In the era of precision medicine and molecular oncology, persons with cancer are gaining access to increasingly advanced forms of treatment. However, while some may be able to benefit from this cutting-edge clinical innovation, many underserved patients are still struggling to receive care. A new law in Massachusetts is set to eliminate a major financial barrier to accessing clinical trials. Lawmakers, health care practitioners, and other stakeholders behind the measure hope that the provision contained in the health care bill “promoting a resilient health care system that puts patients first” will increase access to care for all, regardless of their sex, age, race, ethnicity, or socioeconomic status.
Patient navigation has always been an essential intervention to improve access to care for vulnerable and underserved patient populations. New data from the Massachusetts General Hospital Cancer Center shows that navigation is also a promising approach to ensure continuity of care during the COVID-19 pandemic.
Controlling the expression of implicit bias in a clinical setting is a very complex balancing act. Physicians need to rely on categorizations based on age, gender, race, and ethnicity when formulating a diagnosis. Once these biases are activated, physicians need to then “individuate” the patient, developing personalized treatment recommendations and engaging in patient-centered dialogue. It is essential to design highly customized education programs and to begin training as early as possible.
Implicit bias is a manifestation of prejudice deriving from thoughts and feelings generated outside of an individual’s conscious awareness. These automatic judgments can be especially dangerous in a clinical setting, where they may be contributing to the health care disparities often experienced by vulnerable and underserved patient populations. A new publication from the University of Arizona presents a promising approach to reducing implicit bias in medical trainees. Alliance to Advance Patient-Centered Cancer Care Investigator Dr. Jeff Stone and his colleagues developed and tested an intervention aimed at reducing the stereotyping of Hispanic patients as medically non-compliant. The term refers to a patient’s unwillingness to follow treatment recommendations or take medications as prescribed. Studies show that physician implicit bias may influence treatment recommendations: one study found that African American patients were significantly less likely to receive a recommendation for thrombolytic drugs to treat myocardial infarctions compared to their white counterparts.
The article published on the JCO Oncology Practice offers a novel approach to incorporating patient navigation services into larger health systems. Dr. Melissa Simon of the Northwestern University Feinberg School of Medicine and her team describe their process of utilizing data derived from their breast cancer patient navigation program to systematically improve care delivery for the vulnerable populations they aim to serve.
A new Alliance to Advance Patient-Centered Cancer Care Webinar
The COVID-19 pandemic has forced many health care systems to alter the way they provide services to their communities, embracing substantial changes to their clinical practice. With institutions considering making some of these changes permanent, it is essential to reflect on the implications for vulnerable and underserved patient
populations. How will they fare navigating a new system of care increasingly centered on technology and remote services?
A new study from Alliance to Advance Patient-Centered Cancer Care program partner, the University of Arizona, dives into financial vulnerability for cancer patients with health insurance, aiming to better understand how health behaviors and psychosocial concerns may be associated with financial burden. Elizabeth Ver Hoeve, MA, from the Department of Psychology at the University of Arizona, is the lead author of the paper, “Patient-Reported Financial Toxicity, Quality of life, and Health Behaviors in Insured US Cancer Survivors,” which was recently published in the journal Supportive Care in Cancer.
Dr. Debra Roter, Johns Hopkins University Distinguished Service Professor in the Department of Health, Behavior, and Society at the Bloomberg School of Public Health, has been working with her team to adapt the intervention so that it can be delivered remotely. All changes will make it much more convenient for patients to participate.
The COVID-19 pandemic has brought many dramatic changes to our everyday life. As millions of Americans have opted to stay at home as much as possible, clinical practices have been expanding telemedicine efforts to reduce the risk of transmission, interacting with patients remotely via technology such as cell phones and other communication applications. While telemedicine has been available for many years, the use of these services has dramatically increased this year. The Cleveland Clinic recently reported logging more than 60,000 telemedicine visits in March. Before the global pandemic, it averaged about 3,400 virtual visits per month.
In a follow-up to their previous publication Oregon’s Familias en Acción replicates benefits for underserved cancer co-survivors through Un Abrazo Para la Familia, the team at the University of Arizona have expanded their Un Abrazo Para La Familia intervention to recruit and deliver the supportive care program to care recipients themselves.
While Abrazo was originally designed to help co-survivors cope with a loved one’s cancer diagnosis, the intervention team decided to expand the program to care recipients themselves. Thirty care recipients from existing cohorts in Tucson & Portland revealed clear benefits for cancer survivors. Data collected show that both cancer knowledge and self-efficacy (confidence in that cancer knowledge) significantly increased within the care recipient group. These results gave researchers the confidence to go forward with the recruitment of survivors as well as co-survivors. More data on the impact of Un Abrazo Para la FamiliaTM should be available soon.
“Just being able to help a patient, even making one appointment is where I get my satisfaction and joy,” Lead Patient Navigator Carmen Benjamin remarked.
The Massachusetts General Hospital Cancer Center navigation intervention is combining electronic health records and human touch to help patients receive the most comprehensive cancer care possible. The center is using TopCare (Technology for Optimizing Population Care in a Resource-limited Environment) software to match patient navigators with newly-diagnosed cancer patients who may require extra support. Navigation services at MGH are rooted in social work, with Lead Patient Navigator Carmen Benjamin and her team working to connect patients with transportation resources, financial services, and offering emotional support during appointments.
We last spoke to Carmen when we filmed the video Massachusetts General Hospital Cancer Center: Patient Navigation as the Cornerstone of Cancer Care. During her interview, she expressed great satisfaction helping cancer patients overcome barriers to care. Since most of Carmen’s patients are underserved, they often present with multiple illnesses to manage in addition to their cancer, and often lack social support: “Just being able to help a patient, even making one appointment is where I get my satisfaction and joy,” she remarked.