PUBH6008 Capstone A Applied Research Project in Public Health Report 2 Sample
Instructions:
By the end of module 3, student must provide to their learning facilitator a brief review of the literature on their chosen topic. The literature review must contain key references/theorists/researchers for the public health topic chosen. The literature review assignment must be designed to address the following questions:
• Who are the key theorists/researchers in your public health topic?
• What are the key issues?
• What are the gaps in the existing body of knowledge?
The literature review should provide a basis for justifying a clear research question or hypothesis to be explored further.
You must also indicate the search strategy used for your literature review. For example, what were the key words you searched for, and which key databases or other sources did you use to conduct your literature review? (e.g. CINAHL, Proquest Public Health, Informit, Medline, Google Scholar).
Assessment Criteria:
• Critical and comprehensive review of the literature (70%) Clarity of research question/hypothesis (10%) General assessment criteria (20%):
o Provides a lucid introduction
o Shows a sophisticated understanding of the key issues
o Shows ability to interpret relevant information and literature in relation to chosen topic
o Demonstrates a capacity to explain and apply relevant concepts o Shows evidence of reading beyond the required readings
o Justifies any conclusions reached with well-formed arguments and not merely assertions
o Provides a conclusion or summary o Correctly uses academic writing, presentation and grammar:
? Complies with academic standards of legibility, referencing and bibliographical details (including reference list)
? Writes clearly, with accurate spelling and grammar as well as proper sentence and paragraph construction
? Uses appropriate APA style for citing and referencing research
Solution
1. Introduction
Cancer Australia (2019) shows that women have been diagnosed with breast cancer far greater incidence than males. By 2021, it is predicted to be the most common type of both male and female cancer diagnoses. There were 17,699 new cases of breast cancer in Australia in 2017. As of 2021, breast cancer is estimated to take the lives of 20,060 women and 170 men in Australia (Cancer Australia, 2019). For Assignment Help, One in fifteen women may have breast cancer by the age of 85 in 2021. Breast cancer is a major issue for governments across the globe (Badger & Landercasper, 2014). High-income nations should prioritise providing equitable access to cancer treatment services. Among women in Australia breast cancer is a common cancer. Concerns about breast cancer's continuum—preventative, incidence/risk detection/diagnosis/treatment/survival—receives a lot of attention. The existence of SES gradients throughout the breast cancer continuum has been shown. However, this has not been proven definitively. The personal and societal repercussions of these injustices, such as premature death and low quality of life, are considerable and must be addressed. To help readers better understand the socioeconomic variables that contribute to breast cancer in Australian women, researchers will perform a complete literature review as part of this study. The study will take into consideration the research gaps and also address different research questions at the end of the study.
(Source- Self-made)
1. Background
Breast Cancer has a number of aspects which have a direct or an indirect impact on the person. Several external factors are responsible for this reason. The effects of socioeconomic position (income, education), neighbourhood disadvantage (residential segregation), and unemployment on breast cancer incidence and survival have been investigated. Breast cancer survival has been correlated with educational attainment and geographic location (Byles et al., 2014). Medical scepticism, illegal process of immigration, inadequate housing, and food insecurity are all examples of social determinants of health, as is lack of access to healthcare facilities, among other factors. Medical scepticism and immigrant status are not the only social determinants of health; additional factors include substandard housing, food insecurity, and restricted access to health care in the community. Breast cancer is associated with one's socioeconomic level (Catsburg et al., 2014). In all ethnic groups, a woman's socioeconomic status is associated with her chance of having breast cancer. According to the National Breast Cancer Foundation, breast cancers that are more difficult to treat in women from poor socioeconomic backgrounds are more likely to have aggressive premenopausal breast cancers. In several studies, researchers found that factors such as socioeconomic status, race, educational attainment, poverty, and access to health insurance and preventive therapy impacted breast cancer survival rates. As a result of their socioeconomic standing, women diagnosed with breast cancer at an advanced stage and who die due to the disease are more likely to be from lower financial groups (Wheeler et al., 2013). According to research published in the journal Breast Cancer Research, breast cancer survivors are less likely to survive in Australia if they are poor, illiterate, or socially isolated. The findings were published in the journal Breast Cancer Research. It is critical to consider a cancer patient's socioeconomic and environmental circumstances to reduce cancer inequities and improve health outcomes (Chen et al., 2015). Many studies have looked at the impact of socioeconomic status (such as money and education) on breast cancer incidence and outcomes, and this is an issue that should be investigated in more depth.
