DAY 1: The Fine Line
It’s a fine line. That is what the manager at La Liga Contra el Cancer in Lima, Peru said about delivering a cervical cancer or even a pre-cancer diagnosis when asked how results are ultimately provided to their patients. The focus of our current project in Peru is to reduce loss to follow up for cervical cancer treatment. We hope to do so by eliminating a step in the treatment pathway via implementation of the Pocket Colposcope and through education of the patients about their diagnosis by possibly counseling them with an image of their own cervical pathology.
The manager of La Liga explained that positive diagnoses have always been delivered in person for both women being referred from mobile clinics and women who are seen directly at La Liga. In order to get them to the clinic to receive this diagnosis, however, they first get a letter in the mail followed by a call telling them they are needed for another appointment. Nothing about cancer is ever mentioned in the letter or call. When I asked why this is how things are done, she explained that it is a fine line in terms of how much information to give a patient right away because, in Peru, the word cancer means death to a lot of people. She explained that the two trains of thought for Peruvians after receiving a cancer diagnosis are denial or acceptance. It is because of the possible cases of denial that La Liga has decided to be vague when asking patients to come in to be given bad news. This is because many patients could be so terrified by the word cancer and the overwhelming thought of treatment/the possible costs associated with their future care, that they’d prefer not knowing their options or being fully educated about their situation. Ignorance is bliss for some. The manager believes that the information, when delivered by a medical provider, could lessen the blow and make the diagnosis not as scary, therefore, making it more likely that a patient will continue the treatment process.
I wonder if the message delivered is too vague and not powerful enough to encourage women, especially the women who live very far away and for whom making it to Lima is a huge hassle, to make the trip. I feel like the way in which a diagnosis is delivered could be another cause of loss to follow up. I fear that if the women are not made aware of the importance of continuing care, they will not make it for another visit only because they did not understand or know the risk they are running. This is something I am excited to ponder and problem solve with the team from La Liga over the next week.