Addressing cancer care needs for Latino adults: A formative qualitative evaluation.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 105-105
Author(s):  
Gladys M. Rodriguez ◽  
Maria Leach ◽  
Jennifer Osorio ◽  
Emily Wood ◽  
Ysabel Duron ◽  
...  
Keyword(s):  
Cancer Diagnosis ◽  
Low Income ◽  
Cancer Care ◽  
Comparative Method ◽  
The United States ◽  
Care Needs ◽  
Community Based ◽  
Care Plans ◽  
Incidence And Mortality ◽  
Latino Adults

105 Background: Cancer remains the number one cause of death among the Latino population despite the decrease in cancer incidence and mortality in the United States. Latino patients experience worse quality of life, more advanced stages of disease, and longer times to definitive diagnosis and treatment initiation. Yet there are few interventions that leverage clinical and community-based approaches to address these disparities. The aim of this formative qualitative study was to explore the specific care needs and barriers encountered by Latino patients to refine a community-based intervention delivered by community health workers (CHWs). Methods: We conducted semi-structured, in-depth, one-on-one qualitative interviews with low-income, Latino adults with a past or current history of cancer and/or their caregivers in a county comprised of 80% Latino populations in California. Interviews were conducted in Spanish, audio-recorded, transcribed and translated. Analysis was based in grounded theory and performed using the constant comparative method. Results: Fourteen interviews were conducted with a total of 18 participants; 9 involved the patient, 4 involved the patient and a designated caregiver, and 1 involved a caregiver only. Four major themes emerged that included: 1) lack of overall understanding of all aspects of cancer including their cancer diagnosis, significance of advance directives, precision medicine, and cancer care plans; 2) severe challenges in communicating cancer care needs and receiving support services due to language barriers; 3) stress and anxiety regarding financial hardships related to job loss and insurance barriers; 4) the need for supportive, bilingual and bicultural personnel to assist in overcoming these challenges. Conclusions: Latino patients with cancer and caregivers described major barriers they encounter after a cancer diagnosis. Participants described important approaches to address these cancer specific needs and reduce cancer disparities among these populations.

scholarly journals Profile of Long-Term Care Recipients Receiving Home and Community-Based Services and the Factors That Influence Utilization in Taiwan

2020 ◽  
Vol 17 (8) ◽  
pp. 2649
Author(s):  
Chia-Mei Shih ◽  
Yu-Hua Wang ◽  
Li-Fan Liu ◽  
Jung-Hua Wu
Keyword(s):  
Low Income ◽  
Long Term Care ◽  
Common Factor ◽  
Behavioral Model ◽  
Care Needs ◽  
Community Based ◽  
Term Care ◽  
Care Recipients ◽  
Community Based Services

In response to the irreversible aging trend, the Taiwan government has promoted the Long-Term Care (LTC) policy 1.0 launched in 2007 and the LTC policy 2.0 reform since 2016. This study aimed to explore the utilization of formal home and community-based care under LTC policy 1.0 to add scientific support for the on-going LTC policy 2.0 reform. Methods: By using Andersen and Aday’s behavioral model of healthcare utilization, the long-term care dataset was analyzed from 2013 to 2016. A total of 101,457 care recipients were identified after data cleaning. Results: The results revealed that about 40.7% of the care recipients stayed in the care system for more than two years. A common factor influencing the length of home and community-based services (HCBS) utilization period included need factors, where more dependent recipients leave the LTC system regardless of their socio-economic status. However, the utilization period of non-low-income households is significantly affected by the level of service resources. Conclusion: For long-term care needs, the phenomenon of a short utilization period was concerning. This study adds information which suggests policy should reconsider care capacity and quality, especially for moderate to severely dependent recipients. This will allow for better understanding to help maintain care recipients in their own communities to achieve the goal of having an aging in place policy.

