“There’s just such a mismatch”: a qualitative exploration of health systems and organizational-level barriers to accessing cancer services among people experiencing structural marginalization

PMCID: PMC12177988

PMID: 40533755

DOI: 10.1186/s12939-025-02554-8

Journal: International journal for equity in health

Publication Date: 2025-6-18

Authors: Horrill TC, Crawford J, Beck S, Bourgeois A, Kaur J, et al.

Key Points

• Cancer service design systematically disadvantages patients experiencing structural marginalization
• 59% of patient participants self-identified as Indigenous, highlighting significant health disparities
• Equity-oriented care models represent a promising approach to addressing systemic barriers in cancer services

Summary

This critical ethnographic study explored barriers to cancer care access among marginalized populations in Canada, revealing significant systemic challenges in healthcare service delivery. By conducting interviews with 24 service providers, 7 key informants, and 29 individuals experiencing structural marginalization, researchers identified four interconnected themes highlighting fundamental mismatches between current cancer service design and the needs of vulnerable populations.

The study uncovered critical gaps in cancer care, demonstrating that service structures often fail to account for social contexts, prioritize operational efficiency over equity, and create environments where stigma and discrimination impede patient access. The findings suggest that healthcare organizations represent crucial sites for transformative change, with equity-oriented healthcare frameworks offering potential solutions to improve care accessibility and patient experiences for marginalized communities.