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Zebrack B, Schapmire T, Damaskos P, Grignon M, Smith SK. The essential and evolving nature of oncology social work: Accomplishments and impact, 2010-present. J Psychosoc Oncol 2024:1-30. [PMID: 39373332 DOI: 10.1080/07347332.2024.2404577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2024]
Abstract
This paper demonstrates the essential nature of oncology social work and the critical role that oncology social workers (OSWs) play in the achievement of high-quality cancer care that improves patient outcomes, contains cost, advances population health, reduces provider burn-out among healthcare providers, and does it in a manner that addresses disparities and achieves equity. To this end, this paper's purpose is two-fold: (1) to review and demonstrate OSW contributions to the advancement of comprehensive cancer care over the last 15 years, and (2) to consider next steps for the Association of Oncology Social Work (AOSW) and the Oncology Social Work profession to achieve its mission and calling. To enhance the viability and security of OSWs and the professional organizations that support them, this report summarizes a breadth and depth of work and includes recommendations for the profession.
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Affiliation(s)
- Brad Zebrack
- University of Michigan School of Social Work, Ann Arbor, Michigan, USA
| | - Tara Schapmire
- School of Medicine, Division of Palliative Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Penny Damaskos
- Sliver School of Social Work, New York University, New York, New York, USA
- Wurzweiler School of Social Work, Yeshiva University, New York, New York, USA
| | | | - Sophia K Smith
- Duke School of Nursing, Faculty Member, Duke Cancer Institute, Durham, North Carolina, USA
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Marsh M, Shah SR, Munce SEP, Perrier L, Lee TSJ, Colella TJF, Kokorelias KM. Characteristics of Existing Online Patient Navigation Interventions: Scoping Review. JMIR Med Inform 2024; 12:e50307. [PMID: 39159443 PMCID: PMC11369544 DOI: 10.2196/50307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 12/19/2023] [Accepted: 06/30/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Patient navigation interventions (PNIs) can provide personalized support and promote appropriate coordination or continuation of health and social care services. Online PNIs have demonstrated excellent potential for improving patient knowledge, transition readiness, self-efficacy, and use of services. However, the characteristics (ie, intervention type, mode of delivery, duration, frequency, outcomes and outcome measures, underlying theories or mechanisms of change of the intervention, and impact) of existing online PNIs to support the health and social needs of individuals with illness remain unclear. OBJECTIVE This scoping review of the existing literature aims to identify the characteristics of existing online PNIs reported in the literature. METHODS A scoping review based on the guidelines outlined in the Joanna Briggs Institute framework was conducted. A search for peer-reviewed literature published between 1989 and 2022 on online PNIs was conducted using MEDLINE, CINAHL, Embase, PsycInfo, and Cochrane Library databases. Two independent reviewers conducted 2 levels of screening. Data abstraction was conducted to outline key study characteristics (eg, study design, population, and intervention characteristics). The data were analyzed using descriptive statistics and qualitative content analysis. RESULTS A total of 100 studies met the inclusion criteria. Our findings indicate that a variety of study designs are used to describe and evaluate online PNIs, with literature being published between 2003 and 2022 in Western countries. Of these studies, 39 (39%) studies were randomized controlled trials. In addition, we noticed an increase in reported online PNIs since 2019. The majority of studies involved White females with a diagnosis of cancer and a lack of participants aged 70 years or older was observed. Most online PNIs provide support through navigation, self-management and lifestyle changes, counseling, coaching, education, or a combination of support. Variation was noted in terms of mode of delivery, duration, and frequency. Only a small number of studies described theoretical frameworks or change mechanisms to guide intervention. CONCLUSIONS To our knowledge, this is the first review to comprehensively synthesize the existing literature on online PNIs, by focusing on the characteristics of interventions and studies in this area. Inconsistency in reporting the country of publication, population characteristics, duration and frequency of interventions, and a lack of the use of underlying theories and working mechanisms to inform intervention development, provide guidance for the reporting of future online PNIs.
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Affiliation(s)
- Meghan Marsh
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Syeda Rafia Shah
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Sarah E P Munce
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
- KITE, Toronto Rehabiliation Institute, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Laure Perrier
- Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | | | | | - Kristina Marie Kokorelias
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
- Section of Geriatrics, Sinai Health and University Health Network, Toronto, ON, Canada
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Davis LE, Strumpf EC, Patel SV, Mahar AL. Income differences in time to colon cancer diagnosis. Cancer Med 2024; 13:e6999. [PMID: 39096087 PMCID: PMC11297540 DOI: 10.1002/cam4.6999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/24/2024] [Accepted: 01/31/2024] [Indexed: 08/04/2024] Open
Abstract
INTRODUCTION People with low income have worse outcomes throughout the cancer care continuum; however, little is known about income and the diagnostic interval. We described diagnostic pathways by neighborhood income and investigated the association between income and the diagnostic interval. METHODS This was a retrospective cohort study of colon cancer patients diagnosed 2007-2019 in Ontario using routinely collected data. The diagnostic interval was defined as the number of days from the first colon cancer encounter to diagnosis. Asymptomatic pathways were defined as first encounter with a colonoscopy or guaiac fecal occult blood test not occurring in the emergency department and were examined separately from symptomatic pathways. Quantile regression was used to determine the association between neighborhood income quintile and the conditional 50th and 90th percentile diagnostic interval controlling for age, sex, rural residence, and year of diagnosis. RESULTS A total of 64,303 colon cancer patients were included. Patients residing in the lowest income neighborhoods were more likely to be diagnosed through symptomatic pathways and in the emergency department. Living in low-income neighborhoods was associated with longer 50th and 90th-percentile symptomatic diagnostic intervals compared to patients living in the highest income neighborhoods. For example, the 90th percentile diagnostic interval was 15 days (95% CI 6-23) longer in patients living in the lowest income neighborhoods compared to the highest. CONCLUSION These findings reveal income inequities during the diagnostic phase of colon cancer. Future work should determine pathways to reducing inequalities along the diagnostic interval and evaluate screening and diagnostic assessment programs from an equity perspective.
