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Is there an optimal target for disparities research?
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There is no one solution to the problem.
There is a fair amount of research out there that has identified disparities across different types of cancer care, including disparities in both screening, treatment and follow-up; however, I’m not sure if research funding is the most immediate way to improve outcomes related to cancer care.
If one is interested in addressing and improving outcomes, then taking what we know and trying to improve the systems and networks to provide care that we know is effective in treating these different populations is probably the shortest and quickest way to improve outcomes. If the goal is to improve outcomes in the short term, research is an important part of that, but there is a lot we already know that we need to act upon.
In some situations, access to care is a very important part of the problem, but access can mean a lot of different things. In a rural setting, access could mean lacking the ability to see a physician because the nearest physician is 500 miles away. But in an inner city setting, access could mean something very different. Access in general is a very important target for efforts to improve disparities, but certainly by no means the only one. Efforts to extend access will help, but in the long term, we’ll need to address more than just the access problem.
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Addressing access to care is, I think, an educational component for both patients and providers. Some of that is trying to build up the resources that are needed for different disparities groups — translators for example — but there are structural barriers that also need to be addressed.
There is always an effort to find the one solution for the disparity problem. The challenge for disparities is that there is no one specific solution. We have to do a number of different things to address the issue.
Michael J. Hassett, MD, MPH, is a Medical Oncologist in the Breast Oncology Center at Dana-Farber Cancer Institute in Boston.
Stop researching. Start acting.
The next step in disparities research is to stop describing the problem, which I think has been adequately done, and start coming up with answers as to why these disparities exist, and ways to remedy the disparities in the care we provide.
When it comes to geographic disparities, an unequal distribution of resources — availability of sub specialty care or access to the latest technology — may contribute to the disparities that we see when we think about rural vs. urban, as well as regional variations.
Racial and socioeconomic disparities are very complicated issues. Understanding those issues probably involves different research techniques than we tend to use in health services research. We need to start paying attention to cultural issues, trust and communication. Patient-provider communication is influenced by the backgrounds from which each individual comes and what they each bring to the table when they have the discussions that lead to health care decisions.
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It’s going to involve things like community outreach and focus groups to really understand how people make decisions, how they make shared decisions with their provider and how that may vary depending on their background.
We’ve mined the data and shown that disparities exist. There have been a plethora of studies that have looked at the predictors we can find in the data that exists. The next step is to develop and test interventions to improve the care we provide, especially to vulnerable populations.
Caprice C. Greenberg, MD, MPH, is an Assistant Professor of Surgery at Harvard Medical School, Associate Director for the Center for Surgery and Public Health at Brigham and Women’s Hospital and a member of the Center for Outcomes and Policy Research at Dana-Farber Cancer Institute.