title: Comparing urban and rural young adult cancer survivors' experiences: a qualitative study.
abstract: BACKGROUND
  Large administrative data set analyses demonstrate that geography has a significant impact on access to health care and subsequent health outcomes. In general, rural populations have poorer access to healthcare services. This article explores the reality of this issue for young adult cancer survivors.
  
  
  METHODS
  Data was of a subset of 30 participants from a larger qualitative study that examined cancer survivorship issues for young adult cancer patients in Canada. The subset of participants are from New Brunswick, a predominantly rural province in Eastern Canada with a population of 750,000 spread out over a large geographical area, and from Canada's largest metropolis center, Greater Toronto Area, with a population of around 6 million.
  
  
  RESULTS
  Analysis of the qualitative data using constructivist grounded theory revealed several expected and unexpected differences between the two geographically distinct groups. The rural group of young adult cancer survivors reported more frequent episodes of delayed diagnosis and lower levels of community support compared to the urban participants. The urban young adult cancer survivors discussed out-of-pocket expenses for cancer treatment more often than the rural participants. Many rural participants made it clear that they were keenly aware that not all cancer care services were readily available where they lived, and yet they reported considerably higher levels of satisfaction with the cancer care that they received than the urban participants.
  
  
  CONCLUSIONS
  Despite the lack of important cancer services in rural areas, rural young adult cancer survivors expressed higher levels of satisfaction with their care than did urban cancer survivors. It appears that levels of satisfaction are related to expectations. Rural participants were aware of the more limited services available and felt that their cancer care practitioners provided the best care possible given the limited resources. Urban participants may have higher expectations of cancer care and felt that the cancer care they received fell below expectations. In the future, researchers may want to focus on cancer care expectations, satisfaction levels and psychosocial outcomes in greater detail.
authors.affiliation: Dalhousie University Family Medicine Teaching Unit, Dr Everett Chalmers Regional Hospital, Fredericton, New Brunswick, Canada. baukje.miedema@horizonNB.ca
authors.forename: Baukje
authors.initials: B
authors.lastname: Miedema
authors.forename: Julie K E
authors.initials: JK
authors.lastname: Easley
authors.forename: Lynne M
authors.initials: LM
authors.lastname: Robinson
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D036301:Qualitative Research; D012424:Rural Population; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data; D014505:Urban Population; D055815:Young Adult