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Affiliation(s)
- Laura E. Davis
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealCanada
- ICESTorontoCanada
| | - Erin C. Strumpf
- Department of Epidemiology, Biostatistics and Occupational HealthMcGill UniversityMontrealCanada
- Department of EconomicsMcGill UniversityMontrealCanada
| | | | - Alyson L. Mahar
- ICESTorontoCanada
- School of NursingQueen's UniversityKingstonCanada
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Pohl SA, Nelson BA, Patwary TR, Amanuel S, Benz EJ, Lathan CS. Evolution of community outreach and engagement at National Cancer Institute-Designated Cancer Centers, an evolving journey. CA Cancer J Clin 2024; 74:383-396. [PMID: 38703384 DOI: 10.3322/caac.21841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/26/2024] [Accepted: 04/09/2024] [Indexed: 05/06/2024] Open
Abstract
Cancer mortality rates have declined during the last 28 years, but that process is not equitably shared. Disparities in cancer outcomes by race, ethnicity, socioeconomic status, sexual orientation and gender identity, and geographic location persist across the cancer care continuum. Consequently, community outreach and engagement (COE) efforts within National Cancer Institute-Designated Cancer Center (NCI-DCC) catchment areas have intensified during the last 10 years as has the emphasis on COE and catchment areas in NCI's Cancer Center Support Grant applications. This review article attempts to provide a historic perspective of COE within NCI-DCCs. Improving COE has long been an important initiative for the NCI, but it was not until 2012 and 2016 that NCI-DCCs were required to define their catchment areas rigorously and to provide specific descriptions of COE interventions, respectively. NCI-DCCs had previously lacked adequate focus on the inclusion of historically marginalized patients in cancer innovation efforts. Integrating COE efforts throughout the research and operational aspects of the cancer centers, at both the patient and community levels, will expand the footprint of COE efforts within NCI-DCCs. Achieving this change requires sustained commitment by the centers to adjust their activities and improve access and outcomes for historically marginalized communities.
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Affiliation(s)
- Sarah A Pohl
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Barry A Nelson
- Dana-Farber/Harvard Cancer Center Faith Based Cancer Disparities Network, Boston, Massachusetts, USA
| | - Tanjeena R Patwary
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Salina Amanuel
- Columbia University Mailman School of Public Health, New York, New York, USA
| | - Edward J Benz
- Dana-Farber Cancer Center, Dana-Farber/Harvard Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher S Lathan
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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Rivera Rivera JN, AuBuchon KE, Schubel LC, Starling C, Tran J, Locke M, Grady M, Mete M, Blumenthal HJ, Galarraga JE, Arem H. Supporting ColoREctal Equitable Navigation (SCREEN): a protocol for a stepped-wedge cluster randomized trial for patient navigation in primary care. Implement Sci Commun 2024; 5:60. [PMID: 38831365 PMCID: PMC11149321 DOI: 10.1186/s43058-024-00598-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 05/27/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Black individuals in the United States (US) have a higher incidence of and mortality from colorectal cancer (CRC) compared to other racial groups, and CRC is the second leading cause of death among Hispanic/Latino populations in the US. Patient navigation is an evidence-based approach to narrow inequities in cancer screening among Black and Hispanic/Latino patients. Despite this, limited healthcare systems have implemented patient navigation for screening at scale. METHODS We are conducting a stepped-wedge cluster randomized trial of 15 primary care clinics with six steps of six-month duration to scale a patient navigation program to improve screening rates among Black and Hispanic/Latino patients. After six months of baseline data collection with no intervention we will randomize clinics, whereby three clinics will join the intervention arm every six months until all clinics cross over to intervention. During the intervention roll out we will conduct training and education for clinics, change infrastructure in the electronic health record, create stakeholder relationships, assess readiness, and deliver iterative feedback. Framed by the Practical, Robust Implementation Sustainment Model (PRISM) we will focus on effectiveness, reach, provider adoption, and implementation. We will document adaptations to both the patient navigation intervention and to implementation strategies. To address health equity, we will engage multilevel stakeholder voices through interviews and a community advisory board to plan, deliver, adapt, measure, and disseminate study progress. Provider-level feedback will include updates on disparities in screening orders and completions. DISCUSSION Primary care clinics are poised to close disparity gaps in CRC screening completion but may lack an understanding of the magnitude of these gaps and how to address them. We aim to understand how to tailor a patient navigation program for CRC screening to patients and providers across diverse clinics with wide variation in baseline screening rates, payor mix, proximity to specialty care, and patient volume. Findings from this study will inform other primary care practices and health systems on effective and sustainable strategies to deliver patient navigation for CRC screening among racial and ethnic minorities. TRIAL REGISTRATION NCT06401174.
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Affiliation(s)
- Jessica N Rivera Rivera
- Healthcare Delivery Research Network, MedStar Health Research Institute, Washington, DC, USA
| | - Katarina E AuBuchon
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Laura C Schubel
- Healthcare Delivery Research Network, MedStar Health Research Institute, Washington, DC, USA
| | - Claire Starling
- Healthcare Delivery Research Network, MedStar Health Research Institute, Washington, DC, USA
| | - Jennifer Tran
- Department of Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Marjorie Locke
- Department of Surgery, MedStar Washington Hospital Center, Washington, DC, USA
| | - Melanie Grady
- MedStar Health Institute for Quality and Safety, Washington, DC, USA
| | - Mihriye Mete
- Department of Behavioral Health Research, MedStar Health Research Institute, Washington, DC, USA
- Department of Psychiatry, Georgetown University School of Medicine, Washington, DC, USA
| | - H Joseph Blumenthal
- Center for Biostatistics, Informatics and Data Science, MedStar Health Research Institute, Washington, DC, USA
| | | | - Hannah Arem
- Healthcare Delivery Research Network, MedStar Health Research Institute, Washington, DC, USA.
- Department of Oncology, Georgetown University, Washington, DC, USA.
