Addressing Disparities in Cancer Care for Black and Minority Ethnic Groups

Introduction:

There is a higher recurrence of certain malignancies in black and minority ethnic groups and the general pace of incidence rate in this population is rising. Medicinal services staffs have a poor cognizance of the prerequisites of ethnic minority groups (Fazil, 2018). There is an absence of information based health education with respect to disease and consciousness of the accessibility of help administrations is restricted among dark and minority ethnic groups. Similarly, there is an absence of cultural skill education for healthcare workers, particularly in malignant growth awareness (Austin, 2009). Moreover, understanding the predominance and encounters of malignant growth among dark and minority ethnic gatherings is obstructed by an absence of information identifying among the community. Therefore, patients who are individuals from dark and minority ethnic community report more negative encounters of disease care than white ethnic groups. However, there is an absence of urgency, need and focus of the malignancy requirements for dark and minority ethnic populaces in NHS strategy reports along with NHS malignant growth information data assortment records (Fazil, 2018).

Study proposes further line up since there is continuing work to improve screening take-up in the UK. Appropriate social mediations to decrease separation for screening methodology was proposed by Szczepura et al., (2008) after they dismembered data for bowel and breast screening take-up execution over 15 years in the UK for minor ethnic gatherings. They found lower bowel and breast screening take-up rates among the minor ethnic people related with the ethnicity of the GP identified with the low take-up of bowel screening anyway not screening of breast malignancy (Robb, 2009).

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Background:

Cancer is a genuine general medical problem in the UK and the commonest reason for death in England and Wales (Department of Health, 2015), there are an expected 42317 newly reported cases of bowel cancer, mortality of 16272 cases within 2015 – 2017. Survival rate from bowel cancer was observed to be 53% within 2013 – 2017 and 54% of preventable cases in the UK. The commonest form of cancer among dark and minority ethnic groups according to the data enrolled in 2015 were prostrate, breast, colorectal and lung tumours representing simply over 50% of the considerable number of all cancers enlisted (53%) (ONS, 2017).

Bowel cancer is a major factor behind torment and mortality all through the world. It speaks to over 9% of all cancer occurrences (Haggar, 2009). It is the third most common disease worldwide and the fourth most fundamental purpose behind death. Countries with the most critical event rates consolidate Canada, Australia, United States, New Zealand and parts of Europe. The nations with the lower incidence rate are India, China, South America and parts of Africa (Haggar, 2009). In 2009, the principal communication of a national examination on the frequency and survival rate of malignant growth in black and minority ethnic groups were evaluated by The National Cancer Intelligence Network and Cancer Research, UK. Subsequently throughout the most recent 4 years The Cancer Patient Experience Survey, appointed by Public Health England, has gathered the minority ethnic information (Quality Health 2014, 2015). There is a general accord that gathering information on ethnicity is troublesome due to an absence of agreement of who is a part of an ethnic group. It was frequently detailed that individuals from black and minority ethnic gatherings by and large are more averse to get cancer than white populaces yet that might be because of a high level of underreporting (Fazil, 2018).

Bowel malignancy screening is the significant malignant growth screening program which is offered to both genders by Public Health England. However, there are contrasts in screening take-up figures which show men are bound to disregard their health implications than ladies. Essentially, it is additionally important that men are more in danger of getting bowel cancer in comparison to women (Logan, 2012). Raising consciousness of bowel malignancy was the focal point of the Decembeard campaign. This occasion urged men to develop whiskers in help, was a hair-raising approach to draw notice to the UK's second greatest malignant disease (Palaces, 2009). The screening plans to identify the stage at initial phase, before individuals are encountering any manifestations, and when treatment is bound to be powerful. In later stages, it’s become more troublesome to treat the bowel cancer. This screening can likewise distinguish polyps, which are not malignant, yet may form into malignancy in future. When recognized they can be evacuated which diminishes the danger developing malignancy. The benefits are that the screening has lessened the danger of death due to bowel malignant growth by 16% (Foss, 2011).

Variations in colorectal malignancy screening add to the high occurrence and mortality from colorectal disease among African as contrasted with whites. A study analyzed colorectal malignancy screening rates by race and different elements utilizing information from the 2010 Behavioral Risk Factor Surveillance System. Among respondents matured 50 to 75 years, 64.5 % revealed being fully informed regarding colorectal malignant growth screening (Shapiro, 2012). The extent of respondents who detailed having had any of the test alternatives was more prominent among people within 65 to 75 years contrasted with those within 50- 64 years, and among people with medical coverage comparative with those with no health care coverage (Shapiro, 2012). The divergence in announced test use by medical coverage status was clear for each of the three test types (FOBT, sigmoidoscopy with FOBT, and colonoscopy). Moreover, paces of test utilization expanded with rising knowledge level and family unit salary. Racial discriminations in colorectal malignant growth screening emerge from an assortment of individual-, supplier, and healthcare organisation related obstructions with respect to contrasts for education, money, and medical coverage inclusion. The presentation of medical coverage inclusion for colorectal disease screening and other routine preventive administrations has opened up new open doors for coping with disparities. In any case, individuals who pick FOBT or sigmoidoscopy as their underlying test could confront high, unforeseen, cash based expenses (Altobelli, 2014; Ahmed, 2013).

