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. 2025 Oct:314:94-102.
doi: 10.1016/j.jss.2025.06.071. Epub 2025 Jul 30.

A Qualitative Study Examining Caregivers' Perspectives on Healthcare System Barriers and Facilitators to Foregut Cancer Care

Jaspinder Sanghera  1 , Ioannis Liapis  1 , Michelle Holland  1 , Ivan Herbey  2 , Katie West  3 , Martin J Heslin  2 , Larry Hearld  4 , Krista Mehari  5 , Smita Bhatia  6 , Annabelle L Fonseca  7
Affiliations

A Qualitative Study Examining Caregivers' Perspectives on Healthcare System Barriers and Facilitators to Foregut Cancer Care

Jaspinder Sanghera et al. J Surg Res. 2025 Oct.

Abstract

Introduction: Caregivers play a critical role in supporting patients with foregut cancer by providing financial, psychosocial, and practical support to patients throughout their treatment journey. However, caregiver perspectives on challenges and supports to accessing cancer care remain understudied. This qualitative study aims to understand caregiver-reported barriers to and facilitators of foregut cancer care.

Methods: Caregivers of patients with foregut cancer who received treatment at a safety-net hospital in the Southeastern United States were purposively selected. Semistructured interviews were recorded, transcribed, and qualitatively analyzed. Using a grounded theory approach, themes were identified through open coding, and then a thematic coding structure was developed to create a codebook. Interrater reliability above 90% was achieved.

Results: A total of 15 participants between the ages of 31-82 y were interviewed. Most caregivers were Black (73%) and female (83%). Themes were identified across three levels: (1) physician and care team, (2) institution, and (3) policy. Limited access to the physician and care team, communication gaps, physician and health system mistrust, navigating a complex health system, and insurance-related barriers were frequently reflected challenges. Facilitators at the provider and institution levels included effective communication, accessible physician and care team, financial assistance programs, written appointment reminders, and support from ancillary staff.

Conclusions: Caregivers, particularly those in socioeconomically disadvantaged settings, face substantial barriers that impact their ability to support patients with foregut cancer. Understanding the unique experiences of caregivers is critical to inform the development of targetable interventions that improve patient-centered oncological care.

Keywords: Barriers; Cancer; Caregiver; Facilitators; Foregut; Health system.

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