Perceptions of cancer care coordination among rural patients in Hawaii.

Abstract

e18553 Background: Rural residents experience disproportionate burdens of cancer including higher incidence and mortality than urban residents. Disparities in rural cancer health outcomes are partially attributed to limited access to specialty care and care coordination challenges in rural areas. To date, little is known about rural cancer patients’ perceptions of care coordination (CC). In this study, we examined rural patients’ perceptions of cancer CC and compared rural and urban patients’ perceptions of cancer CC using the Care Coordination Instrument (CCI), a validated patient-report measure of CC. Methods: 80 rural patients receiving active treatment for any cancer residing in rural areas of Hawaii (Hawaii Island, Kauai) completed the CCI from Sept. 2020 to Dec. 2021. These rural areas are on separate islands from Oahu (urban) where tertiary care hospitals in Hawaii are located. Data for the urban cohorts ( n = 220) were derived from our archival data. The CCI assesses overall patients’ perceptions of CC (Total) and includes subscales that evaluate CC across three domains (Communication, Navigation, Operational). We used descriptive statistics to describe rural patients’ CC details and linear regression models to compare CCI scores between rural and urban patients. Results: Among 300 patients, demographic and clinical characteristics were similar between the rural and urban cohorts (mean age = 63.6, 56% female, most common cancer type: 28% breast and 25% GI). Patients were racially diverse, with 25% White/Caucasian, 24% Japanese, 16% Native Hawaiian, and 24% two or more race. Among rural patients, 43% indicated having traveled by air to another island (Oahu; urban) for cancer treatment (50% surgery). Of these patients, 38% indicated having paid out-of-pocket for cancer care-related travel costs. 65% of these patients reported travel costs as a burden, with 6% of patients having canceled or delayed treatment due to costs. Overall, there were no differences on the Total CCI scores between rural and urban patients ( p = 0.73). However, significant differences were found for Communication and Navigation ( p = 0.02 and p = 0.04, respectively), with rural patients reporting lower scores on these domains. No differences were found for the Operational domain scores. Conclusions: Our results demonstrate that that while rural patients’ overall perceptions of CC were similar to their urban cohorts, rural patients perceived greater CC challenges related to the communication and navigation aspects of CC. Off-island cancer care-related travel costs were reported as a significant burden for rural patients who must travel to another island for their cancer treatment. These findings highlight the need for interventions to address financial, communication and navigation challenges for rural patients in order to improve the quality of cancer care delivery in rural areas.