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Oppong BA, Rumano RP, Paskett ED. Expanding the use of patient navigation: health coaching-based navigation as a novel approach to addressing deficits in breast cancer survivorship support. Breast Cancer Res Treat 2024; 205:1-3. [PMID: 38273216 DOI: 10.1007/s10549-023-07213-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/07/2023] [Indexed: 01/27/2024]
Abstract
Patient navigation (PN) was created to address barriers to screening and workup for cancers. Since its inception it has resulted in improved mammography utilization, diagnostic resolution, and time to breast cancer treatment initiation in medically underserved populations. Because an abundance of evidence has established PN's positive impact, its use has expanded within the breast cancer care continuum, from screening, treatment, and ultimately survivorship. Increasing applications for navigation now also include support in the treatment and survivorship phase. After treatment, populations who struggle with the complex medical systems where oncology care is often delivered, also lack the support resources needed to successfully transition to survivorship. Support in the psychosocial realm is important for these patients as they continue surveillance and adherence to maintenance medications, such as hormonal therapy.
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Affiliation(s)
- Bridget A Oppong
- The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, United States.
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, United States.
| | - Ruvarashe P Rumano
- The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, United States
- College of Public Health, The Ohio State University, Columbus, United States
| | - Electra D Paskett
- The Ohio State University James Comprehensive Cancer Center, Columbus, Ohio, United States
- Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, United States
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Varanasi AP, Burhansstipanov L, Dorn C, Gentry S, Capossela MA, Fox K, Wilson D, Tanjasiri S, Odumosu O, Saavedra Ferrer EL. Patient navigation job roles by levels of experience: Workforce Development Task Group, National Navigation Roundtable. Cancer 2024; 130:1549-1567. [PMID: 38306297 DOI: 10.1002/cncr.35147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
PLAIN LANGUAGE SUMMARY Cancer patient navigators work in diverse settings ranging from community-based programs to comprehensive cancer centers to improve outcomes in underserved populations by eliminating barriers to timely cancer prevention, early detection, diagnosis, treatment, and survivorship in a culturally appropriate and competent manner. This article clarifies the roles and responsibilities of Entry, Intermediate, and Advanced level cancer patient navigators. The competencies described in this article apply to patient navigators, nurse navigators, and social work navigators. This article provides a resource for administrators to create job descriptions for navigators with specific levels of expertise and for patient navigators to advance their oncology careers and attain a higher level of expertise.
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Affiliation(s)
| | | | - Carrie Dorn
- National Association of Social Workers, Washington, DC, USA
| | - Sharon Gentry
- Academy of Oncology Nurse and Patient Navigators (AONN+), Lewisville, North Carolina, USA
| | | | - Kyandra Fox
- Patient Navigation, Education and Training, Susan G. Komen Foundation, Allen, Texas, USA
| | - Donna Wilson
- HCA Henrico Doctors' Hospital/Virginia Cancer Patient Navigator Network (VaCPNN), Midlothian, Virginia, USA
| | - Sora Tanjasiri
- Department of Health, Society and Behavior, University of Irvine, Irvine, California, USA
| | | | - Elba L Saavedra Ferrer
- College of Education and Human Sciences, University of New Mexico, Albuquerque, New Mexico, USA
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Hill TT, Cooper IR, Gill PK, Okonkwo-Dappa AJ, Heykoop CH. Learnings from Racialized Adolescents and Young Adults with Lived Experiences of Cancer: "It's Okay to Critique the System That Claims to Save Us". Curr Oncol 2024; 31:1091-1101. [PMID: 38392075 PMCID: PMC10888397 DOI: 10.3390/curroncol31020081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/17/2024] [Accepted: 02/14/2024] [Indexed: 02/24/2024] Open
Abstract
Interest in AYA cancer care has increased globally over the recent past; however, most of this work disproportionately represents white, heterosexual, middle-income, educated, and able-bodied people. There is recognition in the literature that cancer care systems are not structured nor designed to adequately serve people of colour or other equity-denied groups, and the structural racism in the system prevents prevention, treatment, and delivery of care. This work seeks to examine structural racism and the ways that it permeates into the lived experiences of AYAs in their cancer care. This article represents the first phase of an 18-month, patient-oriented, Participatory Action Research project focused on cancer care for racialized AYAs that is situated within a broader program of research focused on transforming cancer care for AYAs. Semi-structured interviews were completed with 18 AYAs who self-identify as racialized, have lived experiences with cancer, and have received treatment in Canada. Following participant review of their transcripts, the transcripts were de-identified, and then coded by three separate authors. Five main themes were identified using thematic analysis, including the need to feel supported through experiences with (in)fertility, be heard and not dismissed, advocate for self and have others advocate for you, be in community, and resist compliance.
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Affiliation(s)
- Tiffany T. Hill
- Anew Research Collaborative, Royal Roads University, Victoria, BC V9B 5Y2, Canada; (I.R.C.); (A.J.O.-D.); (C.H.H.)
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Carr AL, Vinod N, Farha P, Lu T, Farha MJ, Graves KD. An exploration of facilitators and barriers to patient navigator core functions with breast cancer patients: Implications for the development of a human-centered mHealth app. PEC INNOVATION 2023; 3:100226. [PMID: 37859864 PMCID: PMC10583173 DOI: 10.1016/j.pecinn.2023.100226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 10/21/2023]
Abstract
Objectives To understand the barriers to core functions and workflow among patient navigators (PN) who navigate people diagnosed with breast cancer (BC). To identify how a mobile health (mHealth) app could assist PNs in providing care to BC patients. Methods This qualitative research study used purposive sampling to recruit stakeholders (N = 33) from January to August 2021. We conducted individual semi-structured interviews with PNs (n = 11), oncology care providers (n = 12), and BC patients (n = 10). We used conventional content analysis to analyze the interview data. Results Participants identified the following sociotechnical systems barriers in PN workflows that negatively impact BC patient care: 1) resources, 2) insurance coverage, 3) communication challenges, and 4) impact of logistical tasks. Participants identified the user experience, app features, and interoperability customizations to enhance PNs' provision of patient care as important design elements to include in a mHealth app. Conclusion Feedback from stakeholders provided valuable insights into key design considerations, functions, and content areas for developing a mHealth app for PN use in BC care delivery. Innovation This is one of the first studies to incorporate the human-centered design and sociotechnical systems frameworks to understand barriers to PN workflow and provision of BC patient care across the cancer care continuum.
