This partially randomized clinical trials studies Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) in reducing cancer care inequality among African American patients with stage I-II breast or lung cancer and their providers. African-Americans diagnosed with breast or lung cancer are more likely to die from the diseases than their white counterparts who are diagnosed with the same disease at the same stage. ACCURE is a healthcare systems intervention with the goal of reducing racial inequities in cancer treatment and outcomes by changing the way doctors look at patient data and providing medical staff training.
Study sponsor and potential other locations can be found on ClinicalTrials.gov for NCT01954641.
PRIMARY OBJECTIVES:
I. Introduce and diffuse 2 transparency intervention components and 2 accountability intervention components, within 2 cancer centers, to reduce racial inequity in quality and completion of breast and lung cancer care.
II. Conduct a 5-year study using interrupted time-series design, with an embedded randomized control trial (RCT), to test the effectiveness of the ACCURE intervention within 2 cancer centers on optimizing therapy and narrowing treatment disparities between White and African American patients with first diagnosis of stage 1-2 breast and lung cancer that contribute to excess mortality.
OUTLINE:
PROVIDERS AND STAFF INTERVENTION: Providers and staff undergo 2-hour Healthcare Equity Training (HET) sessions followed by 1-hour booster sessions for continuing medical education (CME)/continuing education (CE) credit every quarter. The HET training curriculum includes an introduction (history of the People’s Institute for Survival and Beyond’s development of Undoing Racism concepts, discussion of issues of inequality treatment, why racism is relevant to practice of medicine, establishment of group norms and presentation of a contract of behavior), understanding the functioning of medical systems (concept and application of "thinking outside the box"), analysis of power and authority, discussion of actual case studies, and a 3-month action plan (discussion with specific ideas regarding advocacy for equal treatment of all patients). Each booster session also consists of reviewing the HET principles (Part I), discussion of progress on systemwide changes for cancer patients and action plans for the next 3 months (Part II), and feedback from the ACCURE Navigator, pressure point encounters, and what changes can be implemented during the next 3 months (Part III).
PATIENTS INTERVENTION: Patients are randomized to 1 of 2 intervention arms.
ARM I (ACCURE NAVIGATOR): Patients complete telephone surveys with the assistance of a patient' navigator on the Baker's Short-Form Test of Functional Health Literacy in Adults, LaVeist's 17-item Medical Mistrust Scale, pressure point encounters identified in Power Analysis, understanding and being heard by cancer center staff, perceived quality of clinical performance, patient satisfaction with care (Likert Scale), and patient satisfaction with shared communication. Patients also complete a yes-no questionnaire about missed appointments, mistake in doing what was recommended, putting off what was recommended, refusing what was recommended, decision to stop treatment for a while, and if someone from the Cancer Center talked to them about how to get back on track with their treatment.
ARM II (USUAL CARE): Patients receive usual care.
Trial PhaseNo phase specified
Trial Typehealth services research
Lead OrganizationUNC Lineberger Comprehensive Cancer Center
Principal InvestigatorEugenia Eng
