Ensuring equitable access to cancer care for Black patients in Canada

Ezeife, Doreen Anuli; Padmore, G. R. A.; Vaska, Marcus; Truong, Tony H.

doi:10.1503/cmaj.212076

Cited by 10 publications

(8 citation statements)

References 27 publications

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“…This implies that there is urgent need for guidance at the policy and organizational level on the roles and scope of practice of caregivers in supporting virtual cancer care that is tailored to the unique needs of cancer patients. Second, previous studies suggest that the cultural background of racialized patients influence their views on symptoms, diagnosis and treatments that may hinder access to cancer care [27]. Our findings unravelled culturally mediated views of older Black cancer patients who were confronted with their children having more influence in their health care during virtual encounters and who were reluctant to share their health information with their children.…”

Section: Discussionsupporting

confidence: 50%

“…Inequities in cancer outcomes can be linked to higher cancer risk, delayed diagnosis and unequal opportunities to access timely treatment. This is more significant for certain population groups that experience marginalized social conditions that are shaped by stigma, discrimination and intergenerational trauma [15,27]. Inequities in cancer care can be further exacerbated at the intersection of social identities with other marginalizing conditions such as unequal access to the social determinants of health, resulting in health inequities that are structured and reinforced by the health care system [22].…”

Section: Discussionmentioning

confidence: 99%

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Improving virtual cancer care for older Black adults: A qualitative study (Preprint)

Wankah,

Chandra,

Lofters

et al. 2024

Preprint

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BACKGROUND Health systems are rapidly promoting virtual cancer care models to improve cancer care of their populations. However, virtual cancer care can exacerbate inequities in cancer care for communities experiencing social disadvantaged. Older Black cancer patients face unique challenges to accessing and utilizing virtual cancer care. OBJECTIVE This study focused on understanding the virtual cancer care experience of older Black patients, their caregivers and healthcare providers to identify strategies that can better support patient-centered virtual cancer care. METHODS A theory-informed thematic analysis was conducted using data collected from six focus groups (N = 55 participants) conducted across ten Canadian provinces. Data coding and thematic analysis was informed by the Patient Centered Care model and the synergies of oppression conceptual lens. RESULTS Five overarching themes describe the experience of older Black patients, caregivers and health care providers in accessing and utilizing virtual cancer care: i) heightened inequities at the intersection of multiple systems of oppression; ii) shifting caregivers’ dynamics; iii) autonomy of choice and choosing based on the purpose of care; iv) digital accessibility and v) effective digital communication. We identify eight barriers and six facilitators to optimal virtual cancer for older Black adults. Barriers include limited digital literacy, linguistic barriers in traditional African/Caribbean languages, and culturally mediated views of patients; and facilitators include community-based cancer support groups, caregivers support and key features of digital technologies. CONCLUSIONS A multipronged approach that simultaneously focuses on addressing barriers and leveraging community strengths can improve access and utilization of virtual cancer care. A redesign of virtual cancer care programs, tailored to the needs of most structurally marginalized groups like older Black adults can enhance the virtual care experience for all population groups. Public policies and organizational practices that address issues like availability of internet in remote areas, resources to support linguistic barriers or culturally sensitive training are important in responding to the complexity of access to virtual cancer care. These findings have implications for other structurally marginalized and underserved communities that have suboptimal access and utilization of virtual care. CLINICALTRIAL N/A

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Section: Discussionsupporting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Improving virtual cancer care for older Black adults: A qualitative study (Preprint)

Wankah,

Chandra,

Lofters

et al. 2024

Preprint

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“…Approximately 60% of all deaths in Canada result mainly from four life-limiting conditions that require palliative care, namely, cancer, cardiovascular diseases, diabetes and chronic respiratory diseases [ 5 ]. Canada’s Black population has an increased risk of developing these life-limiting conditions [ 6 ], with Black adults having an increased risk of heart failure and stroke compared to other ethnic groups [ 4 , 7 ]. Diabetes is 2.1 times more common among Black than among white adults [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Diabetes is 2.1 times more common among Black than among white adults [ 8 ]. Black males are among those with high incidence and mortality rates from prostate, liver, and stomach cancers while Black females have a high prevalence of multiple myeloma and breast cancer [ 6 , 9 , 10 ]. These data suggest a growing need for palliative and end-of-life care among Blacks in the coming years.…”