A further issue is that African and low-pay people regularly have extra hindrances to screening apart from medical coverage protection such as absence of information about colorectal malignant growth and the significance of screening, dread, doubt of physicians, poor information on risk factors and less time accessible to rehearse preventive wellbeing practices (Wallace, 2013). Despite the fact that getting a physician’s proposal is the most significant indicator of malignant growth screening, African in comparisons to whites gets lesser suggestions to get screened for colorectal disease. In spite of the fact that healthcare services and framework acts as significant boundaries to colorectal malignancy screening, studies have not reliably discovered that medical coverage protection alone diminishes imbalances in screening uptake (Wallace, 2013). Therefore, extensive projects planned for expanding colorectal disease screening and focusing on the differences concerning screening may profit by customer and supplier interventions. Therefore, with a standard healthcare provider, progression of essential medical services and great correspondence with the provider will improve the screening outcomes (Cooper, 2008; Sabatino, 2012).

Research Aim: To study the impacts of health professionals in tackling bowel cancer among black African men in the United Kingdom

Research Objectives:

To increase the awareness among the focus group population for bowel cancer

To study the Acts and policies of the government of the UK for effective screening uptake for bowel cancer among the population

To discuss the gaps and required recommendations for effective of bowel cancer among the population by the health professionals.

Methodology and Justification:

Methodologies stipulate the details for using a specific research strategy and the explanation of the research process. The systematic review will be defined and the rationale for using this approach will be described. Research will be based on randomised controlled trials, crossover trials, cohort studies, clinical audits, clinical outcome studies, surveys, interviews and systematic review. The data will be analysed in form of the literature review.

Search Strategy

The study is based on the secondary research to gather the evidence from the existing literatures. Essential examinations are chosen dependent on the best comprehension of the focal research objectives. Reasonable sources were recognized in the wake of investigating different electronic databases which contains countless excellent peer survey substance, for example, Google Scholar, Cumulative Index of Nursing and Allied Health Literature, Medline, PubMed, EMBASE, Karger, Taylor, Ovid, EBSCO host and Francis Online. Grey literatures databases, used by the specialist for looking through logical substance are Open Gray, Med Nar and GreyNet International. The inquiry was finished with limitation to the most refreshed substance up to the year 2019 so applicable and most recent substance can be accessible for the writing audit reason. All the in-text references of the resulted papers were also reviewed to analyse and evaluate the content of the relevant databases. The research analyst utilized systems, for example, "truncation search" notwithstanding indicators for the words. This specific methodology has helped the analyst to acquire a wide scope of data from a few database sources. Again the inquiry results were expanded with the utilization of Boolean operators for instance “OR”, “AND” for decreasing down the query items. An in-depth analysis on the topic of the research has been conducted based on case-controlled, cohort and cross-sectional studies published within the past 10 years focusing on the topic of bowel cancer among African male populations (Machi, 2016).

Study selection:

The inclusion and exclusion criteria are developed once the research idea becomes familiar with the literature search. To characterize the exclusion and inclusion criteria the title of the article and conceptual ought to contain the catchphrases or the positive inquiry thing. To characterize the rejection criteria, any examinations that are falling "out of extension" for the study and not coordinating with the set research addresses won't be considered. Any writing not written in the English language won't be considered for the audit reason. Therefore all the pieces of literature based on the defined inclusion and exclusion criteria are considered for the literature review (Randolph, 2009).

For this study the inclusion and exclusion criteria include:

For this study the inclusion and exclusion criteria include

Study Design:

As suggested from previous pieces of literature that the vital step of the systematic review is to gather available evidences which can explain the research question. The pyramid of the hierarchy of literature guides the researcher to choose the study design which would provide effective evidence to support the hypothesis of the study. Cohort studies can be both prospective and retrospective in nature. Cohort studies can be considered to be ideal to evaluate the link between the risk factors and the outcomes and they can be prospective or retrospective in nature. On the other hand, the case-control studies are retrospective in nature and it compares the difference between two groups, i.e, one group having the problem and the other one is the control group (the problem does not persist). This type of study also helps to establish the link between the risk factors and the health outcome. The significance of the cross-sectional studies is that they give a clear conception about the exposure and the interesting outcome within the same time. The following parameters are considered to be the disadvantages for conducting the study: selection bias, time used up in the study, absence of follow up in the study.