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Affiliation(s)
- Alaina L. Carr
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Naomi Vinod
- Department of Psychology, Howard University, Washington, DC, USA
| | | | - Tan Lu
- Avident Health LLC, Baltimore, MD, USA
- Department of Surgery, MedStar Union Memorial and Good Samaritan Hospitals, Baltimore, MD, USA
| | - Maen J. Farha
- Avident Health LLC, Baltimore, MD, USA
- Department of Surgery, MedStar Union Memorial and Good Samaritan Hospitals, Baltimore, MD, USA
| | - Kristi D. Graves
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
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Mayo SJ, Panesar P, Edwards B, Howell D. Information needs across time after a hematological cancer diagnosis: A qualitative study of patient and clinician perspectives. PATIENT EDUCATION AND COUNSELING 2023; 117:107970. [PMID: 37716029 DOI: 10.1016/j.pec.2023.107970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/16/2023] [Accepted: 09/02/2023] [Indexed: 09/18/2023]
Abstract
OBJECTIVE The aim of this study was to characterize the information needs experienced by adult patients across the continuum of their hematological cancer. METHODS Individual semi-structured telephone interviews were conducted with 28 adults with hematological cancer and 18 clinicians recruited from across Canada and analyzed using interpretive description. RESULTS Distinct information needs were organized across seven points of the cancer continuum: prior to diagnosis, at diagnosis, prior to treatment, during treatment, after treatment, relapse/non-response, and end of life. Patients' information needs reflected a desire to better understand their current physical and psychosocial circumstances, as well as how to make decisions about their treatment, self-management, and health care. The need to receive information in a preparatory way was relevant across all phases of the cancer continuum. CONCLUSION Our work contributes an initial approach for providing patient education and counselling for people with hematological cancers, which can be tailored based on individuals' unique characteristics and treatment pathways. PRACTICE IMPLICATIONS Adults with hematological cancers require information to support decision making over the course of their diagnosis, treatment, and survivorship, but can experience information overwhelm. These findings provide an approach for organizing the delivery of information based on different points of need across the cancer continuum.
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Affiliation(s)
- Samantha J Mayo
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada; Princess Margaret Cancer Centre, Toronto, Canada.
| | - Prabdeep Panesar
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | | | - Doris Howell
- Princess Margaret Cancer Centre, Toronto, Canada
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Semprini JT, Biddell CB, Eberth JM, Charlton ME, Nash SH, Yeager KA, Evans D, Madhivanan P, Brandt HM, Askelson NM, Seaman AT, Zahnd WE. Measuring and addressing health equity: an assessment of cancer center designation requirements. Cancer Causes Control 2023; 34:23-33. [PMID: 36939948 PMCID: PMC10512189 DOI: 10.1007/s10552-023-01680-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/27/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE By requiring specific measures, cancer endorsements (e.g., accreditations, designations, certifications) promote high-quality cancer care. While 'quality' is the defining feature, less is known about how these endorsements consider equity. Given the inequities in access to high-quality cancer care, we assessed the extent to which equity structures, processes, and outcomes were required for cancer center endorsements. METHODS We performed a content analysis of medical oncology, radiation oncology, surgical oncology, and research hospital endorsements from the American Society of Clinical Oncology (ASCO), American Society of Radiation Oncology (ASTRO), American College of Surgeons Commission on Cancer (CoC), and the National Cancer Institute (NCI), respectively. We analyzed requirements for equity-focused content and compared how each endorsing body included equity as a requirement along three axes: structures, processes, and outcomes. RESULTS ASCO guidelines centered on processes assessing financial, health literacy, and psychosocial barriers to care. ASTRO guidelines related to language needs and processes to address financial barriers. CoC equity-related guidelines focused on processes addressing financial and psychosocial concerns of survivors, and hospital-identified barriers to care. NCI guidelines considered equity related to cancer disparities research, inclusion of diverse groups in outreach and clinical trials, and diversification of investigators. None of the guidelines explicitly required measures of equitable care delivery or outcomes beyond clinical trial enrollment. CONCLUSION Overall, equity requirements were limited. Leveraging the influence and infrastructure of cancer quality endorsements could enhance progress toward achieving cancer care equity. We recommend that endorsing organizations 1) require cancer centers to implement processes for measuring and tracking health equity outcomes and 2) engage diverse community stakeholders to develop strategies for addressing discrimination.
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Affiliation(s)
- Jason T Semprini
- Department of Health Management and Policy, College of Public Health, University of Iowa, 145 N. Riverside Dr. N277, Iowa City, IA, 52240, USA.
