We Don't Care What You Know Until You Show Us That You Care': Characterizing Access to Healthcare among Black, Hispanic and White Cancer Survivors

C.E. Credits: P.A.C.E. CE Florida CE
Speaker
  • Associate Professor, Vice Chair for Diversity, Equity and Inclusion, Department of Population Health Sciences, Duke University School of Medicine, Associate Research Professor, Duke Global
    Biography

      Dr. Akinyemiju is an Associate Professor of Epidemiology with expertise in cancer epidemiology, cancer biology, epidemiologic methods, and health disparities.  Her research interests include quantifying the impact of social (e.g. access to healthcare and structural racism) and biological factors (e.g. metabolic and inflammatory dysregulation) on racial disparities in cancer risk, tumor aggressiveness, quality of treatment and survival. This line of inquiry has resulted in over 100 publications till date. Dr. Akinyemiju is the PI of an NIH funded study examining the role of metabolic dysregulation and associated epigenetic changes in risk of aggressive, hormone-receptor negative breast cancer in women of African descent, and an R01 characterizing racial differences in various healthcare access dimensions, and how these predict poor treatment utilization and lower survival among Black, Hispanic and White ovarian cancer patients. These ultimate goal of these studies is to provide novel, empirical and generalizable insights that can help identify and prioritize specific modifiable factors that can be targeted to reduce cancer disparities and improve care for all patients, findings that will likely be beneficial across a range of cancer types where racial disparities remain an intractable problem.


    Abstract

    Background: Healthcare access (HCA) encompasses five important dimensions: Affordability, Availability, Accessibility, Accommodation and Acceptability. Published studies of cancer typically focus on affordability, availability and accessibility, however accessibility and accommodation are typically less studied

    Objectives: The goal of the current study is to conduct a qualitative study characterizing cancer survivor’s perceptions of HCA dimensions and to identify key facilitators or barriers to equitable healthcare among Black, Hispanic and White cancer survivors

    Methods: We recruited a total of 32 cancer survivors into a qualitative study to understand their cancer treatment journey and experiences accessing healthcare. Over 60% of participants were Black, and 18% were Hispanic. Focus groups were moderated by an experienced facilitator, and data were coded and analyzed using NVivo 12 to identify key themes. Peer debriefing was done to evaluate the credibility and completeness of analysis

    Results: Across the five HCA dimensions evaluated, acceptability emerged as the most important among cancer survivors. Acceptability was discussed in a variety of positive ways, such as the importance of bedside manner, patient-provider communication, and empathy. Accommodation—relating to ability to see provider when convenient, limited language barriers—were also identified as important. Faith and access to support groups were noted as facilitators of healthcare access, while role conflict was noted as a barrier

    Conclusion: Access to healthcare is a top priority for cancer survivors, and impacts quality of initial treatment, supportive care and survival. Even when there were underlying concerns about affordability and accessibility, issues related to acceptability were key to survivor’s feeling a sense of psychological safety with their providers might be a specific, quantifiable and impactful measure of patient-centered, high-quality care

    Learning Objectives:

    1. Understand the 5 dimensions of healthcare access

    2. Identify the salient healthcare access dimension for cancer survivors


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