Accountability for Cancer Care Through Undoing Racism and Equity
| Status: | Completed |
|---|---|
| Conditions: | Breast Cancer, Lung Cancer, Cancer, Cancer |
| Therapuetic Areas: | Oncology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 8/3/2018 |
| Start Date: | April 2013 |
| End Date: | March 2018 |
Purpose: African American cancer patients, as compared to their White counterparts, continue
to initiate treatment later and remain less apt to undergo complete treatment; fueling worse
treatment outcomes including shorter survival. The concepts of "transparency" and
"accountability," as mechanisms of systems change have been applied for decades by
anti-racism organizations to civil rights and social change. Yet, the application of these
concepts to health systems' change and unequal treatment has rarely been done. The Greensboro
Health Disparities Collaborative and two Cancer Centers have joined together to specify
structures built into cancer care systems that make cancer care vulnerable to institutional
racism and investigate how they can be changed to reduce racial inequity in quality and
completion of treatment for Stage 1-2 breast and lung cancer patients.
Participants: White and African American patients with first diagnosis of Stage 1-2 breast
and lung cancer, with intention to treat, and their cancer care staff at 2 cancer centers.
The 2 cancer centers are Cone Health Cancer Center (CHCC) in Greensboro, North Carolina and
the University of Pittsburgh Medical Center (UPMC) Hillman Comprehensive Cancer Center in
Pittsburgh, Pennsylvania.
Procedures (methods): Using a 5-year interrupted time-series, with an embedded randomized
control trial (RCT) study design, we will test the effectiveness of the ACCURE intervention
components. Having received Institutional Review Board approval for Phase 1, we completed a
5-year, retrospective review of de-identified Electronic Medical Record data to establish a
baseline of repeated outcome measures, convening of an expert committee to design the
intervention, and design of the real-time, electronic breast and lung cancer registry coupled
with dummy testing of the registry system.
The randomized trial will compare patients who receive usual care to those who receive visits
and calls from a trained ACCURE Navigator, who is well versed in issues specific to breast
and lung cancer and trained to serve as a two-way communication bridge to optimize the cancer
care system's accountability and transparency for equity in quality of care. Given
unintended, but likely variation in implementation of the ACCURE intervention by the two
Cancer Centers (at our two research sites), 6 elements of implementation and their potential
effect on outcomes will be documented through a process evaluation.
to initiate treatment later and remain less apt to undergo complete treatment; fueling worse
treatment outcomes including shorter survival. The concepts of "transparency" and
"accountability," as mechanisms of systems change have been applied for decades by
anti-racism organizations to civil rights and social change. Yet, the application of these
concepts to health systems' change and unequal treatment has rarely been done. The Greensboro
Health Disparities Collaborative and two Cancer Centers have joined together to specify
structures built into cancer care systems that make cancer care vulnerable to institutional
racism and investigate how they can be changed to reduce racial inequity in quality and
completion of treatment for Stage 1-2 breast and lung cancer patients.
Participants: White and African American patients with first diagnosis of Stage 1-2 breast
and lung cancer, with intention to treat, and their cancer care staff at 2 cancer centers.
The 2 cancer centers are Cone Health Cancer Center (CHCC) in Greensboro, North Carolina and
the University of Pittsburgh Medical Center (UPMC) Hillman Comprehensive Cancer Center in
Pittsburgh, Pennsylvania.
Procedures (methods): Using a 5-year interrupted time-series, with an embedded randomized
control trial (RCT) study design, we will test the effectiveness of the ACCURE intervention
components. Having received Institutional Review Board approval for Phase 1, we completed a
5-year, retrospective review of de-identified Electronic Medical Record data to establish a
baseline of repeated outcome measures, convening of an expert committee to design the
intervention, and design of the real-time, electronic breast and lung cancer registry coupled
with dummy testing of the registry system.
The randomized trial will compare patients who receive usual care to those who receive visits
and calls from a trained ACCURE Navigator, who is well versed in issues specific to breast
and lung cancer and trained to serve as a two-way communication bridge to optimize the cancer
care system's accountability and transparency for equity in quality of care. Given
unintended, but likely variation in implementation of the ACCURE intervention by the two
Cancer Centers (at our two research sites), 6 elements of implementation and their potential
effect on outcomes will be documented through a process evaluation.
The ACCURE Interventions include:
1. Quality Improvement / Race specific feedback for providers regarding breast and lung
surgery and adjuvant treatments.
2. A real time registry with automated electronic health record feeds that provides warning
signs if milestones in cancer care have not been met or if patients miss scheduled
appointments
3. Health Equity Training for cancer center staff at quarterly intervals
4. Accure Navigation (based on special training regarding trust, culturally appropriate
communication, and Kleinman's Patient Model of Illness)
5. Additional efforts will be made to collect information on symptoms and side effect
management from patients and medical charts.
1. Quality Improvement / Race specific feedback for providers regarding breast and lung
surgery and adjuvant treatments.
2. A real time registry with automated electronic health record feeds that provides warning
signs if milestones in cancer care have not been met or if patients miss scheduled
appointments
3. Health Equity Training for cancer center staff at quarterly intervals
4. Accure Navigation (based on special training regarding trust, culturally appropriate
communication, and Kleinman's Patient Model of Illness)
5. Additional efforts will be made to collect information on symptoms and side effect
management from patients and medical charts.
Inclusion Criteria:
- White or African American patients aged 18 or older
- Recently received a first diagnosis of stage 1 or 2 breast or lung cancer
- Patient plans to initiate oncology treatment with curative intent
Exclusion Criteria:
- Have cognitive impairments or limited English proficiency that would preclude their
ability to comprehend survey questions
We found this trial at
2
sites
Click here to add this to my saved trials
Pittsburgh, Pennsylvania 15232
Phone: 412-647-8588
Click here to add this to my saved trials