| | - Caitlin B Biddell
- Department of Health Policy and Management, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jan M Eberth
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Mary E Charlton
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Sarah H Nash
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Katherine A Yeager
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Donoria Evans
- National Partnerships and Innovations, American Cancer Society, Decatur, GA, USA
| | - Purnima Madhivanan
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona. Tucson, Tuscon, AZ, USA
| | - Heather M Brandt
- St. Jude Children's Research Hospital and St. Jude Comprehensive Cancer Center, Memphis, TN, USA
| | - Natoshia M Askelson
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Aaron T Seaman
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, USA
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Whitney E Zahnd
- Department of Health Management and Policy, College of Public Health, University of Iowa, 145 N. Riverside Dr. N277, Iowa City, IA, 52240, USA
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Glaser KM, Dauphin C, Johnson D, Harris N, Crabtree-Ide CR, Bouchard EG. Advancing community-academic partnerships to achieve breast health equity: Applying the community-based participatory model to build capacity for sustained impact. Cancer 2023; 129:3162-3170. [PMID: 37691523 PMCID: PMC10513749 DOI: 10.1002/cncr.34976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND This formative study leveraged a community-academic partnership to identify barriers to care that are potential sources of breast cancer disparities in Black women. Through this partnership and using a community-based participatory research approach, the objective was to develop a community task force to inform future interventions aimed at addressing breast cancer disparities and increasing health equity. METHODS The authors assessed gaps in care related to breast cancer in Buffalo, New York, by collecting and analyzing qualitative data from focus groups and interviews with breast cancer survivors and breast navigation groups assessing barriers and facilitators across the cancer care continuum. Then, community-based participatory research approaches were used to build a task force to develop an action plan addressing gaps in care. RESULTS The authors conducted a thematic analysis of qualitative findings to understand barriers and facilitators to cancer care. Three main domains of themes emerged, including medical mistrust, fear, and stigma; the importance of patient navigation as a form of social support; and the importance of faith and faith-based community. Finally, the findings were presented to a newly formed community task force to validate the data collected and set future priorities to address breast cancer disparities and increase breast health equity in the region. CONCLUSIONS The authors observed that health equity is a critically important issue in cancer care and that developing culturally tailored interventions has the potential to improve care delivery and reduce breast cancer disparities. Learning from and working with community members helps set the future agenda related to health equity. PLAIN LANGUAGE SUMMARY Our overall goal was to assess gaps in breast cancer care in Buffalo, New York, and to use community-based participatory approaches to build a task force to work toward breast health equity. Recent and historical data indicate that the Western New York community is facing a continued wide gap in breast cancer mortality trends between Black and White patients. We collected qualitative data to understand potential sources of inequity related to breast cancer and presented findings to a community task force to set future priorities for addressing breast cancer disparities and increasing breast health equity in our region.
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Affiliation(s)
- Kathryn M. Glaser
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Cassy Dauphin
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
- The National Witness Project, Inc., Buffalo, New York
| | - Detric Johnson
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
- The National Witness Project, Inc., Buffalo, New York
| | - Narseary Harris
- The National Witness Project, Inc., Buffalo, New York
- First Ladies of Western New York, Buffalo, New York
| | | | - Elizabeth G. Bouchard
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, New York
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13
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Frosch ZAK, Hasler J, Handorf E, DuBois T, Bleicher RJ, Edelman MJ, Geynisman DM, Hall MJ, Fang CY, Lynch SM. Development of a Multilevel Model to Identify Patients at Risk for Delay in Starting Cancer Treatment. JAMA Netw Open 2023; 6:e2328712. [PMID: 37578796 PMCID: PMC10425824 DOI: 10.1001/jamanetworkopen.2023.28712] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/05/2023] [Indexed: 08/15/2023] Open
Abstract
Importance Delays in starting cancer treatment disproportionately affect vulnerable populations and can influence patients' experience and outcomes. Machine learning algorithms incorporating electronic health record (EHR) data and neighborhood-level social determinants of health (SDOH) measures may identify at-risk patients. Objective To develop and validate a machine learning model for estimating the probability of a treatment delay using multilevel data sources. Design, Setting, and Participants This cohort study evaluated 4 different machine learning approaches for estimating the likelihood of a treatment delay greater than 60 days (group least absolute shrinkage and selection operator [LASSO], bayesian additive regression tree, gradient boosting, and random forest). Criteria for selecting between approaches were discrimination, calibration, and interpretability/simplicity. The multilevel data set included clinical, demographic, and neighborhood-level census data derived from the EHR, cancer registry, and American Community Survey. Patients with invasive breast, lung, colorectal, bladder, or kidney cancer diagnosed from 2013 to 2019 and treated at a comprehensive cancer center were included. Data analysis was performed from January 2022 to June 2023. Exposures Variables included demographics, cancer characteristics, comorbidities, laboratory values, imaging orders, and neighborhood variables. Main Outcomes and Measures The outcome estimated by machine learning models was likelihood of a delay greater than 60 days between cancer diagnosis and treatment initiation. The primary metric used to evaluate model performance was area under the receiver operating characteristic curve (AUC-ROC). Results A total of 6409 patients were included (mean [SD] age, 62.8 [12.5] years; 4321 [67.4%] female; 2576 [40.2%] with breast cancer, 1738 [27.1%] with lung cancer, and 1059 [16.5%] with kidney cancer). A total of 1621 (25.3%) experienced a delay greater than 60 days. The selected group LASSO model had an AUC-ROC of 0.713 (95% CI, 0.679-0.745). Lower likelihood of delay was seen with diagnosis at the treating institution; first malignant neoplasm; Asian or Pacific Islander or White race; private insurance; and lacking comorbidities. Greater likelihood of delay was seen at the extremes of neighborhood deprivation. Model performance (AUC-ROC) was lower in Black patients, patients with race and ethnicity other than non-Hispanic White, and those living in the most disadvantaged neighborhoods. Though the model selected neighborhood SDOH variables as contributing variables, performance was similar when fit with and without these variables. Conclusions and Relevance In this cohort study, a machine learning model incorporating EHR and SDOH data was able to estimate the likelihood of delays in starting cancer therapy. Future work should focus on additional ways to incorporate SDOH data to improve model performance, particularly in vulnerable populations.
