Community engagement, partnerships can reduce cancer disparities, improve population health

NASHVILLE, Tenn. — A five-step roadmap helped Duke Cancer Institute establish a health equity program designed to reduce cancer disparities and improve population health through community partnerships.

Nadine J. Barrett, PhD , MA, MS , director of the Office of Health Equity and Disparities at Duke Cancer Institute, provided an overview of the effort during a presentation at the Association for Community Cancer Centers National Oncology Conference.

“The key question is: How do we create partnerships and ensure the work we’re doing can be leveraged in such a way that people in our community can actually benefit,” Barrett said. “Also, at a time when we are required to do so much for different accreditation agencies, how do we identify ways to do health assessments in a way that is meaningful to our own institutions and meets the needs in our community, and how does this help leverage our partnerships toward using those assessments to improve health?”

Duke Cancer Center’s effort consisted of creation of a diverse and engaged community advisory council; robust and collaborative health assessments; identification of priorities for programs and services, as well as research; aligned partnership programming; and programmatic evaluations and outcome measures.

The advisory council — designed to reflect patients in the community and the organizations that serve those constituents — included representatives of strategic associations and faith organizations, community members, and individuals appointed by local and state health entities.

“We need to ensure the work we are doing reflects the diversity in our back yard so it can be as effective as possible,” Barrett said. “Sometimes we think we need to have all of the answers, but there is tremendous value in engaging members of the community to help us.”

The advisory council conducted community and patient town hall sessions, health system and community listening sessions, and outreach programs and health assessments.

“The goal is to intentionally engage diverse community organizations and, together, determine how best to align our key priorities,” Barrett said. “This was driven by the community, for the community, which is what makes it so powerful.”

From there, a strategic plan emerged. The advisory council identified three integrated focus areas: community engagement and longitudinal patient navigation; diversity in research and clinical trials; and health disparities education, training and research.

This framework led to the development of a community-facing navigation program that consisted of four key pillars: initial participant contact through outreach activities, referrals or efforts of faith partners; an assessment of needs and barriers, which examined health care access and service availability, transportation, child care, work schedule and cultural needs; a financial/insurance assessment; and screening and, if necessary, follow-up.

PAGE BREAK

In 2 years, the community navigators in conjunction with their partners educated 5,043 people about cancer risks, symptoms, screenings and clinical research. They screened 1,523 people through partnered community outreach; of this group, 34.3% were undocumented, 57.9% were uninsured and 12.9% had no primary care provider.

Fifty-two of the individuals who underwent screening received follow-up care, such as biopsies or additional diagnostics.

The effort also led to the creation of Project PLACE, the acronym for which stands for Population-Level Approaches to Cancer Elimination.

The initiative, which has received NCI funding, has engaged 17 community partners to capture 2,000 surveys to define the catchment area and develop subsequent collaborative strategies around research. The effort is designed to reach diverse racial and ethnic groups, urban and rural communities, and LGBTQ individuals.

The overall health equity program initiative demonstrates the importance of intentionally engaging diverse community councils and organizations to explore priorities and determine how to align key priorities, Barrett said.

“Don’t reinvent the wheel; engage in what is already happening,” she said. “And if we think outside of the box about how to collaborate, there are great opportunities to create that win-win.”

For more information:

Come Together: A health disparities and equity cancer program built on community collaboration. Presented at: Association of Community Cancer Centers National Oncology Conference; Oct. 18-20, 2017; Nashville, Tenn.

Disclosure: Barrett reports no relevant financial disclosures.