Identifying and overcoming racial disparities in triple-negative breast cancer care: Insights from an equity-focused quality improvement initiative.
Authors: Dooyema Samuel , Nanda Rita , Lad Thomas E. , Dewald Ilona , McKinnon Kelly E. , Carter Jeffrey D. , Heggen Cherilyn 
Published: June 2023

e18668

Background: Black women incur greater incidence of triple negative breast cancer (TNBC) than White women and when adjusted for age and clinical factors, suffer higher overall mortality, which can be resolved when adjusted for factors relating to care access. This quality improvement (QI) initiative assessed root causes of disparities in care delivery and health equity among TNBC patients in a large health system to identify gaps and develop action plans for improvement. Methods: In March 2021, baseline surveys designed to assess factors that affect quality care of diverse TNBC patients were completed by 10 healthcare providers (HCPs). Baseline chart audits were performed to distinguish contributions to disparities in TNBC treatment and outcomes (N = 100; Black n = 52, Non-Black n = 48). HCPs participated in an audit-feedback (AF) session to (a) assess system-specific practice gaps identified in the provider survey and chart audit, (b) prioritize areas for improvement, and (c) develop action plans for addressing root causes. Post-intervention surveys (N = 11) measured changes in participants’ beliefs and confidence in care delivery. A follow-up chart audit was performed to assess behavioral and practice change (N = 100; Black n = 50, Non-Black n = 50). Results: Baseline surveys revealed the greatest challenge in TNBC patient care was recognizing adverse events (50%) and managing patient non-adherence (30%) . Yet, while 60% of HCPs reported always mentioning the importance of treatment adherence, 0% reported discussing in detail. Chart audits observed substantial disparities in mean days from diagnosis to treatment (67 days Black vs 37 days Non-Black), yet 0% of HCPs named time to treatment a major/main care coordination challenge. Following the AF session, HCPs committed to prioritize improvement within their team individualizing treatment decisions (36% pre-AF vs 73% post-AF). Subsequently, follow-up chart audits revealed increased documented discussions about treatment options (30% vs 59%) and risks and benefits of therapies (58% vs 64%). Mean time from diagnosis to treatment improved for both Black (67 days vs 44 days) and all patients (53 days vs 42 days). Conclusions: Barriers to equitable, patient-centered care in patients with TNBC included insufficient care coordination, delayed time to treatment, and inadequate personalizing of treatment plans by HCPs. Disparities between Black and non-Black patients in the time from diagnosis to treatment were reduced following the QI initiative. Action plans developed by HCPs demonstrate effective strategies to address identified gaps and improve equitable care for patients with TNBC. Study Sponsor Statement: The study reported in this abstract was funded by an educational grant from AstraZeneca, Genentech, and Merck & Co. Inc., who had no role in the study design, execution, analysis, or reporting.