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Affiliation(s)
- Zachary A. K. Frosch
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
- Cancer Prevention and Control Research Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jill Hasler
- Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Elizabeth Handorf
- Cancer Prevention and Control Research Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania
- Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Tesla DuBois
- Cancer Prevention and Control Research Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Richard J. Bleicher
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Martin J. Edelman
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Daniel M. Geynisman
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Michael J. Hall
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
- Cancer Prevention and Control Research Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Carolyn Y. Fang
- Cancer Prevention and Control Research Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Shannon M. Lynch
- Cancer Prevention and Control Research Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania
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14
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Griesemer I, Lightfoot AF, Eng E, Bosire C, Guerrab F, Kotey A, Alexander KM, Baker S, Black KZ, Dixon C, Ellis KR, Foley K, Goettsch C, Moore A, Ryals CA, Smith B, Yongue C, Cykert S, Robertson LB. Examining ACCURE's Nurse Navigation Through an Antiracist Lens: Transparency and Accountability in Cancer Care. Health Promot Pract 2023; 24:415-425. [PMID: 36582178 PMCID: PMC11384289 DOI: 10.1177/15248399221136534] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
There are persistent disparities in the delivery of cancer treatment, with Black patients receiving fewer of the recommended cancer treatment cycles than their White counterparts on average. To enhance racial equity in cancer care, innovative methods that apply antiracist principles to health promotion interventions are needed. The parent study for the current analysis, the Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) intervention, was a system-change intervention that successfully eliminated the Black-White disparity in cancer treatment completion among patients with early-stage breast and lung cancer. The intervention included specially trained nurse navigators who leveraged real-time data to follow-up with patients during their treatment journeys. Community and academic research partners conducted thematic analysis on all clinical notes (n = 3,251) written by ACCURE navigators after each contact with patients in the specialized navigation arm (n = 162). Analysis was informed by transparency and accountability, principles adapted from the antiracist resource Undoing Racism and determined as barriers to treatment completion through prior research that informed ACCURE. We identified six themes in the navigator notes that demonstrated enhanced accountability of the care system to patient needs. Underlying these themes was a process of enhanced data transparency that allowed navigators to provide tailored patient support. Themes include (1) patient-centered advocacy, (2) addressing system barriers to care, (3) connection to resources, (4) re-engaging patients after lapsed treatment, (5) addressing symptoms and side effects, and (6) emotional support. Future interventions should incorporate transparency and accountability mechanisms and examine the impact on racial equity in cancer care.
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Affiliation(s)
- Ida Griesemer
- VA Boston Healthcare System, Boston, MA, USA
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
| | - Alexandra F Lightfoot
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Center for Health Promotion and Disease Prevention, Chapel Hill, NC, USA
| | - Eugenia Eng
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Claire Bosire
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Fatima Guerrab
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- Community-Campus Partnerships for Health, Raleigh, NC
| | - Amanda Kotey
- Alliant Health Solutions, Inc., Atlanta, GA, USA
| | - Kimberly M Alexander
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- The Alexander Group, Durham, NC, USA
- Elon University, Elon, NC, USA
| | - Stephanie Baker
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- Elon University, Elon, NC, USA
| | - Kristin Z Black
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- East Carolina University, Greenville, NC, USA
| | - Crystal Dixon
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- Wake Forest University, Winston-Salem, NC, USA
| | - Katrina R Ellis
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- University of Michigan, Ann Arbor, MI, USA
| | - Karen Foley
- University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Antionette Moore
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- Winston-Salem State University, Winston-Salem, NC, USA
| | - Cleo A Ryals
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Cone Health Cancer Center, Greensboro, NC, USA
| | - Beth Smith
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Christina Yongue
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Samuel Cykert
- Greensboro Health Disparities Collaborative, Greensboro, NC, USA
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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15
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Martins A, Aldiss S, Taylor RM, Gibson F. Care coordination, consistency and continuity: the case of the key worker role in children’s cancer care. Int J Qual Stud Health Well-being 2022; 17:2092958. [PMID: 35757984 PMCID: PMC9246033 DOI: 10.1080/17482631.2022.2092958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose The overall aim was to evaluate the key worker role across principal treatment centres for children with cancer in England, Wales and Scotland. Methods Mixed-methods case study gathering data from multiple perspectives using questionnaires, interviews, focus groups and reports/performance documents over a two-year period. Framework approach was adopted to analyse transcripts and documentary data. Results Participants included: 22 nurse specialist key workers, 103 parents, 85 professionals and 10 children/young people. Qualitative and quantitative data were woven together, to best illuminate key worker services. Four main models of care were described as well as the context of care and process of care. Key working effectiveness centred around three pillars: care coordination; expert knowledge, experience and expertise; relationship. These were essential to improved family experience, emotional wellbeing, and delivery of individualized care closer to home. Conclusions The role is complex and diverse, responding to local needs. Certain conditions, (e.g., high caseload) placed limits on enacting the three pillars, diminishing the positive experience of families. When they worked well, key workers reduced the fragmented nature of services and families placed great value on keeping the same key worker from diagnosis into long-term care. Retaining these roles, where already in place, or including, if not, we would recommend, factoring into budgets to sustain and expand such roles.
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Affiliation(s)
- Ana Martins
- UCLH Cancer Clinical Trials Unit, University College London Hospitals, London, UK
| | - Susie Aldiss
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
| | - Rachel M Taylor
- Centre for Nurse, Midwife and Allied Health Profession Led Research (CNMAR), University College London Hospitals NHS Foundation Trust, London, UK
| | - Faith Gibson
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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16
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Herb J, Friedman H, Shrestha S, Kent EE, Stitzenberg K, Haithcock B, Mody GN. Barriers and facilitators to early-stage lung cancer care in the USA: a qualitative study. Support Care Cancer 2022; 31:21. [PMID: 36513843 PMCID: PMC9747538 DOI: 10.1007/s00520-022-07465-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 11/09/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Improved outcomes in lung cancer treatment are seen in high-volume academic centers, making it important to understand barriers to accessing care at such institutions. Few qualitative studies examine the barriers and facilitators to early-stage lung cancer care at US academic institutions. METHODS Adult patients with suspected or diagnosed early-stage non-small cell lung cancer presenting to a multidisciplinary lung cancer clinic at a US academic institution over a 6-month period beginning in 2019 were purposively sampled for semi-structured interviews. Semi-structured interviews were conducted and a qualitative content analysis was performed using the framework method. Themes relating to barriers and facilitators to lung cancer care were identified through iterative team-based coding. RESULTS The 26 participants had a mean age of 62 years (SD: 8.4 years) and were majority female (62%), white (77%), and urban (85%). We identified 6 major themes: trust with providers and health systems are valued by patients; financial toxicity negatively influenced the diagnostic and treatment experience; social constraints magnified other barriers; patient self-advocacy as a facilitator of care access; provider advocacy could overcome other barriers; care coordination and good communication were important to patients. CONCLUSIONS We have identified several barriers and facilitators to lung cancer care at an academic center in the US. These factors need to be addressed to improve quality of care among lung cancer patients. Further work will examine our findings in a community setting to understand if our findings are generalizable to patients who do not access a tertiary cancer care center.
