Increasing Access to Definitive Treatment for Prostate Cancer by Removing Transportation Barriers for Underserved Patients: A Multilevel Feasibility Study
Abstract
Scientific Objective and Rationale: In the United States, significant racial disparities persist for prostate cancer. This is especially true for Black men, who experience a twofold-higher risk of mortality compared to White men. In settings where Black and White men have equal access to care such as the military health system, there is very little racial difference in prostate cancer treatment and outcomes, suggesting that improving access to timely treatment for Black men can reduce disparities. While research on access to treatment typically focuses on insurance coverage, access is a multidimensional concept encompassing geographic, convenience, and cultural factors. Travel burden, reflected by the time and energy associated with travel to reach prostate cancer treatment, is associated with delays and worse outcomes. Residential segregation places Black men far from high quality care and reliable transportation networks, increasing their travel burden relative to White men. Therefore, reducing travel burden could improve equitable access to prostate cancer treatment, reducing Black-White disparities. Our proposal aims to produce evidence that can inform facility-level interventions to reduce travel burden for high-risk, historically marginalized populations seeking prostate cancer treatment. Our study will address this gap using data from three sources. In Aim 1, we will conduct a quantitative cohort study of the impact of travel burden, estimated using a novel geospatial model, on treatment disparities. Mapping results will allow us to determine neighborhoods where reducing travel burden could lead to greatest increases in access to treatment in Black men. The mapped results will be made available online to inform future interventions aimed at addressing disparities in prostate cancer treatment. In Aim 2, we will conduct a pilot pre-post evaluation to estimate the impact of a rideshare intervention on missed appointments in Black men seeking prostate cancer treatment. Men who are eligible based on demographic and clinical criteria will be invited to participate through our Prostate Cancer Outreach Clinic, which serves primarily minoritized populations in the Greater Boston area. Historic controls will be identified and matched to participants based on geographic and clinical characteristics. In Aim 3, we will conduct qualitative research to identify facilitators and barriers of the intervention, seeking inputs from intervention recipients and implementers. Findings from this research will be reviewed by a diverse stakeholder board, with representation from patient advocacy groups, hospital officials, and urban planners. Using a Delphi process, we will synthesize feedback from our stakeholders to inform strategies for the refinement, sustainability, and scaling of successful components of our pilot to other hospital networks in Massachusetts. Evidence from this research will inform a randomized controlled trial of transportation-based interventions to reduce travel burden for high-risk and historically marginalized populations seeking prostate cancer treatment. Applicability of Research: This research will improve our understanding of how hospital-based prostate cancer programs can address travel burden, an access barrier that disproportionately impacts Black men. Our study incorporates complementary methods (epidemiologic research, program evaluation, qualitative research) to generate evidence regarding the feasibility and impact of interventions to reduce travel burden for high-risk, historically marginalized groups of men at risk of prostate cancer. Through continuous engagement with our diverse stakeholder board, we can ensure that policymakers at state and local levels can use these findings to implement programs to reduce barriers to treatment for their communities. This approach aligns with the Health Disparity Research Award’s overarching challenge of advancing health equity and reduc
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 04, 2024
- Source ID
- HT94252310784
Entities
People
- Quoc-Dien Trinh
Organizations
- United States Army