The purpose of this study is to gain an in-depth understanding of African American breast cancer survivors' experiences, barriers and facilitators in accessing breast cancer treatment, and challenges in adherence to follow-up care. We conducted seven focus groups with 32 African American women with breast cancer in three rural counties in eastern North Carolina during August-November 2013. Surveys were also utilized to gather basic demographic and breast health history information. Thematic analysis was performed using the immersion crystallization approach. Several common areas of life affected by breast cancer included faith and support networks, psychosocial well-being, and quality of care issues. Faith in God was an important coping mechanism essential to all women in the study and a critical facilitator in survivorship. Support networks consisted of family, church-family, friends, and co-workers. The concept of fear included the discovery of breast cancer and fear of death, negative side effects of treatment, and social stigma of having breast cancer. Factors that influenced provider-patient relationship were age of provider, perceived lack of empathy, and providers leaving during treatment. Participants also expressed their lack of knowledge regarding a number of the side effects they were experiencing during and after their treatment. Results of this study contribute to the assessment of potential coping mechanisms used by African American breast cancer survivors (i.e., spirituality, positive attitudes, and support networks) that can potentially be effective and have a positive impact on the adjustment of life for survivors.

Objective: Because farmers' markets include a variety of fruits and vegetables, shopping at farmers' markets would likely improve diet quality among lowincome consumers, as well as promote sustainable direct farm-to-consumer business models. However, not much is known about how to promote farmers' market shopping among low-income consumers. Therefore, the purpose of the present paper was to examine barriers to and facilitators of shopping at farmers' markets and associations between shopping at farmers' markets and self-reported dietary behaviours (fruit and vegetable, sugar-sweetened beverage and fast-food consumption) and BMI. Design: Cross-sectional analyses of associations between farmers' market shopping frequency, awareness of markets, access to markets, dietary behaviours and BMI.

This study elucidates opportunities for future research aimed at improving equity for cancer treatment-related symptom management. For Black women, warnings about anticipated symptoms and treatment for ongoing symptoms were particular areas of concern. Routine symptom assessment for all women, as well as clinicians' management of symptoms for racially diverse cancer patients, need to be more thoroughly studied and addressed.

162 Background: Health-related quality of life (HRQOL) is an important cancer care outcome. Patient-physician communication is linked to HRQOL, yet less is known about the role of other aspects of the patient-physician relationship in explaining HRQOL outcomes in cancer patients. Using secondary data from the Accountability for Cancer Care through Undoing Racism and Equity study, we examined associations between multiple patient-physician relationship factors and HRQOL in breast and lung cancer patients. Methods: The analysis included 283 patients receiving care at two cancer centers from 2013-2017. Survey data on socio-demographics, HRQOL, and patient-physician relationship (i.e., doctors’ respectfulness, time spent with doctors, doctors’ involvement of patient in decision-making, satisfaction with quality of care) were collected at baseline and during treatment. The primary outcome was a binary measure of poor-fair (vs. good-excellent) HRQOL 90 days post-diagnosis. We employed multivariate logistic regression to assess associations between patient-physician relationship factors and HRQOL. Results: In adjusted analyses, patients reporting high levels of physician respect had 78% lower odds of reporting poor-fair HRQOL than patients reporting low levels of respect (Adjusted Odds Ratio[AOR] = 0.22; 95%CI = 0.08-0.59). Patients who were optimally involved in their care had lower odds of poor-fair HRQOL than those less involved (AOR = 0.30; 95%CI = 0.12-0.77). Finally, patients who very satisfied with the quality of their care had a 40% lower odds of poor-fair HRQOL than those less satisfied with care (AOR = 0.40; 95% CI = 0.13-0.99). There was no association between amount of time spent with doctor and HRQOL. Conclusions: Multiple aspects of the patient-physician relationship, including doctor’s respectfulness, doctors’ involvement of patient in decision-making, and patient satisfaction with quality of care are associated with HRQOL among breast and lung cancer patients. Given the important role that HRQOL plays in treatment adherence and outcomes, these findings highlight the need for systems of care that optimize the physician-patient relationship in cancer care.

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There are persistent disparities in the delivery of cancer treatment, with Black patients receiving fewer of the recommended cancer treatment cycles than their White counterparts on average. To enhance racial equity in cancer care, innovative methods that apply antiracist principles to health promotion interventions are needed. The parent study for the current analysis, the Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) intervention, was a system-change intervention that successfully eliminated the Black–White disparity in cancer treatment completion among patients with early-stage breast and lung cancer. The intervention included specially trained nurse navigators who leveraged real-time data to follow-up with patients during their treatment journeys. Community and academic research partners conducted thematic analysis on all clinical notes (n = 3,251) written by ACCURE navigators after each contact with patients in the specialized navigation arm (n = 162). Analysis was informed by transparency and accountability, principles adapted from the antiracist resource Undoing Racism® and determined as barriers to treatment completion through prior research that informed ACCURE. We identified six themes in the navigator notes that demonstrated enhanced accountability of the care system to patient needs. Underlying these themes was a process of enhanced data transparency that allowed navigators to provide tailored patient support. Themes include (1) patient-centered advocacy, (2) addressing system barriers to care, (3) connection to resources, (4) re-engaging patients after lapsed treatment, (5) addressing symptoms and side effects, and (6) emotional support. Future interventions should incorporate transparency and accountability mechanisms and examine the impact on racial equity in cancer care.

The abundance of literature documenting the impact of racism on health disparities requires additional theoretical, statistical, and conceptual contributions to illustrate how anti-racist interventions can be an important strategy to reduce racial inequities and improve population health. Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) was an NIH-funded intervention that utilized an antiracism lens and community-based participatory research (CBPR) approaches to address Black-White disparities in cancer treatment completion. ACCURE emphasized change at the institutional level of healthcare systems through two primary principles of antiracism organizing: transparency and accountability. ACCURE was successful in eliminating the treatment completion disparity and improved completion rates for breast and lung cancer for all participants in the study. The structural nature of the ACCURE intervention creates an opportunity for applications in other health outcomes, as well as within educational institutions that represent social determinants of health. We are focusing on the maternal healthcare and K-12 education systems in particular because of the dire racial inequities faced by pregnant people and school-aged children. In this article, we hypothesize cross-systems translation of a system-level intervention exploring how key characteristics of ACCURE can be implemented in different institutions. Using core elements of ACCURE (i.e., community partners, milestone tracker, navigator, champion, and racial equity training), we present a framework that extends ACCURE's approach to the maternal healthcare and K-12 school systems. This framework provides practical, evidence-based antiracism strategies that can be applied and evaluated in other systems to address widespread structural inequities.