title: Just give me hope: lived experiences of Medicaid patients with advanced cancer.
abstract: The purpose of this phenomenological exploration was to describe the lived experiences of persons diagnosed with advanced cancer who receive Medicaid. Themes emerged from the transcribed interviews of 10 participants in accordance with the cancer trajectory. Before diagnosis, participants were uninsured or underinsured and had more severe symptoms prior to late diagnosis. Upon diagnosis, they desired hopeful, respectful communication and experienced strong emotional reactions. There was also an abrupt change in the use of health care resources. During cancer treatment, they experienced social isolation from family and friends while receiving strong psychosocial support from the health care team. Throughout the cancer trajectory, they focused on living, reclaiming normalcy, and expressed resiliency and spirituality. Findings support the need to recognize the "fighting spirit" of patients regardless of prognosis or socioeconomic status; the impact of hopeful, respectful communication; and the value of oncology social work assistance when navigating the cancer experience. Lack of health care coverage prior to severe symptoms prevented earlier diagnosis and contributed to poor physical outcomes. Medicaid eligibility enabled these patients to receive quality health care and focus on living beyond cancer.
authors.affiliation: School of Medicine, University of Louisville, Louisville, Kentucky 40202, USA. tara.schapmire@louisville.edu
authors.forename: Tara J
authors.initials: TJ
authors.lastname: Schapmire
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Head
authors.forename: Anna C
authors.initials: AC
authors.lastname: Faul
mesh_terms: D000328:Adult; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid; D017057:Medically Uninsured / Q000523:psychology; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D012934:Social Isolation; D012944:Social Support; D029181:Spirituality; D014481:United States; D055815:Young Adult