Experiencing breast cancer in managed care.

The interest of managed care organizations (MCOs) in decreasing care and outcome variance and lowering costs has created many concerns including those pertaining to the complex and costly nature of cancer care. In this study, we used a hermeneutic phenomenological approach involving semistructured interviews of 14 women with breast cancer to examine MCO enrollees' experiences related to their cancer treatment. Results comprise two themes: managed care tasks and managing or mediating between the MCO and the cancer. These themes, and their accompanying categories, depict the increased burden encountered by women experiencing breast cancer in a managed care system who perceived that they were solely responsible for mediating between their care providers and MCO. Though enrolled in less-restrictive MCOs, participants expressed many difficulties in managing dissimilar and disconnected demands posed by the cancer and the MCO. These findings might serve as a basis for policy and practice changes to decrease this real patient burden.