Delivering End-of-Life Cancer Care: Perspectives of Providers

2017 ◽  
Vol 35 (3) ◽  
pp. 497-504 ◽  
Author(s):  
Manali I. Patel ◽  
Vyjeyanthi S. Periyakoil ◽  
David Moore ◽  
Andrea Nevedal ◽  
Tumaini R. Coker
Keyword(s):  
End Of Life ◽  
Health Care Providers ◽  
Cancer Care ◽  
Care Delivery ◽  
Comparative Method ◽  
The United States ◽  
Home Delivery ◽  
Care Providers ◽  
Face To Face ◽  
Care Services

Objectives: Persistent gaps in end-of-life cancer care delivery and growing associated expenditures remain imminent US public health issues. The objective of this study was to understand clinical providers’ experiences delivering cancer care for patients at the end of life and their perspectives on potential solutions to improve quality of care. Methods: Semistructured interviews were conducted with 75 cancer care providers across the United States. The interviews were recorded, transcribed, and analyzed using constant comparative method of qualitative analysis. Results: Providers identified 3 major cancer care delivery challenges including lack of time to educate patients and caregivers due to clinical volume and administrative burdens, ambiguity in determining both prognosis and timing of palliative care at the end-of-life, and lack of adequate systems to support non-face-to-face communication with patients. To address these challenges, providers endorsed several options for clinical practice redesign in their settings. These include use of a lay health worker to assist in addressing early advance care planning, proactive non-face-to-face communication with patients specifically regarding symptom management, and community and in-home delivery of cancer care services. Discussion: Specific strategies for cancer care redesign endorsed by health-care providers may be used to create interventions that can more efficiently and effectively address gaps in end-of-life cancer care.

Evaluation of a Behavioral Intervention With Multiple Components Among Low-Income and Uninsured Adults With Obesity and Diabetes

2017 ◽  
Vol 32 (2) ◽  
pp. 409-422 ◽  
Author(s):  
SangNam Ahn ◽  
Joonhyung Lee ◽  
Jenny Bartlett-Prescott ◽  
Lisa Carson ◽  
Lindsey Post ◽  
...  
Keyword(s):  
Treatment Group ◽  
Behavioral Intervention ◽  
Low Income ◽  
Comparison Group ◽  
The United States ◽  
Health Promotion Program ◽  
Community Based ◽  
Multiple Components ◽  
Obesity And Diabetes ◽  
Uninsured Adults

Purpose: To examine the effects of a community-based behavioral intervention with multiple components on health outcomes among low-income and uninsured adults who were obese and had diabetes and treated in a “real-world” setting. Design: A longitudinal design with a retrospective comparison group was used to examine the ability of a health promotion program to improve body mass index (BMI) and hemoglobin A1c (HbA1c) among 87 treatment group and 62 comparison group participants. Setting: Urban/metropolitan city in the United States. Intervention: A community-based behavioral intervention with 3 components including health-coach visits, registered dietitian visits, and exercise consultations delivered over 12 months. Measures: Biometric measurements were collected at baseline, 3, 6, 9, 12, and 18 months, whereas self-reported measurements were collected at baseline, 6 months, and 12 months. Analysis: Linear mixed models with participant-level random intercepts were fitted for BMI and HbA1c. Results: The treatment group demonstrated reductions in BMI (percentage change = −2.1%, P < .001) and HbA1c (−0.6%, P < .001) as well as improvement in diabetes knowledge (+5.4%, P = .025), whereas the comparison group did not show any improvements in biometric measures. Dietitian visits were the most effective treatment component to reduce HbA1c (coefficient = −0.08, P = .025). Conclusion: Multiple component behavioral intervention in community settings, particularly when delivered by registered dietitians, shows promise to combat the dual epidemic of obesity and diabetes among low-income and uninsured patients.

scholarly journals Wait times for surgical and adjuvant radiation treatment of breast cancer in Canada and the United States: Greater socioeconomic inequity in America

2009 ◽  
Vol 32 (3) ◽  
pp. 239 ◽  
Author(s):  
Kevin M Gorey ◽  
Isaac N Luginaah ◽  
Eric J Holowaty ◽  
Karen Y Fung ◽  
Caroline Hamm
Keyword(s):  
Breast Cancer ◽  
Socioeconomic Status ◽  
Low Income ◽  
Cancer Care ◽  
Radiation Treatment ◽  
The United States ◽  
Historical Study ◽  
Adjuvant Radiation ◽  
Breast Cancer Care ◽  
Socioeconomic Inequity

