Power analysis: An anti-racism tool for mapping pressure point encounters in cancer care inequities

 

Background: Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) is a systems change intervention addressing disparities in treatment initiation and completion that result in poorer health outcomes for African American breast and lung cancer patients compared to White. Using an Undoing Racism™ framework, which emphasizes institutional transparency and accountability, ACCURE implemented a “power analysis” of the cancer treatment system as a mechanism for patients to describe “pressure point encounters” that facilitated or hindered their treatment.

Methods: We conducted eight focus groups, four with African American and four with White breast and lung cancer survivors, at our two partner cancer centers. A community-based participatory research (CBPR) approach was used to develop focus group guides, train coders, and conduct qualitative data analysis. Transcripts were coded and analyzed by a racially diverse community-academic team. Findings were used to inform the development of Healthcare Equity Trainings (HET), conducted with providers and staff at each cancer center.

Results: Findings revealed overall satisfaction with cancer care with subtle distinctions in how African American and White lung and breast cancer patients experience treatment, including difficulties with communication regarding appointments, side effects and pain, and coordination of care in the emergency room. Incorporating findings into HET engaged cancer center staff and providers in recognizing pressure points in the cancer system and generating systems-level solutions.

Conclusion: Power analysis is a useful diagnostic tool to map patients’ interactions with cancer systems and a catalyst for ACCURE’s efforts to reduce inequities in quality and completion of lung and breast cancer care.