Development of an Actionable Framework to Address Cancer Care Disparities in Medically Underserved Populations in the United States: Expert Roundtable Recommendations

Abstract

Purpose: Cancer disparities persist among medically underserved populations despite widespread efforts to address them. We describe the development of a framework for addressing cancer care disparities across the cancer care continuum (CCC), guided by the CCC domains established by the Institute of Medicine/National Academies of Sciences, Engineering, and Medicine (IOM/NAS).

Materials and methods: An environmental scan was conducted to identify strategies and associated experts who are providing or have successfully provided community- and/or patient-centric IOM/NAS-defined domain standards to our target populations. A multistakeholder expert roundtable working group was convened for framework development. A premeeting survey informed agenda development, documented expert practices for target populations, and identified priority areas for meeting focus.

Results: The environmental scan identified 84 unique experts across 8 stakeholder groups and 44 patient organizations; 50 were invited to the roundtable and 33 participated. They broadly represented disease sites, geography, and experience with target populations and all CCC domains. The premeeting survey (16 responses) identified coordination of care or patient navigation (66.7%), community engagement (60.0%), and healthcare system changes (53.3%) as priority focus areas. The experts identified access and treatment barriers or gaps within and between CCC domains, specified key notable practices to address these, and developed an actionable framework and recommendations for each priority focus area.

Conclusion: The framework and recommendations are intended to guide researchers, healthcare leaders, advocates, community- and patient-focused service organizations, and policy leaders to address and promote health equity in cancer care access and treatment outcomes.

Fig A1.

Flow diagram of experts invited to the roundtable meeting.

Fig A2.

Experience of survey respondents in one or more of the CCC domains across target populations (based on 16 responses). CCC, cancer care continuum; LGBTQ, lesbian, gay, bisexual, transgender, and questioning.

Fig A3.

Domain of the CCC that was the primary focus of survey respondents (based on 16 responses). CCC, cancer care continuum.

Fig A4.

Areas of focus with the potential to have the greatest impact on cancer patient outcomes in target populations as a result of the expert roundtable meeting (based on 15 responses).

Fig A5.

Geographic distribution of roundtable participants (N = 33).

Fig A6.

Summary of the approach used to develop an actionable framework to address cancer care disparities in medically underserved populations in the United States.

Fig A7.

Summary of expert informed key findings and priority actions across and between the cancer continuum of care for medically underserved populations in the United States.