Evaluation of a three-part equity intervention for women of color with breast cancer.

Abstract

TPS1129 Background: Women of color (WOC) with breast cancer miss and fail key points in care due to racial disparities in cancer services. Conscious and unconscious bias means that these women are not treated in a timely way or as rigorously. They are offered fewer options, and the patient navigation and education needed for them to self-advocate is ignored. Black women in particular have the highest breast cancer death rates. Care delivery differs even independent of such variables as literacy, income, and education. Separately and incrementally, findings to date have shown the potential oof patient navigation, equity assessment, and mobile support to reverse these disparities. In pilot investigations –– partnering with academic cancer centers –– The Chrysalis Initiative (a nonprofit patient advocacy and research organization) has validated the potential of combining these approaches in a three-part intervention. Based on preliminary work, it is hypothesized patients will: experience significantly greater adherence to the recommended continuum of care, without disruption or barriers; more often seek second opinions and additional supportive resources, and engage in clinical trials; demonstrate less co-morbidities, through more preventive measures and healthful lifestyle; suffer fewer interactions perceived to be influenced by racism; undergo less financial distress, with guidance on managing and planning costs; feel more confident and more optimistic in their outlook; and achieve better clinical results and lower costs. Methods: To determine and document the full impact, both quantitatively and qualitatively, of the experimental three-part intervention, the trial is: delivering navigation/coaching services to the study population, using counselors who are predominantly WOC who have experienced the challenges of breast cancer care. Surveys and interviews pre- and post-intervention will add to impact measures; providing the experimental group with the BC Navi App on both iOS and Android devices . Developed in partnership with InTouch, the app supports engagement and tracking. It provides a dashboard for care evaluation to supplement EMR data; conducting an equity assessment of breast cancer services of partnering clinical programs through use of focus groups with staff, patients, and community; procedural checks; and data collection from center EHR systems. The review audits 40 domains of care based on NCCI, NCI, ASCO, ACR, and other standards. The assessment team works closely and collaboratively with each cancer center’s clinical and administrative staff to reveal disparities and find consensus on ways to close gaps. This trial in progress is randomizing 200 subjects to the coaching/mobile app intervention arm and 100 to benefits of the equity assessment only, with comparison to nonWOC with breast cancer. The trial aims to disseminate the three-part intervention in easily reproducible form.