Increasing Engagement in Patient Reported Outcome Measurement to Address Breast Cancer Care Disparities using Health Information Technology in Community Cancer Settings

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Project Summary/Abstract Major disparities in breast cancer-related outcomes have been widely documented across the cancer care continuum, with Black patients experiencing higher mortality and decreased quality of life (QOL) compared to White patients. Despite compelling evidence that routine patient-reported outcome (PRO) measurement can improve outcomes and patient experiences in oncology, PRO reporting remains low among Black patients and within the community cancer care (CCC) setting where they often receive care. The overall goal of this proposed study is to increase Black breast cancer patient engagement in PRO reporting by establishing flexible and contextually aligned HIT-assisted PRO implementation models in CCCs serving a high proportion of Black patients. Completing this work will set the stage to increase routine use of PROs in clinical care to improve health outcomes and reduce disparities among Black patients. In partnership with the Association of Community Cancer Centers (ACCC), we will develop models for successful implementation of PRO reporting in five CCCs in the ACCC network that serve a high proportion of Black cancer patients (Boston Medical Center, Boston, MA; Baptist Hospital, Memphis TN; Brooklyn Methodist, Brooklyn NY; University of Maryland, Baltimore, MD; Luminis Health, Lanham, MD). The HIT platform for this study will be imPROVE, an Epic- integrated PRO platform with automated feedback and resources (AFR) centered around the preferences, needs and values of Black patients. In line with the priorities of the NCI and NIMHD, we will (Aim 1) identify challenges, barriers, and enablers to HIT-assisted PRO data collection among Black breast cancer patients receiving care in CCCs and develop PRO implementation models that address these factors; (Aim 2) conduct a phased implementation of the PRO data collection models in five CCCs using PDSA cycles to refine models and the RE-AIM framework to evaluate success; and (Aim 3) explore the potential of detecting disparities in outcomes based on PRO data used in clinical care to inform future quality improvement efforts. Our expected outcomes are generalizable knowledge of the factors that trigger or deter Black breast cancer patient engagement, and models with training materials and tools for feasible, pragmatic, and sustainable PRO program implementation across the ACCC network. More than 80% of cancer patients nationwide receive their care at CCCs, and approximately 65% of the nation’s cancer patients are treated by a member of the ACCC network. The completion of this foundational work, with broad dissemination of lessons learned through the ACCC and beyond, will unlock the benefits of PRO reporting to historically underserved patients and advance equitable cancer care. This work will also support a continued program of research to expand implementation and evaluation of PRO programs among other diverse patient populations in oncology, determine the added benefit of AFR, and further the use of PRO data for quality improvement.