2. Methodology
The methodology helps set the study's base; it helps to ensure that all the information collected in the study is reliable and valid and is collected and analysed in an organised and logical way (Clauser et al., 2012). Considering the same, the research design, research method, data extraction, data analysis, and ethical consideration are listed below.
Research design and method: Qualitative research methods have been used considering the topic, aims, and objective of the research. It helped the researcher to get a depth analysis of the included study. Besides, as the topic deals with the role and importance of socioeconomic factors in breast cancer among Australian women, which is a contextual term and hence considering the fact, qualitative research has been adopted (Loney & Nagelkerke, 2014).
The research method that has been used in the research is secondary research methods, with the help of which previously published peer reviewed data are extracted and analysed (Shin et al., 2018). It assisted in ensuring that all the data that has been incorporated in the research is true and reliable. Besides, conducting primary research as the method will be time-consuming, and hence, second research is the best option is chosen accordingly (Weber et al., 2013).
Data extraction and analysis: Data extraction and analysis are important to ensure that all the data is extracted from a valid and authentic database. Here search strategy has been used to extract peer reviewed articles. Keywords have been formulated, which includes "breast cancer", "Australia", "Australian women", "socioeconomic factors" with the help of Boolean operators (AND and OR) (Agarwal et al., 2017). All the articles that have been used in the research are extracted from Torren's library. While extracting the articles, different filters or inclusion and exclusion criteria have been applied to ensure relatability with the research topic. Articles published within ten years of publication range is included in the study to ensure that only current updated information is included in the research. English has been used as the language of the included study to ensure the wider acceptability of the research.
After extracting the articles, thematic analysis has been used as a data analysis process. Here, the extracted data is manually reviewed to get familiarised with the data (Akinyemiju et al., 2015). Further, the data is coded and divided into themes that help achieve the research aims and objectives. It assisted in aligning the extracted data in a more logical and systematised flow.
Ethical consideration: Ethical and legal consideration in research is very important to avoid any ethical, moral and legal issues due to the research. To ensure the same, initially, ethical approval is taken from the concerning authority via an ethical approval form (Akinyemiju et al., 2016). The ethical approval form includes all the research details, such as research aims and objectives, methods, expected findings and others. Besides, the research language is also as simple as possible to make clear communication with the audience and to avoid any sort of miscommunication regarding the content that can harm their moral or religious beliefs (Tervonen et al., 2016).
4. Literature Review
Key theorists and works in the field
The cases of Breast Cancer were reduced during the nineteenth century. This was mainly because people were aware of the socio economic impac6t on the disease from an early age. They improved sanitation and infection control aspects in the society, making it healthier. Dr. William Stewart Halsted was a pioneer in aseptic surgery and anaesthesia in the late 1880s. This was the most primitive research and work in this field. Preceding Halsted's radical mastectomy, the 20-year survival rate for breast cancer was 10%; after that it was almost 45%
Janet Lane-Claypon published her first case-controlled research on breast cancer epidemiology in 1925 which also included the different aspects of the society. She conducted a thorough research by using 500 breast cancer affected people and 500 healthy individuals. During this time period, radiotherapy and breast-preserving procedures increased in Australia. Dr. Crile published a series of articles and book chapters criticising the Halsted radical mastectomy. Crile's article “What Women Should Know About Breast Cancer Controversy” was published which explained in details about the socio-economic determinants as well. A paradigm changes in thinking about cancer as a systemic illness occurred in the 1970s with the discovery of metastatic disease and less intrusive therapies by American society of cancer. These are the major researches and theorists in the area.
Key issues
The key issues include understanding the lack of understanding of the socioeconomic determinants of that have a direct impact on breast cancer in Australian Women.
4.1 Theme-1: Breast Cancer and Racial Discrimination are Interrelated
Institutional discrimination includes disparities in access to goods, services, and opportunities in society; personal mediated forms of racial discrimination include prejudice or discrimination; and internalised forms of racial discrimination (Bellavance & Kesmodel, 2016). Australians' access to housing, educational opportunities, and jobs is influenced by these and other forms of racism and prejudice. Disparities in breast cancer risk are exacerbated by variables such as racism, a lack of access to healthcare, obesity and other risk factors, and changes in biology due to chronic stress (e.g., inflammation and oxidative stress). It has been shown that persons who are more discriminated against in society are more likely to get cancer, specifically breast cancer, in comparison to those from wealthier backgrounds. They are unable to get in because of a lack of access and inadequate amenities. This is yet another crucial reason why the vast majority of them are kept untreated, and the situation for these individuals continues to deteriorate. The immigrants, as well as the aboriginals, might be regarded to be a part of this framework in Australia, especially the recent arrivals.
