Advancing Patient-Centered Care to Overcome Health Disparities in Multiple Myeloma: Key Findings from a Quality Improvement Initiative
Authors: Mikhael Joseph , Rodriguez Cesar , Pierre Amy E. , Nawaz M. Sarfraz , Moses-Okwei Ellie , Gurska Lindsay , Zyborowicz Emily , Sullivan Shelby , Carter Jeffrey , Heggen Cherilyn 
Published: December 2024

Background

Previous initiatives (Mikhael ASH 2020, 2022) identified discordances between providers and historically underrepresented patients with multiple myeloma (MM) in treatment goals and decision-making, with many patients feeling overwhelmed and facing language barriers. Shared decision-making (SDM) is crucial to ensure that patients' preferences and needs are central to the treatment process, especially in a diverse MM population where cultural, linguistic, and socio-economic differences impact engagement and understanding. To improve equitable MM care, we conducted a quality improvement (QI) study to uncover underlying root causes and develop strategies to overcome barriers to engaging diverse patients in SDM.

Methods

This QI initiative included 78 provider surveys, with pre- and post-surveys from 64 and 31 providers, respectively, participating in team-based audit-feedback (AF) sessions, and 90-day follow-up (FL/U) surveys. The surveys evaluated practice patterns, challenges, and barriers to equitable care. Care teams from each clinic, along with a regional MM expert and a nationally renowned MM physician, participated in AF sessions to (a) assess system-specific practice gaps identified via the surveys, (b) prioritize areas for improvement, and (c) develop action plans to address root causes.

Results

Surveys: While 91% of providers deemed patient engagement in SDM very important, only 77% reported always involving patients in the decision-making process regarding their treatment plans, citing patients' low health literacy (37%) and not enough time to engage in SDM (30%) as top barriers. When asked the extent to which a patient's race/ethnicity adversely affects MM outcomes, 43% perceived a moderate to major impact (acknowledging racial/ethnic and language barriers), while 57% deemed the impact to be minor or none. HCPs identified patients' biggest challenges in MM care as worrying about being unable to work or meet responsibilities at home (24%) and difficulty communicating concerns to their care team (22%).

AF Sessions: HCPs participating in the AF sessions reported barriers in delivering equitable MM care, such as applying collaborative SDM approaches that account for MM patients' cultural norms and health literacy needs (28%), providing adequate patient education (14%), and individualizing treatment based on patient- and disease-related factors (14%). Action plans to achieve equitable care for diverse patients included: improving patient education, assessing whether patients understand the treatment options, spending more time engaging patients to help them understand factors that may influence their MM care, and improving access to clinical trials and novel MM therapies. Plans to address language barriers included developing tools to engage patients in their own languages, implementing language interpretation services, and utilizing patient navigators.

In 90-day FL/U surveys (n = 13), 100% of respondents reported dedicating more time and resources to engaging diverse patients with MM in SDM, as well as improving on incorporating clinical and patient factors into personalized treatment plans. Improvements were noted in patient education with 85% reporting their care teams spent more time on one-on-one discussions with patients, and 69% providing patient education resources in patient's first language; 92% reported implementing language interpretation services. Despite these improvements, patients' low health literacy (54%) and patients' language barriers (39%) remain barriers for care teams in engaging patients in SDM.

Conclusions

Through this initiative, clinical teams developed and implemented clinical practice changes related to improved SDM, individualized treatment, and native language resources to enhance equitable MM care. The initiative resulted in meaningful confidence gains among HCPs in incorporating SDM into patient care for diverse populations. However, there remains a need for further HCP education regarding the impacts of race/ethnicity on MM outcomes. These findings will inform future efforts to support evidence-based, equitable MM care.

Study Sponsor Statement

The study reported in this abstract was funded by educational grants from AbbVie, Pfizer, Inc., Sanofi, and Janssen Biotech, Inc., administered by Janssen Scientific Affairs, LLC., who had no role in the study design, execution, analysis, or reporting.