14. Health Care: Antiracism Organizing for Culture and Institutional Change in Cancer Care

Black, Kristin Z.; Baker, Stephanie; Robertson, Linda; Lightfoot, Alexandra F.; Alexander-Bratcher, Kimberly; Befus, Deanna; Cothern, Carol; Dixon, Crystal; Ellis, Katrina; Guerrab, Fatima; Schaal, Jennifer; Simon, Beth; Smith, Beth A.; Thatcher, Kari; Wilson, Sonja M.; Yongue, Christina; Eng, Eugenia

doi:10.2105/9780875533049ch14

Cited by 4 publications

(4 citation statements)

References 12 publications

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“…As one IS-relevant example informed by CBPR, Cykert et al (2020) conducted a pragmatic quality improvement (QI) trial across five cancer centers (ACCURE: The Accountability for Cancer Care through Undoing Racism and Equity) to address potential bias among clinicians shaping differential decision-making for Black and white patients. In addition to training medical and administrative staff on antiracism and healthcare equity ( Black et al, 2019 ), researchers found that the use of a real-time electronic health record registry that signaled unmet care/missed appointments combined with race-specific measurement and clinical feedback on cancer treatments and nurse navigation enhanced treatment completion among breast/lung cancer patients and decreased racial inequities. Other promising health system studies have used implementation strategies (e.g., on-site coaching, facilitation, audit/feedback), race-specific data, and stakeholder engagement to build capacity around implementing evidence-based QI methods to target racial inequities ( Cooper et al, 2013 ; Halladay et al., 2013 ; Purnell et al, 2016 ).…”

mentioning

confidence: 99%

Application of an antiracism lens in the field of implementation science (IS): Recommendations for reframing implementation research with a focus on justice and racial equity

Shelton

Adsul

et al. 2021

Implementation Research and Practice

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Background Despite the promise of implementation science (IS) to reduce health inequities, critical gaps and opportunities remain in the field to promote health equity. Prioritizing racial equity and antiracism approaches is critical in these efforts, so that IS does not inadvertently exacerbate disparities based on the selection of frameworks, methods, interventions, and strategies that do not reflect consideration of structural racism and its impacts. Methods Grounded in extant research on structural racism and antiracism, we discuss the importance of advancing understanding of how structural racism as a system shapes racial health inequities and inequitable implementation of evidence-based interventions among racially and ethnically diverse communities. We outline recommendations for explicitly applying an antiracism lens to address structural racism and its manifests through IS. An anti-racism lens provides a framework to guide efforts to confront, address, and eradicate racism and racial privilege by helping people identify racism as a root cause of health inequities and critically examine how it is embedded in policies, structures, and systems that differentially affect racially and ethnically diverse populations. Results We provide guidance for the application of an antiracism lens in the field of IS, focusing on select core elements in implementation research, including: (1) stakeholder engagement; (2) conceptual frameworks and models; (3) development, selection, adaptation of EBIs; (4) evaluation approaches; and (5) implementation strategies. We highlight the need for foundational grounding in antiracism frameworks among implementation scientists to facilitate ongoing self-reflection, accountability, and attention to racial equity, and provide questions to guide such reflection and consideration. Conclusion We conclude with a reflection on how this is a critical time for IS to prioritize focus on justice, racial equity, and real-world equitable impact. Moving IS towards making consideration of health equity and an antiracism lens foundational is central to strengthening the field and enhancing its impact. Plain language abstract There are important gaps and opportunities that exist in promoting health equity through implementation science. Historically, the commonly used frameworks, measures, interventions, strategies, and approaches in the field have not been explicitly focused on equity, nor do they consider the role of structural racism in shaping health and inequitable delivery of evidence-based practices/programs. This work seeks to build off of the long history of research on structural racism and health, and seeks to provide guidance on how to apply an antiracism lens to select core elements of implementation research. We highlight important opportunities for the field to reflect and consider applying an antiracism approach in: 1) stakeholder/community engagement; 2) use of conceptual frameworks; 3) development, selection and adaptation of evidence-based interventions; 4) evaluation approaches; 5) implementation strategies (e.g., how to deliver evidence-based practices, programs, policies); and 6) how researchers conduct their research, with a focus on racial equity. This is an important time for the field of implementation science to prioritize a foundational focus on justice, equity, and real-world impact through the application of an anti-racism lens in their work.

