Access to cancer preventive care and program considerations for people experiencing homelessness across four European countries: an exploratory qualitative study

Tobias Schiffler, Christina Carmichael, Lee Smith, Ascensión Doñate-Martínez, Tamara Alhambra-Borrás, Miguel Rico Varadé, Jaime Barrio Cortes, Matina Kouvari, Pania Karnaki, Maria Moudatsou, Ioanna Tabaki, Alejandro Gil-Salmeron, Igor Grabovac

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)

Abstract

Background
People experiencing homelessness (PEH) have a higher prevalence of adverse health outcomes and premature mortality compared to the non-homeless population. These include a higher burden of cancer and cancer-specific morbidity and mortality—outcomes that may be a consequence of significant barriers to accessing primary and secondary prevention and community health services. This study aimed to better comprehend the health needs and barriers to accessing preventive cancer care for PEH across four European countries as well as necessary considerations for developing interventions around cancer prevention for this population.

Methods
In this exploratory qualitative study, 69 semi-structured interviews were conducted across Austria, Greece, Spain, and the UK, with a sample comprising 15 professionals working in homelessness support services, 19 health professionals, and 35 PEH. Interviews took place between August 1 and October 31, 2021, and data were analysed inductively and iteratively following a thematic approach.

Findings
Findings were organised into two overarching themes: (1) Experiences and understanding of cancer prevention and treatment and (2) Considerations for program interventions. While cancer was a significant worry among PEH across all settings, they generally had minimal knowledge and understanding of cancer symptoms and prevention. Specific programs for cancer prevention for PEH were described as almost non-existent. Health professionals in some settings indicated that cancer in PEH was often missed in the early stages and instead diagnosed when the severity of symptoms intensified.

Interpretation
Overall, our findings indicate many commonalities in the health needs of PEH and the barriers they face when they seek access to cancer-specific healthcare services in the European context.

Funding
This study received funding from the European Union’s Horizon 2020 Research and Innovation Programme under GA 965351.
Original languageEnglish
Article number102095
JournaleClinicalMedicine
Volume62
Early online date20 Jul 2023
DOIs
Publication statusPublished - Aug 2023
Externally publishedYes

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