Here the utilization of Positivism explore theory will be increasingly suitable which expresses that the examination and understanding of the exploration information could get fruitful through the obtained truth and clear realities from verified sources. This specific methodology will permit the scientist to build up an explanatory psyche to examine about the concerned research issue. An organized and quantitative research approach was applied to taking care of the exploration issue. Fundamental review approach has been alluded to as the procedure with the end goal of the writing survey. It is finished by applying orderly technique procedures, for example, basic examination explore considers, investigation of the auxiliary information, and the information that had been delivered quantitatively and subjectively (Saunders, et al, 2018). This particular approach has been used to obtain a detailed and exhaustive analysis of all the available kinds of literature on the electronic databases based on the inclusion criteria. The benefits associated with this method of systemic review is that it applies analytical and scientific methods for identifying and selecting the research which in turn reduces any form of bias in the study along with the productions of accurate and reliable results and conclusions in relation to the research hypothesis of the study.

Risk of bias:

Systematic review is evidence based that looks into existing literature in detail and in a methodological fashion to answer a definite question and to recognize gaps in prevailing literature (Betanny-Saltikov, 2012). It is viewed as replaceable with the inner legitimacy of the investigation and hence is characterized as "the degree to which the structure and direct of an examination are probably going to have forestalled inclination (bias)". The device, for example, ROBINS-E, ROBINS-1 and Cochrane device looks at about a error in the examination structure and furthermore inspect the result to evaluate the conceivable predisposition in the investigation. To inspect about the error in a randomized control study (RCT), advancement of the guideline and systematic review study with Cochrane apparatus is applied while in the event that when an observational investigation of a measure is contrasted and theoretical randomized control study the examination of the information is carried on by ROBINS-I device (Sterne, et al, 2016; Savovic, et al 2014; Higgins, et al, 2011). The tool examines the five different domains of bias such as attrition performance, selection, reporting and others.

Ethical Considerations:

No ethical consideration is required for study involving only literature review. The data will be stored in an encrypted device with password protection system. The hard copies of the data will be stored within a secure cabinet in a locked room to maintain the legal standards. The destruction procedure of the collected data will be permanent and irreversible. It may include the overwriting of the data with a series of characters or pulverizing the hard disks (Wager and Wiffen, 2011).

Research Time Table:Reflection:

Research Time Table:Reflection: Research Time Table:Reflection:

The writing phase of the research proposal is a crucial one as here I thoroughly studied on the focused topic. While studying, I understood that the topic is extremely crucial as it will address the population who are suffering from various issues such as racial discriminations, low paid population with most of them having any medical coverage. Moreover, I also acquired the knowledge about the bowel cancer disease and the significance of the screening programmes initiated by government of the UK. I was surprised after analysing the statistical data that African male populations are less educated about the disease along with the significance of the screening programmes. Therefore, I felt that I have addressed a critical issue that demands attention for the betterment of the focus group population by studying on the strategies that has to be employed for increasing awareness, the updated policies for cancer treatment for the population and the role of the GP for the accurate suggestions for screening uptakes of bowel cancer.

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References:

Ahmed, N.U., Pelletier, V., Winter, K. and Albatineh, A.N., 2013. Factors explaining racial/ethnic disparities in rates of physician recommendation for colorectal cancer screening. American journal of public health, 103(7), pp.e91-e99.

Altobelli, E., Lattanzi, A., Paduano, R., Varassi, G. and Di Orio, F., 2014. Colorectal cancer prevention in Europe: burden of disease and status of screening programs. Preventive medicine, 62, pp.132-141.

Austin, K.L., Power, E., Solarin, I., Atkin, W.S., Wardle, J. and Robb, K.A., 2009. Perceived barriers to flexible sigmoidoscopy screening for colorectal cancer among UK ethnic minority groups: a qualitative study. Journal of medical screening, 16(4), pp.174-179.

Bettany-Saltikov, J., Kandasamy, G., Van Schaik, P., McSherry, R., Hogg, J., Whittaker, V., Arnell, T. and Racero, G.A., 2019. School‐based education programmes for improving knowledge of back health, ergonomics and postural behaviour of school children aged 4–18: A systematic review. Campbell Systematic Reviews, 15(1-2), pp.1-11.

Boyle, P. and Langman, M.J., 2000. ABC of colorectal cancer: Epidemiology. Bmj, 321(Suppl S6), p.0012452.