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Affiliation(s)
- Joshua Herb
- Division of Surgical Oncology, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Hannah Friedman
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sachita Shrestha
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Erin E Kent
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karyn Stitzenberg
- Division of Surgical Oncology, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Benjamin Haithcock
- Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gita N Mody
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Surgery, Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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17
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Fan Q, Keene DE, Banegas MP, Gehlert S, Gottlieb LM, Yabroff KR, Pollack CE. Housing Insecurity Among Patients With Cancer. J Natl Cancer Inst 2022; 114:1584-1592. [PMID: 36130291 PMCID: PMC9949594 DOI: 10.1093/jnci/djac136] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/03/2022] [Accepted: 06/13/2022] [Indexed: 01/11/2023] Open
Abstract
Social determinants of health are the economic and environmental conditions under which people are born, live, work, and age that affect health. These structural factors underlie many of the long-standing inequities in cancer care and outcomes that vary by geography, socioeconomic status, and race and ethnicity in the United States. Housing insecurity, including lack of safe, affordable, and stable housing, is a key social determinant of health that can influence-and be influenced by-cancer care across the continuum, from prevention to screening, diagnosis, treatment, and survivorship. During 2021, the National Cancer Policy Forum of the National Academies of Science, Engineering, and Medicine sponsored a series of webinars addressing social determinants of health, including food, housing, and transportation insecurity, and their associations with cancer care and patient outcomes. This dissemination commentary summarizes the formal presentations and panel discussions from the webinar devoted to housing insecurity. It provides an overview of housing insecurity and health care across the cancer control continuum, describes health system interventions to minimize the impact of housing insecurity on patients with cancer, and identifies challenges and opportunities for addressing housing insecurity and improving health equity. Systematically identifying and addressing housing insecurity to ensure equitable access to cancer care and reduce health disparities will require ongoing investment at the practice, systems, and broader policy levels.
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Affiliation(s)
- Qinjin Fan
- Correspondence to: Qinjin Fan, PhD, Surveillance & Health Equity Science Department, American Cancer Society, 3380 Chastain Meadows Pkwy, NW Suite 200, Kennesaw, GA 30144, USA (e-mail: )
| | - Danya E Keene
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Matthew P Banegas
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, CA, USA
| | - Sarah Gehlert
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Laura M Gottlieb
- Social Interventions Research and Evaluation Network, University of California, San Francisco, CA, USA
| | - K Robin Yabroff
- Surveillance & Health Equity Science Department, American Cancer Society, Atlanta, GA, USA
| | - Craig E Pollack
- Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Johns Hopkins School of Nursing, Baltimore, MD, USA
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18
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Dwyer AJ, Wender RC, Weltzien ES, Dean MS, Sharpe K, Fleisher L, Burhansstipanov L, Johnson W, Martinez L, Wiatrek DE, Calhoun E, Battaglia TA. Collective pursuit for equity in cancer care: The National Navigation Roundtable. Cancer 2022; 128 Suppl 13:2561-2567. [PMID: 35699616 DOI: 10.1002/cncr.34162] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 11/11/2021] [Accepted: 01/08/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND The evidence continues to build in support of implementing patient navigation to reduce barriers and increase access to care. However, health disparities remain in cancer outcomes. The goal of the National Navigation Roundtable (NNRT) is to serve as a convener to help support the field of navigation to address equity. METHODS To examine the progress and opportunities for navigation, the NNRT submitted a collection of articles based on the results from 2 dedicated surveys and contributions from member organizations. The intent was to help inform what we know about patient navigation since the last dedicated examination in this journal 10 years ago. RESULTS The online survey of >700 people described navigators and examined sustainability and policy issues and the longevity, specific role and function, and impact of clinical and nonclinical navigators in addition to the role of training and supervision. In addition, a full examination of coronavirus disease 2019 and contributions from member organizations helped further define progress and future opportunities to meet the needs of patients through patient navigation. CONCLUSIONS To achieve equity in cancer care will demand the sustained action of virtually every component of the cancer care system. It is the hope and intent of the NNRT that the information presented in this supplement will be a catalyst for action in this collective action approach.
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Affiliation(s)
- Andrea J Dwyer
- Department of Community and Behavioral Health, The Colorado School of Public Health, University of Colorado, Aurora, Colorado
| | - Richard C Wender
- Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elsa S Weltzien
- Department of Community and Behavioral Health, The Colorado School of Public Health, University of Colorado, Aurora, Colorado
| | - Monica S Dean
- Academy of Oncology Nurse and Patient Navigators, Cranbury, New Jersey
| | | | - Linda Fleisher
- Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | | | - Wenora Johnson
- Fight Colorectal Cancer Patient Advocate, Springfield, Missouri
| | | | | | - Elizabeth Calhoun
- Department of Population Health, University of Kansas School of Medicine, Kansas City, Kansas
| | - Tracy A Battaglia
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
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Venkataramanan R, Pradhan A, Kumar A, Purushotham A, Alajlani M, Arvanitis TN. Digital Inequalities in Cancer Care Delivery in India: An Overview of the Current Landscape and Recommendations for Large-Scale Adoption. Front Digit Health 2022; 4:916342. [PMID: 35832659 PMCID: PMC9272889 DOI: 10.3389/fdgth.2022.916342] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction COVID-19 pandemic has caused major disruptions to delivery of various cancer care services as efforts were put to control the outbreak of the pandemic. Although the pandemic has highlighted the inadequacies of the system but has also led to emergence of a new cancer care delivery model which relies heavily on digital mediums. Digital health is not only restricted to virtual dissemination of information and consultation but has provided additional benefits ranging from support to cancer screening, early and more accurate diagnosis to increasing access to specialized care. This paper evaluates the challenges in the adoption of digital technologies to deliver cancer care services and provides recommendation for large-scale adoption in the Indian healthcare context. Methods We performed a search of PubMed and Google Scholar for numerous terms related to adoption of digital health technologies for cancer care during pandemic. We also analyze various socio-ecological challenges—from individual to community, provider and systematic level—for digital adoption of cancer care service which have existed prior to pandemic and lead to digital inequalities. Results Despite encouraging benefits accruing from the adoption of digital health key challenges remain for large scale adoption. With respect to user the socio-economic characteristics such as age, literacy and socio-cultural norms are the major barriers. The key challenges faced by providers include regulatory issues, data security and the inconvenience associated with transition to a new system. Policy Summary For equitable digital healthcare, the need is to have a participatory approach of all stakeholders and urgently addressing the digital divide adequately. Sharing of health data of public and private hospitals, within the framework of the Indian regulations and Data Protection Act, is critical to the development of digital health in India and it can go a long way in better forecasting and managing cancer burden.