Purpose. The demand for cancer care has increased among aging North American populations as cancer treatment innovations have proliferated. Gaps between supply and demand may be growing. This study examined whether socioeconomic status has a differential effect on waits for surgical and adjuvant radiation treatment (RT) of breast cancer in Canada and the US. Methods. Ontario and California cancer registries provided 929 and 984 breast cancer cases diagnosed between 1998 and 2000 in diverse urban and rural places. Residence-based socioeconomic data were taken from censuses. Cancer care variables were reliably abstracted from health records: stage, receipt of surgery and RT, and waits from diagnosis to initial and initial to adjuvant treatment. Median waits were compared within- and between-country with the non-parametric Mann-Whitney U-test. Categorically long, age-adjusted wait comparisons used the Mantel-Haenszel chi-square test. Results. There were significant associations between lower socioeconomic status and longer surgical waits, lower access to adjuvant RT and to longer RT waits across diverse places in California. None were observed in Ontario. The two cohorts did not practically differ on access to surgery or on surgical waits. Compared with their counterparts in California, low-income Ontarians, particularly those in small urban places, gained greater access to RT, while high-income Americans had shorter waits for RT. Conclusions. This historical study contextualized Canada’s “waiting-list problems” with evidence on breast cancer care, where lower income Americans seemed to have waited as long as similar Canadians. Many more low-income Americans seemed to experience the longest wait of all for adjuvant care. They simply did not receive it. In contrast to stark American socioeconomic inequity, this study evidenced remarkable equity in Canadian breast cancer care.

scholarly journals The Implementation of Evidence-Based Obesity Education Curricula to Prevent Cancer in a Predominantly Mexican–American Community on the U.S.-Mexico Border

2021 ◽  
Author(s):  
Roy Valenzuela ◽  
Alma Morales ◽  
Jon Sheen ◽  
Sylvia Rangel ◽  
Jennifer J. Salinas
Keyword(s):  
Physical Activity ◽  
Low Income ◽  
Mexican Americans ◽  
Weight Status ◽  
Cognitive Theory ◽  
Underserved Populations ◽  
Evidence Based ◽  
Community Based ◽  
Incidence And Mortality ◽  
Low Income Housing

Abstract Although cancer is the leading cause of death among Mexican-Americans, few community-based programs target obesity reduction as a way to reduce the prevalence of obesity-related cancer in underserved populations. Evidence suggests that obesity correlates with 13 types of cancer. The objective is to provide an overview of evaluation and selection of evidence-based content; details of the implementation process; modifications needed to tailor education programs to specific needs of different target audiences; and demonstrate challenges of implementing a community-based prevention program intended to reduce cancer incidence and mortality in Mexican-Americans. We used the Social Cognitive Theory (SCT) to develop a 10-topic menu of educational classes using elements of multiple evidence-based curricula. Outcome measures for physical activity and nutrition were determined using the International Physical Activity Questionnaire (IPAQ) and the Dietary Screener Questionnaire (DSQ). Weight status was determined using weight, body fat, and body mass index (BMI). To date, 2845 adults received wellness education from our program. Multiple delivery models were used to reach a larger audience; they included a 4-week model, 5-week model, employer model, low-income housing, 1- and 2-h sessions, and clinic encounters. Individuals were given education at multiple community locations including senior centers (14%), churches (0.6%), employers (17.6%), low-income housing (8.2%), community centers (16.6%), clinics (11.5%), and schools (32.5%). Our study indicates that our delivery model is feasible and can disseminate evidence-based obesity education. Further investigation is necessary to assess long-term behavioral change and to assess the most effective model for delivery.

Using palliative care to maximize the value of care for patients with advanced cancer.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 59-59
Author(s):  
Risha Gidwani ◽  
Randall Gale ◽  
Diane E. Meier ◽  
Steven M Asch
Keyword(s):  
Palliative Care ◽  
Patient Outcomes ◽  
Advanced Cancer ◽  
Cancer Care ◽  
Financial Burden ◽  
Medical Costs ◽  
The United States ◽  
Care Patient ◽  
Care Needs ◽  
Patients With Cancer

