Date of Award

January 2023

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Leah M. Ferrucci

Second Advisor

Maureen Canavan

Abstract

Background: Cancer patients who self-identify as Black and Hispanic are more likely to receive delays in care as compared to their Non-Hispanic White counterparts. Current research suggests that while providers are aware of racial-ethnic disparities in access to treatment at a nationallevel, they either fail to recognize hospital-level or practice-level disparities (occurring within the provider’s own clinical care) or attribute it to patient-level factors. However, this phenomenon of decreased awareness among providers regarding factors specific to them or their hospital/practice is not well understood and has yet to be studied in the oncology space. Methods: We conducted a non-randomized pre-post educational intervention pilot study with 18 breast cancer providers at the Smilow Cancer Center in February 2023. Prior to the educational intervention providers completed an online cross-sectional survey that assessed baseline understanding of disparities at three levels (national-level, within Smilow, and within the provider’s own practice also referred to as individual-level). The providers then watched a live data presentation focusing on racial-disparity metrics and completed a post-intervention crosssectional survey. Differences between pre- and post-intervention survey responses were evaluated with Fisher’s exact tests. Results: Among 18 breast cancer providers, awareness of race as a factor in influencing differences in oncological care increased significantly (from 33.3% to 77.8%, p = 0.02) pre-topost intervention at the Smilow-level, but did not change at the national- or individual-level. Providers identified social determinants of health—non-medical factors that have an impact on health, such as housing insecurity, poor employment conditions, and food insecurity—as the main cause of disparities both nationally and within Smilow. At the individual-level, most providers believed that patient-level factors rather than provider-level factors were driving differences in oncological care metrics and reported that larger systems, such as healthcare or government, were responsible for reducing disparities. Conclusion: In this small pilot study among providers with relatively high awareness of racial/ethnic disparities regarding cancer care at baseline, a brief educational intervention did not increase awareness of national- and individual-level factors, but did increase awareness of Smilow-level factors. As the oncology field is starting to address inequities in care, it is crucial for providers to not only acknowledge existence of these disparities in access to care, but also to establish clinically actionable guidelines to reduce these disparities within their own practice. Future studies should focus on how systemic factors influence oncology care and identify strategies to address these inequities.

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This is an Open Access Thesis.

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