4.1.1 Sub-theme- Practices Associated with Cancer Treatment
According to the research findings, a person's encounter with racism is associated with cancer-related health practices such as smoking, excessive drinking, and obesity. Patients may not make use of healthcare services to the maximum degree feasible due to their mistrust of healthcare professionals and prior unfavourable experiences with healthcare professionals (Ellis et al., 2014). According to a new study, an area average and a binary categorisation are both associated with a higher risk of mortality from any cause. It has been shown that having a higher redlining score is associated with a lower risk of breast cancer-specific death. According to the findings, when forecasting breast cancer mortality, race and ethnicity were shown not to influence the racial bias score or the redlining index. According to the Black Women's Health Study findings, there is a relationship between breast cancer incidence and women's perceived discrimination. It has been shown that discrimination in the general population is associated with an increase in the risk of breast cancer daily (Friis et al., 2018). According to the findings, women under the age of 50 who reported meeting prejudice daily were found to have a greater prevalence of bias than women under the age of 50 who reported encountering prejudice on a less frequent basis. According to the study, individuals who reported discrimination at work had 1.32 incidence rate ratios compared to those who did not report discrimination at work (Friis et al., 2018).
4.2 Theme-2: Breast Cancer and Immigrant Status
A large body of Australian research has shown that the risk of breast cancer in immigrant women increases with time, particularly in younger women. As a result of the disparities in breast cancer mortality rates linked to their place of origin, lifestyle factors such as diet and nutrition, or characteristics associated with reproduction. The nationality of a person is another factor that may impact the stage of breast cancer at the time of diagnosis and overall survival (Gardner, Adams & Jeffreys, 2013). In one observational study, women from China, Japan, and the Philippines who had three or four Western-born grandparents had a 50% greater chance of developing breast cancer than women from the East whose whole family was born in the West. For more than a decade, residents in Western nations had an 80 per cent higher cancer risk than those who had just recently arrived in the country. According to a recent study, Asian Australian women are more likely than their non-Asian counterparts to develop breast cancer (Gentil et al., 2012). This could be due to rising rates of breast cancer in their home countries.
4.2.1 Sub Theme- People Who are at Greater Risks
Women above the age of 50 and those suffering from a localised sickness have a greater prevalence of breast cancer. The presence of oestrogen and progesterone receptors in the bodies of black women from native population was shown to be associated with an increased risk of breast cancer in these individuals. Compared to women from other countries, women born in Australia had a worse five-year survival rate for breast cancer (Glaser, 2013). Among the foreign-born population, there were a significant number of women who were born in the Caribbean. When comparing the incidence of breast cancer among Australian immigrants born in South Asia to that of long-term residents, it was discovered that they had a lower incidence. One study showed that women who spent a long time in the hospital had a greater chance of acquiring breast cancer. According to research, stage-I breast cancer was shown to be less likely among immigrant women than in women born in Australia. During a study of cancer among immigrants, it was observed that there was a healthy immigrant effect (Gomez et al., 2015). According to the figures, breast cancer incidences among recently arrived Australians were much lower than native-born Australians, and the disparity seemed to be narrowing with time.
4.3 Theme-3: Breast Cancer and Social Support
Lack of social connections as well as isolations is often considered to be one of the most important aspects as well as determinants that are having a direct impact on breast cancer. People's social networks are a great resource for exchanging information, advice, and practical aid and delivering and receiving it (Hastert et al., 2014). Having a strong social network and receiving a great deal of support from friends and family members may help to enhance one's health and quality of life. According to multiple studies, breast cancer patients who were married had better prognoses than those who were single when diagnosed with the disease. The existence of social support has been shown to promote physical and mental well-being, resulting in a decrease in depression and an improvement in the overall quality of life for those who receive it (Klassen & Smith, 2011). Patient capacity to properly navigate and experience the healthcare system is influenced by several elements, including social support and networks. People who had outstanding social support and were more active in their care and treatment regimens had access to a greater variety of healthcare choices and treatment options than others.
