title: Uterine cancer: exploring access to services in the public health system.
abstract: BACKGROUND
  Māori are the indigenous peoples of New Zealand and experience higher rates of uterine cancer and poorer survival rates. Postmenopausal bleeding (PMB) is the most common presenting symptom for uterine cancer. Prompt investigation is essential with 28 days being viewed as an appropriate time from first medical contact (FMC) to first specialist appointment (FSA).
  
  
  OBJECTIVE
  To compare access to services for the investigation of PMB between Māori and non-Māori women.
  
  
  METHODS
  The time interval between FMC to FSA was obtained from medical records for women presenting to gynaecology clinics for PMB. Dates of first bleeding symptoms, knowledge and access issues were collected in a nurse-administered questionnaire.
  
  
  RESULTS
  A total of 154 women (n = 27 Māori and 127 non-Māori) participated in the study. 23% of women had their FSA from FMC within 28 days and 67% waited more than six weeks. The 75th percentile was approximately two weeks longer for Māori women. 25% (n = 37) of women were not aware that they needed to see a doctor about PMB, and this was significantly more common for Māori women (44%; 95% CI 25-65) than non-Māori women (20%; 95% CI 13-28; P = 0.011).
  
  
  CONCLUSIONS
  The majority of women were not seen for FSA within 28 days of their FMC. Māori women were more likely to experience lengthy delays and to report that they did not know they should see a doctor about PMB. Further investigation into reasons for delays and initiatives to improve access to services and health information appears warranted.
authors.affiliation: Women's Health Research Centre, Department of Primary Healthcare and General Practice, University of Otago, Wellington, New Zealand.
authors.forename: Beverley
authors.initials: B
authors.lastname: Lawton
authors.forename: Sara K
authors.initials: SK
authors.lastname: Filoche
authors.forename: Sally B
authors.initials: SB
authors.lastname: Rose
authors.forename: James
authors.initials: J
authors.lastname: Stanley
authors.forename: Sue
authors.initials: S
authors.lastname: Garrett
authors.forename: Bridget
authors.initials: B
authors.lastname: Robson
authors.forename: Selina
authors.initials: S
authors.lastname: Brown
authors.forename: Peter
authors.initials: P
authors.lastname: Sykes
mesh_terms: D005260:Female; D006176:Gynecology; D006297:Health Services Accessibility; D006801:Humans; D009520:New Zealand; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D017698:Postmenopause; D011634:Public Health; D011795:Surveys and Questionnaires; D061665:Time-to-Treatment; D014592:Uterine Hemorrhage / Q000208:ethnology* / Q000628:therapy
keywords: access to services; disparities; indigenous peoples; investigation; uterine cancer