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Grant Details

Grant Number: 4R01CA150980-05 Interpret this number
Primary Investigator: Eng, Eugenia
Organization: Univ Of North Carolina Chapel Hill
Project Title: Accountability for Cancer Care Through Undoing Racism and Equity (ACCURE)
Fiscal Year: 2016


DESCRIPTION (provided by applicant): African American cancer patients, as compared to White counterparts, continue to initiate treatment later and remain less apt to undergo complete treatment; fueling worse treatment outcomes including shorter survival. The concepts of "transparency" and "accountability," as mechanisms of systems change have been applied for decades by anti-racism organizations to civil rights and social change. Yet, the application of these concepts to health systems' change and unequal treatment has rarely been done. Objective: The Greensboro Health Disparities Collaborative and two Cancer Centers have joined together to specify structures built into cancer care systems that make cancer care vulnerable to institutional racism and investigate how they can be changed to reduce racial inequity in quality and completion of treatment for Stage 1-2 breast and lung cancer patients. Accountability for Cancer Care through Undoing Racism and Equity (ACCURE) systems change intervention is informed by CBPR principles, the Undoing RacismTM framework, and findings from our preliminary studies. Methods: ACCURE has 2 transparency components and 2 accountability components, hypothesized to reduce racial inequities in completing treatment of early stage breast and lung cancer : 1) Analysis of Power and Authority for patients to voice their feedback on "pressure points encounters" during treatment that undermine quality and completion of cancer care; 2) Healthcare Equity Training + booster sessions for providers on the relevance of institutional racism to cancer care; 3) Monthly Clinical Performance Reports delivered by a Physician Champion to clinicians and their teams on race-specific, quality of care data for their patients + suggestions for improving care; and 4) a specially trained ACCURE Navigator to provide a 2-way communication bridge for hearing and responding to patients. To assess the separate and combined effects, in real time, from the intervention on completion of treatment, we propose a 5-year interrupted time series, with an embedded, 3-year randomized control trial, study design. Potential Impact of findings are to: help define "meaningful use" requirements for health IT, established by national policy-making bodies; contribute to the American College of Surgeons Rapid Quality Reporting System; and, ultimately, create sustainable change within systems of care. Our systems approach has the potential to optimize transparency of and accountability for racial equity in completing treatment in 1500 cancer centers affecting 1.4 million cancer patients annually.


