Labban Muhieddine, Stone Benjamin V, Steele Grant L, Salinas Kevin E, Agudile Emeka, Katz Mark H, Rihan-Porter Nancy, Reich Amanda J, Cole Alexander P, Landers Stewart, Trinh Quoc-Dien
Department of Urology and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA.
Cancer. 2024 Oct 15;130 Suppl 20:3590-3601. doi: 10.1002/cncr.35366. Epub 2024 Jun 4.
Despite mandated insurance coverage since 2006 and robust health infrastructure in urban settings with high concentrations of minority patients, race-based disparities in prostate cancer (PCa) treatment persist in Massachusetts. In this qualitative study, the authors sought to identify factors driving inequities in PCa treatment in Massachusetts.
Four hospitals offering PCa treatment in Massachusetts were selected using a case-mix approach. Purposive sampling was used to conduct semistructured interviews with hospital stakeholders. Additional interviews were conducted with representatives from grassroots organizations providing PCa education. Two study staff coded the interviews to identify major themes and recurrent patterns.
Of the 35 informants invited, 25 participated in the study. Although national disparities in PCa outcomes were readily discussed, one half of the informants were unaware that PCa disparities existed in Massachusetts. Informants and grassroots organization representatives acknowledged that patients with PCa are willing to face transportation barriers to receive treatment from trusted and accommodating institutions. Except for chief equity officers, most health care providers lacked knowledge on accessing or using metrics regarding racial disparities in cancer outcomes. Although community outreach was recognized as a potential strategy to reduce treatment disparities and engender trust, informants were often unable to provide a clear implementation plan.
This statewide qualitative study builds on existing quantitative data on the nature and extent of disparities. It highlights knowledge gaps in recognizing and addressing racial disparities in PCa treatment in Massachusetts. Improved provider awareness, the use of disparity metrics, and strategic community engagement may ensure equitable access to PCa treatment.
Despite mandated insurance and urban health care access, racial disparities in prostate cancer treatment persist in Massachusetts. This qualitative study revealed that, although national disparities were acknowledged, awareness about local disparities are lacking. Stakeholders highlighted the importance of ancillary services, including translators, rideshares, and navigators, in the delivery of care. In addition, whereas hospital stakeholders were aware of collected equity outcomes, they were unsure whether and who is monitoring equity metrics. Furthermore, stakeholders agreed that community outreach showed promise in ensuring equitable access to prostate cancer treatment. Nevertheless, most interviewed stakeholders lacked clear implementation plans.
尽管自2006年起就有强制保险覆盖，且城市地区拥有强大的医疗基础设施，有大量少数族裔患者，但马萨诸塞州前列腺癌（PCa）治疗中基于种族的差异依然存在。在这项定性研究中，作者试图确定导致马萨诸塞州PCa治疗不平等的因素。
采用病例组合法选择了马萨诸塞州四家提供PCa治疗的医院。采用目的抽样法对医院利益相关者进行半结构化访谈。还对提供PCa教育的基层组织代表进行了额外访谈。两名研究人员对访谈进行编码，以确定主要主题和反复出现的模式。
在邀请的35名受访者中，25人参与了研究。尽管人们很容易讨论PCa治疗结果的全国性差异，但一半的受访者并不知道马萨诸塞州存在PCa治疗差异。受访者和基层组织代表承认，PCa患者愿意克服交通障碍，到值得信赖且服务周到的机构接受治疗。除首席公平官外，大多数医疗服务提供者缺乏获取或使用癌症治疗结果中种族差异相关指标的知识。尽管社区外展被认为是减少治疗差异和建立信任的潜在策略，但受访者往往无法提供明确的实施计划。
这项全州范围的定性研究建立在关于差异的性质和程度的现有定量数据基础之上。它突出了在认识和解决马萨诸塞州PCa治疗中的种族差异方面存在的知识差距。提高医疗服务提供者的意识、使用差异指标以及进行战略性社区参与，可能确保公平获得PCa治疗。
尽管有强制保险且城市地区可获得医疗服务，但马萨诸塞州前列腺癌治疗中的种族差异依然存在。这项定性研究表明，尽管人们承认全国性差异，但对当地差异缺乏认识。利益相关者强调了辅助服务（包括翻译、拼车服务和导航员）在提供护理方面的重要性。此外，虽然医院利益相关者了解收集到的公平结果，但他们不确定是否以及由谁在监测公平指标。此外，利益相关者一致认为社区外展在确保公平获得前列腺癌治疗方面有前景。然而，大多数接受采访的利益相关者缺乏明确的实施计划。