59 Background: Cancer is one of the highest cost conditions in the United States, with growth in cancer costs outpacing general medical costs. This is troubling from a patient perspective. Patients with cancer experience significantly greater financial burdens compared with patients with other medical conditions. Many patients forgo or discontinue cancer treatment partly because they do not want to burden their families with significant debt. The growth of cancer and other medical costs is also threatening the health of the U.S. economy, prompting calls for the need for high-value practices. In healthcare, value indicates an achievement of patient outcomes proportional to the resources spent to achieve them. Increasing the provision of palliative care may be one way to achieve higher value care in cancer. Methods: We summarize the literature regarding palliative care, patient outcomes, and costs to assess the value of palliative care in advanced cancer. We also review the literature to identify reasons for low patient receipt of palliative care. Results: Palliative care represents a strong opportunity to improve the value of cancer care. Palliative care is associated with better informed and more satisfied patients and families, a reduction in use of undesired medical services, and does not pose a risk of increased mortality. Reasons for low rates of palliative care include a mismatch between how patients perceive palliative care and how physicians believe patients perceive palliative care, a lack of familiarity with locally-available palliative services, and a perceived incompatibility with cancer therapy. Conclusions: Palliative care for patients with cancer can improve the patient and family experience while maximizing value for the healthcare system and averting unnecessary patient financial burden. Systems redesign is needed in order to support oncologists in supporting the palliative care needs of their patients and realizing this high-value cancer care.

Identifying critical data elements for a provincial transition plan from a primary care perspective.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 54-54
Author(s):  
Stacey Hunter ◽  
Stefanie De Rossi ◽  
Angelika Gollnow ◽  
Grace Kim ◽  
Ed Kucharski ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Care ◽  
Primary Care Providers ◽  
The United States ◽  
Provincial Government ◽  
Care Providers ◽  
Care Plans ◽  
Delphi Approach ◽  
Transition Plan ◽  
Data Elements

54 Background: Cancer Care Ontario is the provincial government advisor on the cancer and renal systems, as well as access to care for key health services. Enhancing flow of patient information and care plans are priorities to improve continuity and quality of survivorship care. Cancer Care Ontario’s Primary and Community Care and Survivorship Programs have initiated work to identify required information that primary care providers (PCPs) should receive about a patient’s cancer care at the point of transition back to primary care. Methods: Fifteen focus groups were conducted with PCPs in Ontario using a guide to facilitate group discussions on the utility and content of transition plans. Based on the collective feedback, thematic analysis was conducted on data elements that were expressed as critical with 12 common themes identified. Transition plan materials across Ontario’s Local Health Integration Networks and relevant jurisdictions in Canada and the United States were also reviewed to abstract a list of all documented data elements. A comprehensive matrix of data elements was then created by incorporating the list of all documented data elements with the 12 common themes. Using this matrix, prevalence of data elements amongst reviewed materials was ranked by frequency. A Modified-Delphi approach was used to validate and prioritize data elements with Cancer Care Ontario provincial and regional primary care clinical leadership. Results: In total, 21 documents were reviewed and 30 standard data elements were identified and ranked by frequency. The 10 most frequent data elements were classified as required for a standard transition plan. The remaining data elements were presented to 29 Cancer Care Ontario Cancer Leads to reach consensus on a core set of data elements to be required for inclusion in a transition plan. Conclusions: Essential data elements for inclusion in a transition plan have been identified from the perspective of PCPs. Next steps include engaging patient and family advisors, oncologists, and health system administrators through a phased regional consultation process. The role of synoptic reporting for a future standard survivorship transition plan will also be explored.

Exploring Motivational Interviewing to Engage Latinos in Advance Care Planning: A Community-Based Social Work Intervention

2018 ◽  
Vol 35 (8) ◽  
pp. 1091-1098 ◽  
Author(s):  
Frances R. Nedjat-Haiem ◽  
Iraida V. Carrion ◽  
Krystyna Gonzalez ◽  
Elizabeth D. Bennett ◽  
Kathleen Ell ◽  
...  
Keyword(s):  
United States ◽  
Motivational Interviewing ◽  
Advance Care Planning ◽  
Stages Of Change ◽  
Comparative Method ◽  
The United States ◽  
Care Planning ◽  
Community Based ◽  
Advance Care ◽  
Eol Care

