Expert: Rural Adults Are ‘More Likely to Be Fatalistic About Cancer, More Likely to Be Overloaded by Cancer Information’

Pharmacy Times interviewed Jakob Jensen, PhD, professor in the Department of Communication at the University of Utah and member of the Huntsman Cancer Institute, on a study he was the senior author of that assessed rural residents’ beliefs and perceptions of cancer-related information in comparison with those of urban residents.

Alana Hippensteele: What did your study show regarding the beliefs and perceptions of cancer among adults living in rural areas?

Jakob Jensen: They're far more likely to be fatalistic about cancer, and they're more likely to be overloaded by cancer information. That is, they report that there's nothing they can really do to prevent cancer, there's nothing to do since cancer is a death sentence, and that they're overwhelmed by the amount of information they're supposed to process compared to their urban counterparts. They're just far more likely to believe these fatalistic statements and these information overload type statements.

Alana Hippensteele: How did these beliefs and perceptions among rural adults compare to those of adults living in urban areas? What was the difference?

Jakob Jensen: Yeah, it's relatively sizable. So urban adults are far less likely to be fatalistic and they're far less likely to be overloaded by information. I suspect that's a coping response, by the way. So, when rural adults lack access, when they lack health care—people don't like to live in a negative situation. So, if you can't change the situation, then you change the way you think about it, right.

I think it was Maya Angelou who taught us that that's how we should function: If you can't change it, then change yourself. Rural adults demonstrate this. When they don't have access, [they] don't want to walk around saying, ‘I don't have access, and that means I'm more likely to die,’ you go, ‘Meh, doesn't matter. There's nothing you could do anyways. Doesn't matter that I don't have access to a mammogram. Mammograms don't matter, they don't help. It doesn't matter that I can't see this specialist or get access to this preventive equipment, because that equipment doesn't work.’

So, the belief pattern they exhibit, there's a rationality to it. The brain is going to deemphasize things, or it's going to tear down things that it knows it has less access to, because then the access issue is not a problem. In fact, then the access issue is irrelevant. And again, as a rural person myself, this really resonates with me, because in rural communities, people will say things like, ‘My uncle went in and found out he had a brain tumor, and he only made it another 2 weeks. I think he worried himself to death. If he had known he had that tumor, he’d probably still be alive.’ That is, even when someone gets access, there's a tendency to try to say, ‘Well the access was bad. If he had just not done anything, he would be better.’

While that can be frustrating, I think for those of us that work in health care, we also need to appreciate that there's a service gap that we have that is real, and patients must live with that gap. And that's hard to do. Right? Especially as we've struggled a bit to implement telemedicine, for example, to reach those communities.

Alana Hippensteele: How has the widespread shift to virtual care during the pandemic shifted access to health care infrastructure in rural areas? Has there been an increase in utilization of virtual health care services among rural residents potentially shifting the preexisting lack of access and concerns related to that into a new direction?

Jakob Jensen: Prior to the pandemic, telemedicine had not realized its potential in the United States. I remember some of the earliest infrastructure was being laid in the late 80s and early 90s with dial up internet, and it had both medicine as well as educational goals.

So, rural communities were going to receive service, we were going to deal with these access gaps, digitally, but we would invest in the infrastructure in rural communities, and they wouldn't get used. Some of that was that the rural communities themselves wouldn't use it. But some of that was also that the providers and educators wouldn't use the system on the other end as well. So, prior to the pandemic, telemedicine in general, and tele-education in general, would have not reached the potential that we had hoped for it initially. I won't say it was a failure because there were pockets of success. There were practices or areas that were seeing more success than others. But the kind of dream we had, like I in the late 80s, early 90s about it was not fully realized for sure.

The pandemic—there's a lot of negative aspects to it. But one positive is that it did accelerate our use of teletechnology. And we all know that we've been living in the “Zoomiverse” for 2 years now. The upside of that is, there's a lot more reason to be optimistic about telemedicine now than there was before the pandemic. I mean, before the pandemic, I would say to people, telemedicine does not have the ability to meaningfully address rural health care problems, because providers will not use it. So, you can build it, but not one none of the providers are interested in using it. And there was a lot of reasons for that—it was complicated from a liability standpoint.

So, there was only a few states that would ensure providers when they were using the systems. For example, for dermatologists, there's only 2 states in the United States that would take the time to ensure dermatologists so they could practice tele-dermatology. So, imagine being a dermatologist and you're told to use a system where your liability insurance may not cover you. I mean, it's just not practical—no way you can practice medicine that way and notice the risk of it. I'm being asked to look at a patient who I can't meet with one on one, and they're going to ask me about things like is this mole cancer, and I can only see a 2-dimensional image in the light of maybe their cell phone like that right here. The dermatologist is saying, ‘It's a high-risk clinical situation, and that misdiagnosis is very high.’

So, telemedicine was struggling, and it still has some of those barriers. I've read some utopian articles where people have said things like, ‘Oh, well, now that the pandemics happened, now telemedicine is booming, and it's the way of the future.’ I still wouldn't go that far—I still think there's a lot of unrealized potential. Some of that comes down to the brick-and-mortar infrastructure, some of that comes down to the insurance and protecting providers when they engage in this.

One problem I have is even the successes that we've had during the pandemic—are they sustainable? Will providers continue to engage in practice in that way? I would love to see us leverage this into opportunity, and I would love to see trials that try to encourage providers to innovate and continue the success that we've had. But the history of that is a bit rocky. So, I still think we're a little way off from that being the real solution. One hundred years from now, maybe we're there. But one of the lessons is it didn't happen as fast as we would hope.