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Affiliation(s)
- Ramachandran Venkataramanan
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, United Kingdom
- Research Division, Karkinos Healthcare, Mumbai, India
- *Correspondence: Ramachandran Venkataramanan
| | - Akash Pradhan
- Research Division, Karkinos Healthcare, Mumbai, India
- Akash Pradhan
| | | | - Arnie Purushotham
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Mohannad Alajlani
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, United Kingdom
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20
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Waters AR, Zamora ER, Fluchel M, Warner EL, Rosen S, Gwilliam V, Tovar GE, Morales JP, Kirchhoff AC. A qualitative inquiry of communication based barriers to the diagnosis of pediatric cancer: Perceptions of primarily Spanish-speaking caregivers. PATIENT EDUCATION AND COUNSELING 2022; 105:1503-1509. [PMID: 34598802 DOI: 10.1016/j.pec.2021.09.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Primarily Spanish-speaking cancer patients and caregivers often experience non-congruence with healthcare providers about beliefs, values, and knowledge of cancer. Our goal was to describe how communication related to the diagnosis of cancer was influenced by culture and language among primarily Spanish-speaking caregivers of pediatric cancer patients. METHODS Caregivers participated in three focus groups about their experiences with their child's diagnosis, communication issues, and understanding of their child's diagnosis and treatment plan. Focus groups were audio recorded, transcribed, and qualitatively analyzed using interpretive description. RESULTS Three themes emerged: 1) Negative experiences and barriers during the cancer diagnosis and treatment, 2) Miscommunication and system complexity, and 3) Language barriers throughout the diagnostic process. Due to barriers and negative experiences, some caregivers reported that their child's diagnosis was delayed, that providers sometimes used dehumanizing language, and that they were confused about diagnostic testing and treatment. CONCLUSION Cultural and linguistic disparities in pediatric oncology must be systematically addressed at the provider, clinic, and system level. PRACTICE IMPLICATIONS High-quality cancer care delivered by oncologists and cancer care teams should include cultural humility when discussing the cancer diagnosis and prognosis.
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Affiliation(s)
- Austin R Waters
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, Salt Lake City, Utah, USA.
| | - Eduardo R Zamora
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, Salt Lake City, Utah, USA; Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Mark Fluchel
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Echo L Warner
- University of Arizona Cancer Center, Tucson, Arizona, USA; College of Nursing, University of Arizona, Tucson, Arizona, USA
| | - Stephanie Rosen
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Vannina Gwilliam
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Guadalupe E Tovar
- Patient and Public Education Department, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Jennyffer P Morales
- Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Anne C Kirchhoff
- Cancer Control and Population Sciences Research Program, Huntsman Cancer Institute, Salt Lake City, Utah, USA; Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
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21
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Billingsley KG. The Next Step in Tumor Board Evolution: Optimizing Care Coordination and Integration : Editorial on "Integrating a Disease-Focused Tumor Board as a Delivery-of-Care Model to Expedite Treatment Initiation for Patients with Liver Malignancies". Ann Surg Oncol 2022; 29:2146-2147. [PMID: 35084625 DOI: 10.1245/s10434-021-10992-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/12/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Kevin G Billingsley
- Department of Surgery, Yale University School of Medicine, Yale Cancer Center, 35 Park St, New Haven, CT, 06519, USA.
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Bhatia D, Sutradhar R, Austin PC, Giannakeas V, Jaakkimainen L, Paszat LF, Lipscombe LL. Periodic screening for breast and cervical cancer in women with diabetes: a population-based cohort study. Cancer Causes Control 2021; 33:249-259. [PMID: 34800194 DOI: 10.1007/s10552-021-01517-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 11/01/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Diabetes is associated with poorer cancer outcomes. Screening for breast and cervical cancer is recommended by clinical guidelines; however, utilization of these tests in people with diabetes has been unclear due to methodological limitations in the evidence base. We used administrative data to determine the association between diabetes and the rates of becoming up-to-date with periodic breast and cervical cancer screening over a 20-year period. METHODS Healthcare databases from Ontario, Canada, were linked to assemble two population-based cohorts of 50-70 and 21-70 year-olds between 1994 and 2011, eligible for breast and cervical cancer screening, respectively. Using age as the time scale, multivariable recurrent events models were implemented to examine the association between the presence of diabetes and the rates of becoming up-to-date with the recommended cancer screenings. RESULTS In each of the breast and cervical cancer screening cohorts, there were, respectively, 1,516,302 (16% had diabetes at baseline) and 4,751,220 (9.5% had diabetes at baseline) screen-eligible women. In multivariable models, prevalent diabetes (duration ≥ 2 years) was associated with lower rates of becoming up-to-date with cervical (hazard ratio, HR 0.85, 95% confidence interval, CI 0.84-0.85) and breast (HR 0.94, CI 0.93-0.94) cancer screening, compared to no diabetes. CONCLUSIONS Having diabetes is associated with decreased rates of becoming up-to-date with two recommended periodic cancer screenings, with a bigger reduction in the rates of becoming up-to-date with cervical cancer screening. Greater attention to cervical cancer preventive services is needed in women with diabetes.
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Affiliation(s)
- Dominika Bhatia
- Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.
| | - Rinku Sutradhar
- Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.,ICES, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Peter C Austin
- Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.,ICES, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Vasily Giannakeas
- ICES, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Women's College Hospital, Women's College Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Liisa Jaakkimainen
- Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.,ICES, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Lawrence F Paszat
- Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.,ICES, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Lorraine L Lipscombe
- Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.,ICES, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Women's College Hospital, Women's College Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.,Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, ONs, M5S 1A8, Canada
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