4.3.1 Sub theme- There is a Risk of Mortality
A study by Klassen & Smith (2011), has shown that women who are socially isolated are twice as likely to die from breast cancer as women who are well-integrated into their communities. The researchers discovered that having a significant number of surviving children, close friends, and family members reduced the participants' death risk (Kuo, Mobley & Anselin, 2011). The Women's Health Initiative investigated the use of social networking sites among breast cancer patients in a research conducted in 2009. However, despite the fact that the association between social support and overall mortality was minor, it was shown to be statistically significant. According to research, persons who are married tend to have longer lives than those who are single. In other words, breast cancer is strongly associated with a number of factors that have a direct influence on the lives of those who are affected by it.
Researchers found that breast cancer patients with strong social networks and support systems had a higher likelihood of survival than those who did not. The findings were published in 2013. According to the findings of research, social isolation does not raise the risk of breast cancer recurrence or survival. The likelihood of dying from any cause increases if you're socially isolated compared to someone in the same age group who isn't isolated. According to the findings of the research, the risk of mortality was higher for women who had less social support than for women who had more social support (Kwapisz, 2018). Following breast cancer diagnosis, three of the four cohorts investigated by the After Breast Cancer Pooling studies had outcomes that were similar for women who had breast cancer. According to the findings of this research, women who were socially isolated were more likely to die from breast cancer, have a recurrence, and have a poor diet in general than those who were socially integrated (Lyle, Hendrie & Hendrie, 2017). It was discovered that there were no statistically significant associations between the specific outcomes of breast cancer and any other outcome variables in the following cohort. Despite the fact that Black women had less friends and family members than white women, there was a link between late-stage sickness and social network summary measures (Stanbury et al., 2016). This might be due to the fact that their sickness was more advanced. It has been shown that a lack of personal ties and emotional support is associated with an increased risk of breast cancer-specific death. Women of colour and white women who did not have emotional support pillars were more likely than other women to die from breast cancer than women of other races and backgrounds. In a population-based study of breast cancer patients, the size of a woman's social network had no influence on her overall survival (Meijer et al., 2012). After a diagnosis has been made, it has been discovered that the presence of friends and family may reduce the chance of death in specific conditions
4.4 Theme-4: Economic Consequences of Breast Cancer
Socioeconomic characteristics, such as poverty, illiteracy, neighbourhood disadvantage, racial segregation in housing, race-based prejudice, lack of social support, and social isolation, have substantially impacted diagnosis and survival in this study. As a result of their lower socioeconomic status, native Australian women are more likely than other women to develop high-grade, late-stage, and oestrogen receptor-negative breast cancer. According to a recent study, social determinants have a substantial role in understanding the racial differences in outcomes among women with aggressive breast cancer subtypes (Melvin et al., 2016). African-Australian women with triple-negative breast cancer are more likely than other women to be discovered and survive at a later stage due to income disparities between races. The socioeconomic level may influence her lifetime risk of breast cancer, which has been underestimated in the past. Early menarche is related to a higher risk for women from lower socioeconomic backgrounds when it comes to breast cancer. It has been shown that emotional or physical maltreatment at a young age is associated with obesity in later years of life (Moher et al., 2015). It is necessary to examine breast cancer risk factors throughout time to understand better the socioeconomic factors that contribute to health inequalities. Native Australian women may be more susceptible to breast cancer due to their poor socioeconomic level as children and as adults and long-term stress as children and adults. Immigrants have been proven to have a decreased risk of breast cancer; however, the effect of immigration on breast cancer risk reduces with time (Supramaniam et al., 2014). Breast cancer stages at diagnosis and survival have both been shown to be significantly influenced by one's country of origin, according to research. As a consequence of lower screening rates, immigrants are more likely than their native-born counterparts to be diagnosed with breast cancer at an advanced stage.
4.4.1 Sub Theme-IT is Impossible to Stress the Significance of Maintaining a Healthy Diet
Because of the high expense of breast cancer treatment, studies examining the association between food insecurity and breast cancer outcomes are urgently required. A lack of nutrients in the diets of undernourished people may exacerbate the development of obesity and diabetes (Moore et al., 2015). It has been shown that food instability, particularly among the elderly and economically poor, may raise the risk of breast cancer and death. Following the publication of these findings, it is necessary to treat breast cancer survivors as a whole, considering their socioeconomic situation. Prevention and treatment strategies that consider a cancer patient's socioeconomic and environmental circumstances are essential for reducing cancer inequalities and improving health outcomes (Moriceau et al., 2015). Oncological outcomes such as cancer incidence, stage at diagnosis, and survival are connected with various phases of cancer neoplasia (i.e., initiation, promotion, and progression). Societal variables that contribute to cancer inequalities may impact patients at any stage of their disease.