'It's like you don't have a roadmap really': using an antiracism framework to analyze patients' encounters in the cancer system.
Authors: Black K.Z. , Lightfoot A.F. , Schaal J.C. , Mouw M.S. , Yongue C. , Samuel C.A. , Faustin Y.F. , Ackert K.L. , Akins B. , Baker S.L. , et al. .
Source: Ethnicity & health, 2021 Jul; 26(5), p. 676-696.
EPub date: 2018-12-13.
PMID: 30543116
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A Multi-faceted Intervention Aimed at Black-White Disparities in the Treatment of Early Stage Cancers: The ACCURE Pragmatic Quality Improvement trial.
Authors: Cykert S. , Eng E. , Manning M.A. , Robertson L.B. , Heron D.E. , Jones N.S. , Schaal J.C. , Lightfoot A. , Zhou H. , Yongue C. , et al. .
Source: Journal of the National Medical Association, 2020 Oct; 112(5), p. 468-477.
EPub date: 2019-03-28.
PMID: 30928088
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The role of patient-physician relationship on health-related quality of life and pain in cancer patients.
Authors: Samuel C.A. , Mbah O. , Schaal J. , Eng E. , Black K.Z. , Baker S. , Ellis K.R. , Guerrab F. , Jordan L. , Lightfoot A.F. , et al. .
Source: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2020 Jun; 28(6), p. 2615-2626.
EPub date: 2019-10-16.
PMID: 31620925
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Evaluating Potential Racial Inequities in Low-dose Computed Tomography Screening for Lung Cancer.
Authors: Richmond J. , Mbah O.M. , Dard S.Z. , Jordan L.C. , Cools K.S. , Samuel C.A. , Khan J.M. , Manning M.A. .
Source: Journal of the National Medical Association, 2020 Apr; 112(2), p. 209-214.
EPub date: 2020-02-15.
PMID: 32067762
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A system-based intervention to reduce Black-White disparities in the treatment of early stage lung cancer: A pragmatic trial at five cancer centers.
Authors: Cykert S. , Eng E. , Walker P. , Manning M.A. , Robertson L.B. , Arya R. , Jones N.S. , Heron D.E. .
Source: Cancer medicine, 2019 Mar; 8(3), p. 1095-1102.
EPub date: 2019-02-04.
PMID: 30714689
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Preempting Racial Inequities in Lung Cancer Screening.
Authors: Richmond J. , M Mbah O. , Z Dard S. , Jordan L.C. , Cools K.S. , Samuel C.A. , M Khan J. , A Manning M. .
Source: American journal of preventive medicine, 2018 Dec; 55(6), p. 908-912.
EPub date: 2018-10-19.
PMID: 30344035
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Racial differences in symptom management experiences during breast cancer treatment.
Authors: Samuel C.A. , Schaal J. , Robertson L. , Kollie J. , Baker S. , Black K. , Mbah O. , Dixon C. , Ellis K. , Eng E. , et al. .
Source: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2018 May; 26(5), p. 1425-1435.
EPub date: 2017-11-18.
PMID: 29150730
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Establishing New Community-Based Participatory Research Partnerships using the Community-Based Participatory Research Charrette Model: Lessons from the Cancer Health Accountability for Managing Pain and Symptoms Study.
Authors: Samuel C.A. , Lightfoot A.F. , Schaal J. , Yongue C. , Black K. , Ellis K. , Robertson L. , Smith B. , Jones N. , Foley K. , et al. .
Source: Progress in community health partnerships : research, education, and action, 2018; 12(1), p. 89-99.
PMID: 29606697
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Provider perspectives on barriers and facilitators to adjuvant endocrine therapy-related symptom management.
Authors: Samuel C.A. , Turner K. , Donovan H.A.S. , Beckjord E. , Cardy A. , Dew M.A. , van Londen G.J. .
Source: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2017 Dec; 25(12), p. 3723-3731.
EPub date: 2017-07-06.
PMID: 28681126
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Examining health-related quality of life patterns in women with breast cancer.
Authors: Pinheiro L.C. , Tan X. , Olshan A.F. , Wheeler S.B. , Reeder-Hayes K.E. , Samuel C.A. , Reeve B.B. .
Source: Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, 2017 Jul; 26(7), p. 1733-1743.
EPub date: 2017-02-28.
PMID: 28247314
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Provider perspectives on patient-provider communication for adjuvant endocrine therapy symptom management.
Authors: Turner K. , Samuel C.A. , Donovan H.A. , Beckjord E. , Cardy A. , Dew M.A. , van Londen G.J. .
Source: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2017 Apr; 25(4), p. 1055-1061.
EPub date: 2016-11-18.
PMID: 27864628
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To be young, Black, and living with breast cancer: a systematic review of health-related quality of life in young Black breast cancer survivors.
Authors: Samuel C.A. , Pinheiro L.C. , Reeder-Hayes K.E. , Walker J.S. , Corbie-Smith G. , Fashaw S.A. , Woods-Giscombe C. , Wheeler S.B. .
Source: Breast cancer research and treatment, 2016 Nov; 160(1), p. 1-15.
EPub date: 2016-09-06.
PMID: 27601138
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Understanding racial differences in health-related quality of life in a population-based cohort of breast cancer survivors.
Authors: Pinheiro L.C. , Samuel C.A. , Reeder-Hayes K.E. , Wheeler S.B. , Olshan A.F. , Reeve B.B. .
Source: Breast cancer research and treatment, 2016 Oct; 159(3), p. 535-43.
EPub date: 2016-09-01.
PMID: 27585477
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Community-Guided Focus Group Analysis to Examine Cancer Disparities.
Authors: Schaal J.C. , Lightfoot A.F. , Black K.Z. , Stein K. , White S.B. , Cothern C. , Gilbert K. , Hardy C.Y. , Jeon J.Y. , Mann L. , et al. .
Source: Progress in community health partnerships : research, education, and action, 2016 Spring; 10(1), p. 159-67.
PMID: 27018365
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Factors associated with decisions to undergo surgery among patients with newly diagnosed early-stage lung cancer.
Authors: Cykert S. , Dilworth-Anderson P. , Monroe M.H. , Walker P. , McGuire F.R. , Corbie-Smith G. , Edwards L.J. , Bunton A.J. .
Source: JAMA, 2010-06-16; 303(23), p. 2368-76.
PMID: 20551407
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Racial Differences in the Influence of Health Care System Factors on Informal Support for Cancer Care Among Black and White Breast and Lung Cancer Survivors.
Authors: Ellis K.R. , Black K.Z. , Baker S. , Cothern C. , Davis K. , Doost K. , Goestch C. , Griesemer I. , Guerrab F. , Lightfoot A.F. , et al. .
Source: Family & community health, 2020 Jul/Sep; 43(3), p. 200-212.
PMID: 32427667
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