Overcoming barriers in equitable care delivery for women with gynecologic cancers: Outcomes and analysis from an educational program on health equity.
Authors: Constanzo Jerfiz D. , Prescott Lauren S. , Westin Shannon Neville , Salani Ritu , Pan Eva Y. , Avila-Wallace Maria , Chon Hye Sook , Rosenthal Kristen M. , Hoskins Ebony R. , Chapman-Davis Eloise 
Published: June 2024

e17581

Background: Despite advances in gynecologic cancer treatment, patients of color disproportionally face barriers to equitable care. Healthcare professional (HCP) surveys can help uncover where practice gaps remain. Here, we report results from surveys administered to HCPs during and after participation in CME/CE education on promoting health equity via incorporation of best practices and facilitating patient resources. Methods: A multidisciplinary curriculum was developed to provide education on optimal and equitable care delivery including to underserved patients. From March 8, 2023, to January 19, 2024, data were collected from HCP surveys administered during and after CME education. HCP-endorsed patient resources were provided for download to all participants. Follow-up data was collected on the impact of the education on current HCP practice and remaining barriers to change practice. Results: A total of 1106 HCPs participated in the live/online program including physicians, nurses, pharmacists, among other HCPs. Only 31% of HCPs asked frequently or always provided like-patient testimonials to underserved populations, which has been demonstrated to improve enrollment on clinical trials (n = 362). Of those completing post CME education surveys (n = 431), 53% indicated a shift from awareness to agreement with best practices, 19% increased adoption or application of best practices, and 19% education helped in another way. Top barriers to change (n = 403) cited by survey completers were acceptance of proposed strategies by peers (29%), patient adherence/compliance (25%), lack of sufficient time (23%), institutional constrains (21%), and formulary restriction (18%). Among 49 HCPs who completed a survey on the applicability of telehealth, 43% indicated telehealth would increase access to care for their underserved patients of color, 33% indicated it could help monitor patients in less time, and 33% said that telehealth could be recommended for remote patients. Barriers to telehealth included aggressive disease or need of frequent monitoring (22%), patients’ lack of computer/internet access (25%), and no/deficient regulatory environment or reimbursement for telehealth (10%). In total, 289 HCPs downloaded resources tailored to improve patient–HCP communication and increase access to available financial resources. Conclusions: Our follow-up surveys during/after completion of a large, multidisciplinary, educational program on gynecologic health equity suggests improvements in HCP perceptions of health disparities and application of best practices. There remain key but addressable barriers to equitable care for underserved patients of color. Continued education is needed on the use of like-patient testimonials and telehealth to promote access, reduce costs, and provide support to vulnerable patients.