Reaching Populations to Address Disparities in Cancer Care Delivery: Results From a Six-Site Initiative

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Noël Arring University of Michigan School of Nursing, Ann Arbor, Michigan

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 DNP, PhD, RN
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Christopher R. Friese University of Michigan School of Nursing, Ann Arbor, Michigan

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 PhD, RN, AOCN
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Bidisha Ghosh University of Michigan School of Nursing, Ann Arbor, Michigan

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 MS
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Marita Titler University of Michigan School of Nursing, Ann Arbor, Michigan

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Heidi Hamann University of Arizona Cancer Center, Tucson, Arizona

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Sanja Percac-Lima MGH Chelsea HealthCare Center, Chelsea, Massachusetts

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 MD, PhD, MPH
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Adrian Sandra Dobs Johns Hopkins Clinical Research Network, Baltimore, Maryland

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Michelle J. Naughton Cancer Control Program, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio

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Pooja Mishra Georgia Cancer Center for Excellence, Grady Health System, Atlanta, Georgia

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Melissa A. Simon Northwestern University Feinberg School of Medicine, Chicago, Illinois

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Bingxin Chen University of Michigan School of Nursing, Ann Arbor, Michigan

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Electra D. Paskett College of Public Health, The Ohio State University, Columbus, Ohio

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Robert J. Ploutz-Snyder University of Michigan School of Nursing, Ann Arbor, Michigan

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Martha Quinn Center for Managing Chronic Disease, University of Michigan School of Public Health, Ann Arbor, Michigan

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Debra L. Barton University of Michigan School of Nursing, Ann Arbor, Michigan

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 PhD, RN
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Background: Large segments of the US population do not receive quality cancer care due to pervasive and systemic inequities, which can increase morbidity and mortality. Multicomponent, multilevel interventions can address inequities and improve care, but only if they reach communities with suboptimal access. Intervention studies often underenroll individuals from historically excluded groups. Methods: The Alliance to Advance Patient-Centered Cancer Care includes 6 grantees across the United States who implemented unique multicomponent, multilevel intervention programs with common goals of reducing disparities, increasing engagement, and improving the quality of care for targeted populations. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework informed the evaluation efforts across sites. Each Alliance site identified their intended populations, which included underrepresented minorities (eg, Black and Latinx persons), individuals who prefer a language other than English, and rural residents. We evaluated the demographic characteristics of participants to determine program reach. Results: Between 2018 and 2020, a total of 2,390 of 5,309 potentially eligible participants were enrolled across the 6 sites. The proportion of enrolled individuals with selected characteristics included 38% (n=908) Black adults, 24% (n=574) Latinx adults, 19% (n=454) preferring a language other than English, and 30% (n=717) rural residents. The proportion of those enrolled who were the intended population was commensurate to the proportion with desired characteristics in those identified as potentially eligible. Conclusions: The grantees met or exceeded enrollments from their intended populations who have been underserved by quality cancer care into patient-centered intervention programs. Intentional application of recruitment/engagement strategies is needed to reach individuals from historically underserved communities.

Submitted July 27, 2022; final revision received January 10, 2023; accepted for publication February 1, 2023. Published online April 11, 2023.

Disclosures: Dr. Friese has disclosed receiving grant/research support from Merck Foundation and NCCN Foundation/Pfizer. Dr. Paskett has disclosed serving as a principal investigator for Genentech, Pfizer, Merck Foundation, and Guardant Health; and serving on an advisory board for GlaxoSmithKline. The remaining authors have disclosed that they have not received any financial considerations from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: Research reported in this publication was supported by the Merck Foundation.

Correspondence: Debra L. Barton, PhD, RN, Office of Research and PhD Programs, University of Michigan School of Nursing, 400 North Ingalls Street, Suite 4320, Ann Arbor, MI 48109-5482. Email: debbartn@umich.edu
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