A multi-stakeholder health policy study using implementation science to advance access to cancer care and clinical trials for medically vulnerable populations: A focus on our Catchment Community

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PROJECT SUMMARY This application is being re-submitted as a PA-20-272 investigator-initiated request responsive to the Notice of Special Interest (NOSI) identified as NOT-CA-23-044, and in response to our P30-CA033572-40 strategic priority to reduce cancer burden and disparities by increasing underrepresented and minority population access to cancer care and clinical trials. Increasing minority access to specialized cancer care and clinical interventional treatment trials are top priorities for medical research organizations including NIH, NCI, and our City of Hope Cancer Center. The strategic plan of the parent P30 grant, and in particular aim 3 of our Community Outreach and Engagement (COE), prioritizes increasing minority enrollment and addressing cancer disparities. To advance our P30 strategic priorities and our COE aim, we propose a health policy study built on multi-stakeholder engagement to increase access to specialty cancer care and clinical trials for medically vulnerable populations, especially targeting our Catchment Communities. The unacceptably low representation of minorities in cancer control policy studies and clinical trials continue to hamper public benefit of medical advancement and legislation. To address this gap, we propose evaluating the implementation of The California Cancer Care Equity Act (CCEA-SB987) that took effect in January 2023, which expands access to specialized cancer care and clinical trials. By ensuring community responsiveness in CCEA-SB987 implementation, our long-term goal is to rapidly increase minority access to cancer care and clinical trials at NCI Cancer Centers. Our innovative approach will enable patients and families, health care providers, health systems, payors, and community members to better understand guidelines and eligibility, and act upon the information. Guided by dissemination and implementation conceptual frameworks, we aim to: (1) Evaluate patient perspectives of notification strategies payors use to inform patients about CCEA-SB987 guidelines and eligibility, using focus groups with patient advisors. We will explore patient perspectives on payor notification strategies (type and delivery modality), payor notification quality (content, clarity, and cultural and linguistic responsiveness), and eligibility guidelines; and (2) Evaluate organization stakeholder perspectives on CCEA- SB987 implementation, using semi-structured interviews with organization/clinic leaders and providers. We will conduct in-depth qualitative interviews to learn about perspectives on engagement in policy implementation, barriers and facilitators to implementation, and eligibility guidelines. We will use the findings from this policy discovery science research to co-create (advocate, clinician, and researcher) communication strategies for optimal provider and patient activation to increase access to the highest quality cancer care and clinical treatment studies afforded by CCEA-SB987. This outcome has direct relevance to our parent grant that targets underrepresented ethnic minorities for increased access to specialty cancer care, including clinical treatment studies at NCI Cancer Centers.