The effect of a multilevel community health worker–led intervention on patient knowledge of precision medicine: A randomized clinical trial.
Authors: Wood Emily Hayes , Rodriguez Gladys M. , Villicana Gerardo , Lopez Guzman Lesly , Reynaga Jajaira , Medrano Hector S. , Perez Cynthia , Trotter Chardria , Koontz Zachary M. , Patel Manali I. 
Published: October 2023

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Background: Precision medicine improves cancer outcomes but, due to inequitable receipt among racial and ethnic minoritized populations, has worsened disparities. In response, we used community-based participatory research and developed a multi-level intervention comprised of 2 parts. The first part included community health worker (CHW) –led patient education about precision medicine among predominantly low-income and Latinx adults with cancer in a rural community. CHWs delivered culturally tailored education regarding precision medicine and the importance for cancer treatment and outcomes and encouraged patients to discuss such testing with their clinicians to ensure receipt. A second part included clinician training regarding disparities in precision medicine and updates to testing guidelines. This randomized clinical trial, Addressing Latinx CANcer Care Equity (NCT04843332), tested whether the intervention improves patient knowledge about precision medicine. Methods: Patients with newly diagnosed or recurrent cancer, age ≥ 18 years, able to consent in English or Spanish, and who self-identified as a racial and ethnic minority OR low-income status OR were insured by public or agricultural company insurance OR uninsured and receiving cancer care at Pacific Cancer Care, a rural community oncology practice in Monterey County, were randomized 1:1 to usual care (control group) or usual care augmented with the multi-level intervention for 12 months (intervention group). The primary outcome was whether the multilevel intervention could increase patient knowledge of precision medicine using a validated 6 question survey from time of enrollment (baseline) to 6-months post-enrollment between groups. Patients were followed for 12 months to assess primary and secondary outcomes. Results: 110 participants were randomized; 70% (n= 67) reported Spanish as their primary language; 81% (n=89) identified as Hispanic. Median age was 55 years (55.4 ± 14.3, mean ± SD); majority had annual household incomes (USD) ≤ $34,999 (59.0%, n=46); majority obtained a high school diploma/GED or less (67.3%, n=74). Most had gastrointestinal (35.5%, n=39) and breast (24.5%, n=27) cancers and were diagnosed with stage 3 or 4 (64.5%, n=71) disease. Precision medicine knowledge was low at baseline across both the control and intervention groups (23.5 ± 19.3 versus 23.0 ± 17.7, respectively). Intervention group participants had greater precision medicine knowledge at 6-months (39.2 ± 23.0) than control group participants (24.2 ± 20.0) with greater increase in knowledge overtime than control group participants (p<0.001). Conclusions: Multilevel interventions are needed to address disparities in precision medicine cancer care. This intervention is one multilevel solution to improve precision medicine knowledge among low-income and racial ethnic minorities with cancer. Clinical trial information: NCT04843332 .