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mentioning

confidence: 99%

Application of an antiracism lens in the field of implementation science (IS): Recommendations for reframing implementation research with a focus on justice and racial equity

Shelton

Adsul

et al. 2021

Implementation Research and Practice

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“…A recent study by Griesemer et al explored the Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) intervention, which successfully mitigated racial disparities in cancer treatment completion at two U.S. cancer centers [77]. The ACCURE intervention encompassed multiple approaches, such as educating healthcare providers about the underlying factors contributing to healthcare disparities [78]. It also featured a Real-Time Registry data system that monitored patient progress in real time, with data broken down by patient race [79].…”

Section: Evidence-based Solutions: Patient Carementioning

confidence: 99%

Importance of Diversity, Equity, and Inclusion in the Hepatopancreatobiliary Workforce

Rengers,

Warner

2024

Cancers

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Diversity is a catalyst for progress that prevents institutional stagnation and, by extension, averts descent to mediocrity. This review focuses on the available data concerning hepatopancreatobiliary (HPB) surgical workforce demographics and identifies evidence-based strategies that may enhance justice, equity, diversity, and inclusion for HPB surgeons and their patients. We report that the current United States HPB surgical workforce does not reflect the population it serves. We review data describing disparity-perpetuating hurdles confronting physicians from minority groups underrepresented in medicine at each stage of training. We further examine evidence showing widespread racial and socioeconomic disparities in HPB surgical care and review the effects of workforce diversity and physician–patient demographic concordance on healthcare outcomes. Evidence-based mitigators of structural racism and segregation are reviewed, including tailored interventions that can address social determinants of health toward the achievement of true excellence in HPB surgical care. Lastly, select evidence-based data driving surgical workforce solutions are reviewed, including intentional compensation plans, mentorship, and sponsorship.

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“…Navigators assist patients through the complex levels of institutional procedures (e.g., setting appointments, connections with organizational resources, providing health education, and/or advocating for patient's concerns to providers). ACCURE Navigators were nurses (with minimally a Bachelor of Science in Nursing and management experience) who went through additional training in antiracism analysis and patient-centered care protocols [i.e., the Teach Back method, Kleinman's Patient Model, and instructions on using the RTR; ( 13 )].…”

Section: Accountability For Cancer Care Through Undoing Racism ® and Equitymentioning

confidence: 99%

“…Concepts from REI's antiracism trainings were adapted into healthcare system-specific focused sessions, delivered quarterly for cancer center providers and staff. These Healthcare Equity Education and Training (HEET) sessions covered antiracism topics (e.g., transparency, accountability, and gatekeeping) and presented site-specific Clinical Performance Reports on patient outcomes by race ( 13 ). This component allowed for transparent discussions among multidisciplinary institutional members, so that further solutions and action could be implemented to address systemic racism within their institutions.…”

Section: Accountability For Cancer Care Through Undoing Racism ® and Equitymentioning

confidence: 99%

Expanding the Reach of an Evidence-Based, System-Level, Racial Equity Intervention: Translating ACCURE to the Maternal Healthcare and Education Systems

Baker

Black

Dixon

et al. 2021

Front. Public Health

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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.

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14. Health Care: Antiracism Organizing for Culture and Institutional Change in Cancer Care

Cited by 4 publications

References 12 publications

Application of an antiracism lens in the field of implementation science (IS): Recommendations for reframing implementation research with a focus on justice and racial equity

Application of an antiracism lens in the field of implementation science (IS): Recommendations for reframing implementation research with a focus on justice and racial equity

Importance of Diversity, Equity, and Inclusion in the Hepatopancreatobiliary Workforce

Expanding the Reach of an Evidence-Based, System-Level, Racial Equity Intervention: Translating ACCURE to the Maternal Healthcare and Education Systems

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