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Accountability for Cancer Care Through Undoing Racism and Equity

Information source: University of North Carolina, Chapel Hill
ClinicalTrials.gov processed this data on August 23, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Breast Cancer; Lung Cancer

Intervention: ACCURE Navigator (Other); Usual Care by Cancer Center Care Team (Other)

Phase: N/A

Status: Recruiting

Sponsored by: University of North Carolina, Chapel Hill

Official(s) and/or principal investigator(s):
Eugenia Eng, MPH, DrPH, Principal Investigator, Affiliation: University of North Carolina, Chapel Hill
Samuel Cykert, MD, Principal Investigator, Affiliation: University of North Carolina, Chapel Hill

Overall contact:
Christina Yongue Hardy, MPH, Phone: 919-843-8885, Email: cyhardy@email.unc.edu

Summary

Purpose: African American cancer patients, as compared to their White counterparts, continue to initiate treatment later and remain less apt to undergo complete treatment; fueling worse treatment outcomes including shorter survival. The concepts of "transparency" and "accountability," as mechanisms of systems change have been applied for decades by anti-racism organizations to civil rights and social change. Yet, the application of these concepts to health systems' change and unequal treatment has rarely been done. The Greensboro Health Disparities Collaborative and two Cancer Centers have joined together to specify structures built into cancer care systems that make cancer care vulnerable to institutional racism and investigate how they can be changed to reduce racial inequity in quality and completion of treatment for Stage 1-2 breast and lung cancer patients. Participants: White and African American patients with first diagnosis of Stage 1-2 breast and lung cancer, with intention to treat, and their cancer care staff at 2 cancer centers. The 2 cancer centers are Cone Health Cancer Center (CHCC) in Greensboro, North Carolina and the University of Pittsburgh Medical Center (UPMC) Hillman Comprehensive Cancer Center in Pittsburgh, Pennsylvania. Procedures (methods): Using a 5-year interrupted time-series, with an embedded randomized control trial (RCT) study design, we will test the effectiveness of the ACCURE intervention components. Having received Institutional Review Board approval for Phase 1, we completed a 5-year, retrospective review of de-identified Electronic Medical Record data to establish a baseline of repeated outcome measures, convening of an expert committee to design the intervention, and design of the real-time, electronic breast and lung cancer registry coupled with dummy testing of the registry system. The randomized trial will compare patients who receive usual care to those who receive visits and calls from a trained ACCURE Navigator, who is well versed in issues specific to breast and lung cancer and trained to serve as a two-way communication bridge to optimize the cancer care system's accountability and transparency for equity in quality of care. Given unintended, but likely variation in implementation of the ACCURE intervention by the two Cancer Centers (at our two research sites), 6 elements of implementation and their potential effect on outcomes will be documented through a process evaluation.

Clinical Details

Official title: Accountability for Cancer Care Through Undoing Racism and Equity

Study design: Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Health Services Research

Primary outcome: Lung Cancer - Lung Resection Surgery within 4 months of diagnosis Breast Cancer - Completion of surgery, radiation if surgery is breast conserving, and adjuvant chemotherapy (when indicated) within 6 months of diagnosis

Secondary outcome: Adherence to scheduled appointments

Detailed description: The ACCURE Interventions include: 1. Quality Improvement / Race specific feedback for providers regarding breast and lung surgery and adjuvant treatments. 2. A real time registry with automated electronic health record feeds that provides warning signs if milestones in cancer care have not been met or if patients miss scheduled appointments 3. Health Equity Training for cancer center staff at quarterly intervals 4. Accure Navigation (based on special training regarding trust, culturally appropriate communication, and Kleinman's Patient Model of Illness)

Eligibility

Minimum age: 18 Years. Maximum age: N/A. Gender(s): Both.

Criteria:

Inclusion Criteria:

- White or African American patients aged 18 or older

- Recently received a first diagnosis of stage 1 or 2 breast or lung cancer

- Patient plans to initiate oncology treatment with curative intent

Exclusion Criteria:

- Have cognitive impairments or limited English proficiency that would preclude their

ability to comprehend survey questions

Locations and Contacts

Christina Yongue Hardy, MPH, Phone: 919-843-8885, Email: cyhardy@email.unc.edu

Cone Health, Regional Cancer Center, Greensboro, North Carolina 27401, United States; Recruiting
Skip Hislop, Phone: 336-832-0814, Email: skip.hislop@conehealth.com

University of Pittsburgh Medical Center, Hillman Comprehensive Cancer Center, Pittsburgh, Pennsylvania 15232, United States; Recruiting
Linda B. Robertson, RN MSN DrPH, Phone: 412-647-8588, Email: robertsonlk@upmc.edu

Additional Information

Critical incident technique: an innovative participatory approach to examine and document racial disparities in breast cancer healthcare services

UNC Center for Health Promotion and Disease Prevention

Greensboro Health Disparities Collaborative

Starting date: April 2013
Last updated: January 9, 2015

Page last updated: August 23, 2015

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