A Community-Engaged Process for Adapting a Proven Community Health Worker Model to Integrate Precision Cancer Care Delivery for Low-income Latinx Adults With Cancer

Abstract

Introduction Disparities in precision cancer care delivery among low-income Latinx adults are well described. In prior work, we developed a community health worker-led goals of care and cancer symptom assessment intervention. The objective of this study was to adapt this intervention for a community setting, incorporating precision cancer care delivery. Methods We used a two-phased systematic approach to adapt an evidence-based intervention for our community. Specifically, we used the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to identify barriers and facilitators to precision cancer care delivery via 1-hr interviews with Latinx adults with cancer, Latinx caregivers, community leaders, primary care and oncology clinicians, and community health workers. Interviews were recorded, transcribed, and analyzed using the constant comparative method and grounded theory analysis. Phase 2 involved interviews with key community advisors using the Expert Panels Method to decide on final adaptations. Results Using this community-engaged approach, we identified specific intervention adaptations to ensure precision cancer care delivery in a community setting, which included: (a) expansion of the intervention inclusion criteria and mode of delivery; (b) integration of low-literacy precision cancer care intervention activities in Spanish in collaboration with community-based organizations; (c) ensuring goals reflective of patient and community priorities. Conclusions This systematic and community-engaged approach to adapt an intervention for use in delivering precision cancer care strengthened an evidence-based approach to promote the needs and preferences of patients and key community stakeholders.

Addressing Global Cancer Care Inequities Using Implementation Science and Community-Engaged Research Approaches

“…Feature preferences of under-resourced populations can improve cancer care delivery and address disparities. 42 For example, research suggests that culturally-targeted communication strategies, including message framing and communitycentred cancer control interventions, can be used to address disparities for specific populations with increased disease burden. [43][44][45] Indeed, patient-centred interventions and equitable delivery tools are necessary to ensure feasible and acceptable solutions, 46 recognising the need for capacity building in many resourceconstrained settings.…”

Addressing Barriers to Clinical Trial Participation for Transgender People With Cancer to Improve Access and Generate Data

“…Institutions could also prioritize telehealth interventions and ensure that trial materials are accessible to all patients regardless of educational background or primary language. 25 As institutions consider the tools and approaches to promoting more flexibility in the conduct of clinical research, they could take into consideration approaches that decrease retraumatization for people who have experienced violence. Trauma-informed care or mechanisms to avoid invasive procedures (eg, self-swab Pap tests) would decrease barriers.…”

Evidence-Based Quality Improvement (EBQI) in the pre-implementation phase: key steps and activities

“…The concept of engaging community partners in all aspects of research is grounded in the notion that the population impacted by the issue, condition, or situation has a unique perspective on the resolution of the issue, which is critical to ensuring the effectiveness and adequacy of health interventions in broader community settings (2,3). Engaging community partners in health research has been proven to be significant in efforts to improve population health in areas such as diabetes, nutrition, infant mortality, cancer, obesity, dental hygiene, etc (4)(5)(6)(7)(8). Dissemination and implementation (D&I) science researchers began to describe the need for participatory engagement among local practitioners nearly two decades ago (9).…”