Engaging Community-Academic Partnerships: The Influence of Health Disparities on Equitable Transitions of Cancer Care

Background: The field of oncology social work has contributed significant financial investments and successes towards advancements in cancer research and care service delivery given by interdisciplinary teams. However, along with these improvements, disparities persist, especially between socially isolated rural and urban areas and with populations of color. Cancer has an expansive set of environmental and social circumstances that impact disparity. Consequently, these circumstances require a multifaceted approach to address the complexities of cancer prevention, the uptake of treatment, and the ongoing comprehensive support for survivors. Thus oncology social work programs are encouraged to initiate conversations with community organizations to nurture trust, convey respect, and create community-defined prioritization of goals. The purpose of this study aimed to 1) provide an overview of engaging communities in evaluating systems of cancer care delivery, 2) explain how using the method of community-based group model building can forge new directions in health equity policy, and 3) present a primer on how to build health service delivery systems using Group Model Building, with an emphasis on stakeholder involvement.

Methods This study utilized Systems Dynamics Group Model Building (GMB) to develop a system map of the factors influencing barriers to access care. GMB is a community-engaged research approach used to involve communities in conceptualizing a system, how it works, what influences access to care, and what gaps exist. Participants (n=85) worked in small groups to document and draw relationships between all factors that impact cancer service delivery. The investigators held separate group modeling sessions with three stakeholder groups 1) people affected by cancer (n=20), 2) non-profits who provide services to cancer survivors (n=40), and 3) academic and hospital leadership who influence service delivery (n=25). A second group modeling session was held with groups (1) and (2) to report back the resulting system model created by the group to validate the information. The final three separate stakeholder models were then combined, representing a global view of the ideal system of cancer care delivery for rural communities.

Results Key themes of these group conversations with stakeholders revealed a renewed interest in understanding the psychosocial factors influencing provider trust and respect and patient trust and respect. Participants mentioned a need for a more diverse provider workforce, more focus on cultural sensitivity, decreased distance to clinics, and increased mental health provider availability. These conversations with stakeholders also highlighted the difficulty of coordinating care in an environment that includes an ever-changing cancer landscape coupled with residential instability and displacement of communities most impacted by disparities.

Conclusions and Implications This research explores services and resources needed to connect marginalized communities with cancer care along with the identification of policy changes required to improve trust, timely access to care, and supportive services. Partnerships between cancer centers, health departments, social work, and communities deliver sustainable tools with important implications for policy change, decreasing psychosocial barriers and increasing utilization of cancer care services by those most impacted by health inequity and cancer disparities.