Advance care planning (ACP) does not readily occur in medical settings and often gets missed. Older Latinos need ACP information to encourage advance directive (AD) completion indicating preferences for end-of-life (EOL) care. Objective: To explore the experiences with counseling using motivational interviewing (MI) techniques and social workers to encourage ACP communication among older Latinos with advance chronic diseases. This study describes stages of readiness to plan for EOL care. Design: We conducted a qualitative study with older Latinos who participated in a community-based intervention in Southern New Mexico. Methods: Participants in the intervention were selected because they received ACP education plus counseling involving MI to address resistance to ACP. Motivational interviewing counseling involved the following: (1) engaging in structured dialogue about ACP, (2) using and completing AD documentation, (3) encouraging ACP communication with providers and families, and (4) applying AD information into actionable behavior. We utilized a constant comparative method and thematic analysis to explore the meaning of older Latinos’ experiences with MI counseling and stages of change. Results: Participants (n = 32) were mostly women (74.3%), half born in the United States and half from Mexico in the United States on average for 31.75 (standard deviation 16.22) years. Many had less than sixth grade education (31.3%) or had not completed high school (21.9%). Key themes indicate the following stages of change: (1) precontemplation, (2) contemplation, (3) preparation, (4) ACP action, and (5) maintenance. Conclusion: This study contributes to the literature by identifying areas for adaption to enhance understanding and increase information to ultimately achieve the completion of ACP among Latinos.

scholarly journals Perspectives of Health Care Payer Organizations on Cancer Care Delivery Redesign: A National Study

2019 ◽  
Vol 15 (1) ◽  
pp. e46-e55 ◽  
Author(s):  
Manali I. Patel ◽  
David Moore ◽  
Jay Bhattacharya ◽  
Arnold Milstein ◽  
Tumaini R. Coker
Keyword(s):  
Health Care ◽  
End Of Life ◽  
Cancer Care ◽  
Care Delivery ◽  
Comparative Method ◽  
The United States ◽  
National Study ◽  
Care Services ◽  
Care Payer ◽  
Logistic Support

INTRODUCTION: Despite advancements in cancer care, persistent gaps remain in the delivery of high-value end-of-life cancer care. The aim of this study was to examine views of health care payer organization stakeholders on approaches to the redesign of end-of-life cancer care delivery strategies to improve care. METHODS: We conducted semistructured interviews with 34 key stakeholders (eg, chief medical officers, medical directors) in 12 health plans and 22 medical group organizations across the United States. We recorded, transcribed, and analyzed interviews using the constant comparative method of qualitative analysis. RESULTS: Participants endorsed strategies to redesign end-of-life cancer care delivery to improve end-of-life care. Participants supported the use of nonprofessionals to deliver some cancer services through alternative formats (eg, telephone, Internet) and delivery of services in nonclinical settings. Participants reported that using nonprofessional providers to offer some services, such as goals of care discussions and symptom assessments, via telephone in community-based settings or in patients’ homes, may be more effective and efficient ways to deliver high-value cancer care services. Participants described challenges to redesign, including coordination with and acceptance by oncology providers and payment models required to financially support clinical changes. Some participants suggested solutions, including providing funding and logistic support to encourage implementation of care delivery innovations and to financially reward practices for delivery of high-value end-of-life cancer care services. CONCLUSION: Stakeholders from payer organizations endorsed opportunities to redesign cancer care delivery, and some are willing to provide logistic, design, and financial support to practices interested in improving end-of-life cancer care.

Successful Strategies to Address Disparities: Insurer and Employer Perspectives

2020 ◽  
pp. 292-300
Author(s):  
Manali I. Patel ◽  
Richard Snyder ◽  
Otis Brawley
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Low Income ◽  
Cancer Care ◽  
Care Delivery ◽  
The United States ◽  
Cancer Disparities ◽  
Care Providers ◽  
High Quality ◽  
Quality Cancer Care

Disparities in cancer have been documented for decades and continue to persist despite clinical advancements in cancer prevention, detection, and treatment. Disparate cancer outcomes continue to affect many populations in the United States and globally, including racial and ethnic minorities, populations with low income and education, and residents of rural areas or low socioeconomic neighborhoods, among others. Addressing cancer disparities requires approaches that are multilevel. Addressing social determinants of health, such as removing obstacles to health (e.g., poverty, discrimination, access to housing and education, jobs with fair pay, and health care) can reduce cancer disparities. However, to achieve cancer health equity, multilevel approaches are required to ensure that access to high-quality cancer care and equitable receipt of evidence-based services can reduce cancer disparities. Policy, health system interventions, and innovative delivery and health care coverage approaches by private and public payers, employer-based payers, and labor union organizations can assist in ensuring access to and receipt of high-quality cancer care while addressing the high costs of care delivery. Partnerships among patients, caregivers, employers, health care providers, and health care payers can make impactful changes in the way in which cancer care is delivered and, in turn, can assist in reducing cancer disparities.

Sign in / Sign up

Export Citation Format

Share Document