews to ascertain the diagnostic journey of 11 non-Hispanic Black ("Black") and 11 non-Hispanic White ("White") patients who were diagnosed with uterine cancer in the past six months. All interviews were audio-recorded, professionally transcribed, and analyzed using thematic analysis. Findings were presented to patients and community advocates for critical review and feedback before being finalized.
Results: Respondents had a median age of 64 years. Thirteen (59.1 %) had stage I tumor, whereas nine (40.9 %) had stage II-IV disease. Respondents were attentive to their symptoms but unaware that they could indicate uterine cancer. This was compounded by women's conditioned acceptance of discomfort and disconnection from gynecological care after reproductive age. Respondents often viewed racial disparities in diagnosis through other social determinants of health, including gender, age, and healthcare access. These overlapping social experiences, coupled with respondents' concentration on recovery, may mask their perceptions about systemic racism. Although few respondents noted negative experiences in their own evaluations leading to the diagnosis of uterine cancer, Black respondents often described how previous discriminatory experiences informed a wariness of healthcare systems.
Conclusion: Lack of public awareness of uterine cancer, gendered expectations for discomfort, and disconnection from gynecologic care all interfered with early diagnosis of uterine cancer. Discriminatory experiences in prior healthcare further complicate Black patients' engagement with the healthcare system.
Competing Interests: Declaration of competing interest Jason D. Wright has received royalties from UpToDate and honoraria from the American College of Obstetricians and Gynecologists and received research funding from Merck. Xiao Xu has received honoraria from the American Association of Gynecologic Laparoscopists. The other authors have no conflict of interest to declare.
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