Section: Introductionmentioning

confidence: 99%

Inequities in access to palliative and end-of-life care in the black population in Canada: a scoping review

Bassah,

Beranek,

Kennedy

et al. 2024

Int J Equity Health

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Background Improving equity and early access to palliative care for underserved populations in Canada is a priority. Little is known regarding access to palliative and end-of-life care in the Black population. Methods We undertook a scoping review using the framework by Arksey and O’Malley to identify knowledge, access gaps, and experiences of palliative and end-of-life care among Blacks living with life-limiting illnesses in Canada. Primary studies, discussion papers, books, and reports were considered eligible. We followed a comprehensive search strategy developed by an information scientist. Searches were performed in the following bibliographic databases: Medline, EMBASE, PsycINFO via OVID, CINAHL via EBSCOhost, Scopus and Cochrane Library via Wiley. The search strategy was derived from three main concepts: (1) Black people; (2) Canada and Canadian provinces; (3) Palliative, hospice, or end-of-life care. No publication date or language limits were applied. Titles and abstracts were screened for eligibility by one reviewer and full text by two independent reviewers. Results The search yielded 233 articles. Nineteen articles were selected for full-text review, and 7 articles met the inclusion criteria. These studies were published between 2010 and 2021, and conducted in the provinces of Ontario and Nova Scotia only. Studies used both quantitative and qualitative methods and included cancer decedents, next of kin, family caregivers and religious leaders. Sample sizes in various studies ranged from 6 − 2,606 participants. Included studies reported a general lack of understanding about palliative and end-of-life care, positive and negative experiences, and limited access to palliative and end-of-life care for Blacks, across all care settings. Conclusion Findings suggest limited knowledge of palliative care and inequities in access to palliative and end-of-life care for Blacks living with life-limiting illnesses in 2 Canadian provinces. There is an urgent need for research to inform tailored and culturally acceptable strategies to improve understanding and access to palliative care and end-of-life care among Blacks in Canada.

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“…Nurse-led digital health innovations have shown to target these gaps in unmet survivorship care needs by broadening the available skilled provider pool beyond specialists for patient-facing care (e.g., symptom monitoring, management, and psychosocial support [10][11][12][13] ). However, equitable access to care continues to be an issue within both conventional specialist-led and virtual care services, as structural barriers (e.g., socioeconomic status, immigration status, neighbourhood disadvantage, geographic location) can prevent patients from accessing timely care 14,15 .…”

Section: Introductionmentioning

confidence: 99%

Nurse-led virtual prostate cancer clinic for survivorship care: Qualitative study of patient experiences and needs

Xiong,

Young,

Pfisterer

et al. 2023

Preprint

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Background: Prostate cancer survivors (PCa) can experience a range of unmet needs over a long horizon of survivorship. Thin healthcare services and specialist-led follow-up care models may not adequately address these needs. Digitally mediated nurse-led virtual care models may help support PCa survivors who have unmet survivorship needs in current healthcare systems. Methods: This qualitative descriptive study explores 10 patients’ experiences with follow-up and virtual care, informing the design of a nurse-led virtual clinic (the “Ned Nurse” Clinic) to provide integrated healthcare services. Results: Patient follow-up care experiences included uncertainty regarding care gaps despite new telemedicine modalities and the need for personalized wellbeing support. Patient recommendations for virtual care related to improving integration of existing care connections, supporting patient self-management, and addressing accessibility. Patients anticipate nurse-led PCa virtual care will: (1) clarify patient and provider roles and responsibilities; (2) improve care ease and access to care; (3) enhance mental wellbeing, and (4) reinforce continuity of care. Conclusion: Patients are keen to benefit from the flexibility and increased resources that digital health may provide, but remain concerned about digital literacy and service changes to support these innovations. Future work should evaluate the efficacy of digitally mediated nurse-led virtual care models to support PCa survivorship.

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Ensuring equitable access to cancer care for Black patients in Canada

Cited by 10 publications

References 27 publications

Improving virtual cancer care for older Black adults: A qualitative study (Preprint)

Improving virtual cancer care for older Black adults: A qualitative study (Preprint)

Inequities in access to palliative and end-of-life care in the black population in Canada: a scoping review

Nurse-led virtual prostate cancer clinic for survivorship care: Qualitative study of patient experiences and needs

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