Methods to Overcome Barriers in Underserved Populations

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Methods to Overcome Barriers in Underserved
Populations

• Dwight E. Heron, MD
• (on behalf of the Cancer Disparities Research
  Partnership)
• ASTRO Education Symposium
• November 6th, 2006

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CDRP Sites

• Laredo Medical Center
• Laredo, Texas
• Rapid City Regional Hospital
• Rapid City, South Dakota
• Centinela Freeman Regional Medical Center
• Inglewood, California
• New Hanover Regional Medical Center
• Wilmington, North Carolina
• Singing River Hospital
• Pascagoula, Mississippi
• UPMC McKeesport
• McKeesport, Pennsylvania

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Populations Served
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Approaches to Outreach

• Key Site Leaders
• Community Research Representative
• Outreach Nurse
• Health Educator
• Community Outreach Specialist
• Professional Development Specialist

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Approaches to Outreach

• Key Functions of Leaders
• Education
• Community events/meetings
• Church groups
• Health Ministries
• Hospital Employees
• Local Businesses
• Physicians
• Employ long-time community representatives from
  respective reservations or lay community

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Approaches to Outreach (cont.)

• Key Functions of Leaders (cont.)
• Brochure educational displays, including design
  of brochures for specific populations (i.e.
  Amish)
• Engages community partners already established in
  communities served to conduct outreach programs
• Tailor education programs for community groups
  (i.e. homeless)
• Engage community physicians in education programs
  with mentor(s)

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Approaches to Navigation

• Navigator Requirements/Qualifications
• Registered Nurses (Rapid City)
• Lay Persons (Centinela Freeman Singing River)
• Health Field Educated, Bachelor Level/Tumor
  Registrar (UPMC McKeesport)

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Approaches to Navigation (cont.)

• Navigator Functions
• Support and guidance of patient family
• Referrals to tribal, community social support
  systems
• Coordinate services with physicians re clinical
  trials eligibility
• Facilitate interactions communications
• Advise patients re ways to pay for care,
  transportation other needed community resources
• Track interventions outcomes

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Approaches to Navigation (cont.)

• Navigator Functions (cont.)
• Provides transportation for patients
• a critical issue in some service areas
• Serve as tumor registrars at 5 sites
• Refers newly diagnosed cancer patients to
  navigator program through physician
• Attends local health fairs to promote program to
  community
• Matches patients navigators based on cultural,
  interpersonal, professional peer
  characteristics
• Empowering patients to overcome barriers

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Approaches to Clinical Trials

• Due to the nature of the unique populations
  served by the various CDRP sites surveyed, each
  sites strategies were explored

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Approaches to Clinical Trials (cont.)

• Rapid City
• Intensive orientation to various tribal health
  councils conducted
• Discussions, radio interviews
• Designed novel trial reducing treatment times
  that appealed to populations living extreme
  distances from medical facility
• Cultural sensitivity relating treatment terms
  in meaningful language context

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Approaches to Clinical Trials (cont.)

• Centinela Freeman
• Developed strategy to overcome barrier of general
  distrust of population to trials
• Used lay navigator to discuss navigation trials
  upon first visit
• Navigators provided the bridge necessary to
  health professionals to reach the community

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Approaches to Clinical Trials (cont.)

• Singing River (progress delayed by Katrina)
• Provided major follow up care post Katrina for 15
  NCI protocol patients (Kiessler AFB Clinic was
  destroyed)
• Established track record
• All new consults screened for clinical trial
  appropriateness
• Full time research nurse clinical research
  associate dedicated to program RN also conducts
  outreach in the community addressing clinical
  trials

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Approaches to Clinical Trials (cont.)

• UPMC McKeesport
• Established RTOG affiliation for UPMC centers (3
  of 5 sites)
• Work closely with two other health systems to
  advise on appropriate trials to offer
• Give physicians ownership of the trial
• Posted information in patient waiting rooms
• Worked with community partner to stimulate
  interest in and overcome distrust of clinical
  trials
• New clinical trials supplement will provide staff
  needed to increase these efforts

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Successes

• Major inroads into American Indian community by
  Rapid City
• Resilient program demonstrated by Singing River
  recovery from Katrina
• Immediate entry into communities via established
  partnerships by UPMC McKeesport
• Flexible adaptive programs demonstrated by all
  with regard to communities served while
  maintaining scope

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Successes (cont.)Accruals to Trials
includes Kiessler follows ups post Katrina
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Advice

• Recommend 12-18 months start-up funding for
  programs initiated in community hospital setting
  followed by 18 months closure/ analysis period
  increasing program period to 7-8 years.
• Partner institutes should be invested
  pro-active in guiding new programs particularly
  with assistance related to administration,
  regulatory financial issues
• Institution should provide support opportunity
  for community representatives to be adequately
  trained