Methods to Overcome Barriers in Underserved Populations

1. Methods to Overcome Barriers in Underserved Populations Dwight E. Heron, MD (on behalf of the Cancer Disparities Research Partnership) ASTRO Education Symposium November 6th, 2006

2. CDRP Sites Laredo Medical Center Laredo, Texas Rapid City Regional Hospital* Rapid City, South Dakota Centinela Freeman Regional Medical Center* Inglewood, California New Hanover Regional Medical Center Wilmington, North Carolina Singing River Hospital* Pascagoula, Mississippi UPMC McKeesport* McKeesport, Pennsylvania *Surveyed site

3. Populations Served

4. Approaches to Outreach • Key Site Leaders • Community Research Representative • Outreach Nurse • Health Educator • Community Outreach Specialist • Professional Development Specialist

5. Approaches to Outreach • Key Functions of Leaders • Education • Community events/meetings • Church groups • Health Ministries • Hospital Employees • Local Businesses • Physicians • Employ long-time community representatives from respective reservations or lay community

6. Approaches to Outreach (cont.) • Key Functions of Leaders (cont.) • Brochure & educational displays, including design of brochures for specific populations (i.e. Amish) • Engages community partners already established in communities served to conduct outreach programs • Tailor education programs for community groups (i.e. homeless) • Engage community physicians in education programs with mentor(s)

7. Approaches to Navigation • Navigator Requirements/Qualifications • Registered Nurses (Rapid City) • Lay Persons (Centinela Freeman & Singing River) • Health Field Educated, Bachelor Level/Tumor Registrar (UPMC McKeesport)

8. Approaches to Navigation (cont.) • Navigator Functions • Support and guidance of patient & family • Referrals to tribal, community & social support systems • Coordinate services with physicians re: clinical trials eligibility • Facilitate interactions & communications • Advise patients re: ways to pay for care, transportation & other needed community resources • Track interventions & outcomes

9. Approaches to Navigation (cont.) • Navigator Functions (cont.) • Provides transportation for patients • – a critical issue in some service areas • Serve as tumor registrars at 5 sites • Refers newly diagnosed cancer patients to navigator program through physician • Attends local health fairs to promote program to community • Matches patients & navigators based on cultural, interpersonal, professional & peer characteristics • Empowering patients to overcome barriers

10. Approaches to Clinical Trials • Due to the nature of the unique populations served by the various CDRP sites surveyed, each sites’ strategies were explored

11. Approaches to Clinical Trials (cont.) • Rapid City • Intensive orientation to various tribal health councils conducted • Discussions, radio interviews • Designed novel trial reducing treatment times that appealed to populations living extreme distances from medical facility • Cultural sensitivity & relating treatment terms in meaningful language context

12. Approaches to Clinical Trials (cont.) • Centinela Freeman • Developed strategy to overcome barrier of general distrust of population to trials • Used lay navigator to discuss navigation & trials upon first visit • Navigators provided the bridge necessary to health professionals to reach the community

13. Approaches to Clinical Trials (cont.) • Singing River (progress delayed by Katrina) • Provided major follow up care post Katrina for 15 NCI protocol patients (Kiessler AFB Clinic was destroyed) • Established track record • All new consults screened for clinical trial appropriateness • Full time research nurse & clinical research associate dedicated to program – RN also conducts outreach in the community & addressing clinical trials

14. Approaches to Clinical Trials (cont.) • UPMC McKeesport • Established RTOG affiliation for UPMC centers (3 of 5 sites) • Work closely with two other health systems to advise on appropriate trials to offer • Give physicians “ownership” of the trial • Posted information in patient waiting rooms • Worked with community partner to stimulate interest in and overcome distrust of clinical trials • New clinical trials supplement will provide staff needed to increase these efforts

15. Successes • Major inroads into American Indian community by Rapid City • Resilient program demonstrated by Singing River recovery from Katrina • Immediate entry into communities via established partnerships by UPMC McKeesport • Flexible & adaptive programs demonstrated by all with regard to communities served while maintaining scope

16. Successes (cont.)Accruals to Trials *includes Kiessler follows ups post Katrina

17. Advice • Recommend 12-18 months start-up funding for programs initiated in community hospital setting followed by 18 months closure/ analysis period increasing program period to 7-8 years. • Partner institutes should be invested & pro-active in guiding new programs particularly with assistance related to administration, regulatory & financial issues • Institution should provide support & opportunity for community representatives to be adequately trained