Abstract B055: Translating research into practice: Early lessons from a pragmatic clinical trial to reduce disparities in breast cancer treatment through a regional patient navigation collaborative
Authors: LeClair Amy , Lemon Stephenie , Haas Jennifer , Friedman Rachel , Cabral Howard , Burns-White Karen , Casanova Nicole , Freund Karen , Battaglia Tracy 
Published: September 2020

Abstract
Racial and socioeconomic disparities in breast cancer mortality persist; in Boston, Black women and Medicaid patients are 2-3 times more likely to have delays in initiating cancer treatment compared to their white and privately insured counterparts. Evidence-based strategies for combating delays exist but are not systematically implemented. Our primary research question is: can systematically implement evidence-based coordination of care across the city of Boston to reduce delays for the most vulnerable women? Translating Research Into Practice (TRIP) addresses racial and socio-economic disparities using the principals of community engaged research. Four of the Massachusetts Clinical and Translational Science Institutes (CTSI) have collaborated with the Boston Breast Cancer Equity Coalition, the Boston Patient Navigation Network, and a Clinical Advisory Panel to systematically implement an evidence-based coordination of care intervention in six Boston hospitals. Key components of the intervention include: patient navigation, a shared regional registry to track women across institutions and facilitate navigator coordination, systematic screening for social barriers to care and referral to free or low-cost community resources. The multi-component implementation strategy includes ongoing stakeholder engagement, navigator performance review and feedback, training and support and navigator peer learning. A stepped-wedge hybrid type I (n=536 post implementation, n=564 historical controls) effectiveness-implementation study design was launched in June 2018, with 6 sites entering intervention phase by December 2019. Primary clinical outcomes are time to first treatment and receipt of guideline concordant care. Secondary implementation outcomes are acceptability, adoption, cost, fidelity, penetration, and sustainability. To date, we have 59 women on study in the intervention phase. We are reaching our target population: 39% of women are Black, 32% of Hispanic ethnicity, 47% are non-English speaking and 81% have Medicaid. Lessons learned with implementing a community-engaged, regional pragmatic trial include: 1) Patient Navigators are eager to collaborate in the care of their patients and to identify best practices; 2) Engaging all stakeholders, including hospital administrators, is necessary to implement health systems programs; 3) Workflow variation across each health system requires significant customization to adapt the evidence and tools; 4) Tension for change exists among all sites because of existing established care coordination programs; and 5) Lack of integration of EHRs within and across health systems makes use of new data platforms challenging. Regional, community-engaged, interdisciplinary collaborations are important to reduce population disparities than often transcend a single institution. TRIP outlines a coordinated model to address disparities in breast cancer care that could be translated to other regions and disease conditions.
Citation Format: Amy LeClair, Stephenie Lemon, Jennifer Haas, Rachel Friedman, Howard Cabral, Karen Burns-White, Nicole Casanova, Karen Freund, Tracy Battaglia. Translating research into practice: Early lessons from a pragmatic clinical trial to reduce disparities in breast cancer treatment through a regional patient navigation collaborative [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B055.