5. Discussion about Gaps in The Literature
Gaps in the literature must be discovered and filled in for readers to appreciate the many limitations and disadvantages that the research attempts to address in its current form. For the same reason, readers need to be aware of the several areas of limitation linked with the research to not blindly trust the different pieces of information offered in a particular study (Parker, 2017). It also aids youngsters in absorbing the many different aspects and views conveyed to them via books and other sources of knowledge. It is possible to identify several limitations in this particular research project and literature review. As a starting point, most journals and publications have carried out a thorough literature review on a representative sample of their respective populations. In one of the studies, the sample size was 400 people, all of whom were in their mid-to late-thirties or older (Roberts et al., 2015). Therefore, the conclusions from that specific research study will only apply to those who fall into that particular age range. In contrast, observations and evidence provided by the individuals enlisted to participate in the sampling procedure should not be overlooked, as previously indicated. This means that the authenticity of the information is mainly dependant on the individuals who are questioned during the sampling phase and their responses to the questions. As a bonus, various areas of clinical terminology and medical illnesses have been taken into account, although they are not treated extensively in the book itself (Roder et al., 2012).
When it comes to medicine, it is often revealed that just the most superficial aspects of the field, such as the association between age and breast cancer and the relationship between physical activity and breast cancer, have been taken into account (Roeke et al., 2018). In this particular research endeavour, due to the restricted quantity of data and information available on the internet, other important issues of genetics and comorbidity are not given adequate consideration. Furthermore, many of the most important pieces of information and publications were refused admission because of worries about privacy. Several researchers in the paper indicated that they had received news that was out of date. Consequently, they had received comparable out of date material that was used in this specific study endeavour. Despite this, the researchers made every effort to incorporate up-to-date material from current publications wherever feasible (Shariff-Marco et al., 2014). Recognising and understanding this gap is crucial for the readers because it will assist them in realising that this research effort has several limitations, which they should consider before using the knowledge from this specific research study in other contexts. Consequently, this component of the study effort has attempted to identify the many gaps and limits that it is now experiencing in its findings. Taking into consideration the research work, we would like to state that the majority of the information has been thoroughly researched to ensure that it is authentic and genuine and that it does not deviate significantly from the original point and information that was intended to be delivered to the readers (Smith & Noble, 2015). On the other hand, the research work has tried to make the readers familiar with the issue vividly by properly using a strong structure of the literature review.
6. Conclusion
The socio-economic condition has a huge impact on breast cancer in Australian society. Different socioeconomic conditions have an impact on any cancer in any part of the world. The socioeconomic condition not only includes unemployment and poverty but also include neighbourhood discrimination and equality. All these important aspects have a role in the mental changes and the kind of physical labour that one has to undergo in their lifetime. This report has tried to briefly narrate the impact that the socio-economic determinants are having on society and how it directly links with the increase in breast cancer cases in Australia. A significant disparity in survival rates was found for cancers of the stomach, lungs, breasts, colon, and rectum among different SES regions in New South Wales. As found elsewhere, socioeconomic inequalities in cancer care in NSW may be partly attributed to differences in the quality and availability of cancer care for different socioeconomic groups. Estimates of the number of lives that may be saved by improving cancer survival in lower-income regions of New South Wales, Australia, suggest that improving lung cancer therapy in lower-income areas should get the greatest focus, at least initially.
The most significant flaw in this specific study endeavour is that the papers employed a sample of various ages from different geographical places, which creates a significant disparity in the findings. As a result, all of the debate and discovery will be focused on that specific age group and its trends. The fact that one article will designate the age group of 10 to 20 years and another will denote the age group of 50 to 60 years depending on the requirements of that particular reference file is deemed to be the most significant gap in this specific study endeavour.
The above research works on the below following questions:
1. What are the different socio-economical determinants that have a direct impact on breast cancer in Australia?
2. How the different socio-economical determinants that have a direct impact on breast cancer in Australia?
3. How are people of different social statuses affected by different socio-economical determinants?
The above questions share some gap, where further research can be carried on the topic of cure of others types of cancer with the help of socio economical determinants. If these determinants can have a negative impact on cancer, then it is important to do research on if it has something to cure the disease.
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