Cooper, G.S. and Doug Kou, T., 2008. Underuse of colorectal cancer screening in a cohort of Medicare beneficiaries. Cancer: Interdisciplinary International Journal of the American Cancer Society, 112(2), pp.293-299.

Department Of Health, 2015. Policy Paper : 2010 to 2015 government policy: cancer research and treatment. Accessed at

policy-cancer-research-and-treatment/2010-to-2015-government-policy-cancer-research-andtreatment on 15/04/2020.

Fazil, Q., 2018. Cancer and black and minority ethnic communities. Better Health Briefing 47.

Foss, F.A., West, K.P. and McGregor, A.H., 2011. Pathology of polyps detected in the bowel cancer screening programme. Diagnostic Histopathology, 17(11), pp.495-504.

Haggar, F.A. and Boushey, R.P., 2009. Colorectal cancer epidemiology: incidence, mortality, survival, and risk factors. Clinics in colon and rectal surgery, 22(04), pp.191-197.

Higgins, J.P.T., Altman, D.G. and Sterne, J.A.C., 2011. on behalf of the Cochrane Statistical Methods Group and the Cochrane Bias Methods Group. Chapter 8: Assessing risk of bias in included studies. Cochrane handbook for systematic reviews of interventions version, 5(0).

Logan, R.F., Patnick, J., Nickerson, C., Coleman, L., Rutter, M.D. and von Wagner, C., 2012. Outcomes of the Bowel Cancer Screening Programme (BCSP) in England after the first 1 million tests. Gut, 61(10), pp.1439-1446.

Machi, L.A. and McEvoy, B.T., 2016. The literature review: Six steps to success. Corwin Press.

Office for National Statistics, 2017. Cancer Registration Statistics England: 2015. Accessed at

Palaces, H.R., 2009. The Tower of London. Retrieved February, 2, p.2009.

Quality Health, 2014. National Cancer Patient Experience Survey: National Results Summary. Accessed at

Robb, K., Stubbings, S., Ramirez, A., Macleod, U., Austoker, J., Waller, J., Hiom, S. and Wardle, J., 2009. Public awareness of cancer in Britain: a population-based survey of adults. Nature Precedings, pp.1-1.

Sabatino, S.A., Lawrence, B., Elder, R., Mercer, S.L., Wilson, K.M., DeVinney, B., Melillo, S., Carvalho, M., Taplin, S., Bastani, R. and Rimer, B.K., 2012. Effectiveness of interventions to increase screening for breast, cervical, and colorectal cancers: nine updated systematic reviews for the guide to community preventive services. American journal of preventive medicine, 43(1), pp.97-118.

Saunders, B., Sim, J., Kingstone, T., Baker, S., Waterfield, J., Bartlam, B., Burroughs, H. and Jinks, C., 2018. Saturation in qualitative research: exploring its conceptualization and operationalization. Quality & quantity, 52(4), pp.1893-1907.

Savović, J., Weeks, L., Sterne, J.A., Turner, L., Altman, D.G., Moher, D. and Higgins, J.P., 2014. Evaluation of the Cochrane Collaboration’s tool for assessing the risk of bias in randomized trials: focus groups, online survey, proposed recommendations and their implementation. Systematic reviews, 3(1), p.37.

Shapiro, J.A., Klabunde, C.N., Thompson, T.D., Nadel, M.R., Seeff, L.C. and White, A., 2012. Patterns of colorectal cancer test use, including CT colonography, in the 2010 National Health Interview Survey. Cancer Epidemiology and Prevention Biomarkers, 21(6), pp.895-904.

Sterne, J.A., Hernán, M.A., Reeves, B.C., Savović, J., Berkman, N.D., Viswanathan, M., Henry, D., Altman, D.G., Ansari, M.T., Boutron, I. and Carpenter, J.R., 2016. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. bmj, 355, p.i4919.

Szczepura, A., Price, C. and Gumber, A., 2008. Breast and bowel cancer screening uptake patterns over 15 years for UK south Asian ethnic minority populations, corrected for differences in socio-demographic characteristics. BMC public health, 8(1), p.346.

Wager, E. and Wiffen, P.J., 2011. Ethical issues in preparing and publishing systematic reviews. Journal of evidence-based medicine, 4(2), pp.130-134.

Wallace, D.A.C., Baltrus, P.T., Wallace, T.C., Blumenthal, D.S. and Rust, G.S., 2013. Black white disparities in receiving a physician recommendation for colorectal cancer screening and reasons for not undergoing screening. Journal of health care for the poor and underserved, 24(3), p.1115.

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