Title

Exploring Provider vs. Patient Perspectives to Increasing Native Radiation Oncology Access

Authors

Michelle Yan, Anthippy Petras, Sara London, Joe Olvera, Solmaz Amiri, Dedra Buchwald, Lia Halasz

Introduction

“Increasing Native Radiation Oncology Access: Disparities and Solutions” (INROADS) aims to characterize barriers and promoters to radiation therapy (RT) access among American Indians and Alaska Natives (AI/ANs) in Washington State. As a collaboration between the University of Washington Radiation Oncology, Washington State University, and AI/AN academic researchers, INROADS aims to create a cancer care toolkit to support the delivery of culturally informed RT to AI/AN patients. In developing this toolkit, a point of reflection centers around the difference between provider and patient perspectives when considering barriers and helpful resources to improve access to and delivery of cancer care and RT.

Methods

Surveys and interviews were conducted to explore barriers to RT and cancer care among 50 healthcare providers, including both oncology and non-oncology specialists, and 46 self-identified AI/AN patients who had received a diagnosis where RT was a treatment option. Efforts were made to establish meaningful partnerships during survey recruitment, particularly with clinics operated by Tribal organizations or located near Tribal lands. Open-ended questions encouraged both providers and patients to identify resources that could improve access to RT and provide support for AI/AN patients. Providers were also specifically asked about their interest in incorporating a patient navigator within their practice. Qualitative responses were coded using Dedoose while the quantitative survey data were analyzed using descriptive statistics and regression analyses.

Results

Providers highlighted key logistical barriers for patients, such as transportation, lodging, and financial support, and showed strong interest in integrating a patient navigator into their practices. Patients emphasized the need for more education in their communities, particularly in primary care and preventive services. Common themes also included the importance of Native representation in healthcare, recognition of Native identities, and discomfort with staff of different genders or non-Native backgrounds. When comparing conversations between radiation oncologists, other providers, and patients, providers tended to focus more on improving access to logistical resources like reliable transportation. Discussions about patient navigators centered on coordinating support to reduce these logistical challenges. However, patients emphasized the emotional aspects of their care. While they appreciated help with housing and transportation, many highlighted how cultural mismatches in provider backgrounds or treatment approaches impacted their comfort with receiving RT and undergoing cancer care.

Conclusion

When developing a toolkit for guideline-concordant RT and culturally informed cancer care, it is important to incorporate patient-centered perspectives. Suggestions include organizing community-based education panels and creating positions for Native staff members within oncology care, with the goal of fostering greater trust and improving outcomes for AI/AN cancer patients.

References

Adams SV, Burnett-Hartman AN, Karnopp A, et al. Cancer Stage in American Indians and Alaska Natives Enrolled in Medicaid. Article. Am J Prev Med. 2016;51(3):368-372. doi:10.1016/j.amepre.2016.02.016 White MC, Espey DK, Swan J, Wiggins CL, Eheman C, Kaur JS. Disparities in cancer mortality and incidence among American Indians and Alaska Natives in the United States. Am J Public Health. 2014;104 Suppl 3(Suppl 3):S377-S387. doi:10.2105/AJPH.2013.301673