Health Equity Action Plan 2020

February is both Black History Month and National Cancer Prevention Month, and a perfect time to highlight updates to Komen San Diego’s Health Equity Action Plan.

In 2014, the Komen San Diego Affiliate launched an effort focused on education, screening and health event efforts in partnership with Black/African American women and community health organizations. The result? Breast health education to over 8,500 residents and the screening of 1,225 Black/African American San Diego women from 2015-2018.
 
In alignment with our 2018-2020 visionary goals, Komen San Diego Affiliate seeks to address the most critical needs and identify strategies beyond patient education and mobile mammography and continue maintaining our regional data and statistics for more efficient tracking of progress and impact to Black/African American female residents in San Diego County.


Statement of Need

  • Black/AA women with family history are less likely to get referred for genetic counseling than white women.
  • Black/AA female patients are diagnosed and receive treatment later compared to white female patients. For younger Black women under the age of 45, when diagnosed, the disease is a more advanced stage and more aggressive.
  • Black/AA women are not receiving the recommended standard of care compared to white breast cancer patients when treatment does begin.
  • Black/AA women are the least referred for clinical trials. Research consistently highlights the lack of representation in clinical trials. 

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  • Black/AA women in San Diego report their perceived top barrier to receiving regular breast health care is not feeling respected
    by physician/not trusting physicians and feeling unable to questions physicians (69%).
  • Black/AA women in San Diego report that breast cancer is one of three (3) top health priorities along with heart disease and diabetes.  
  • The number of Black/AA women in San Diego who participate in clinical trials is unknown. 
  • Demographic data Black/AA women in San Diego does not take into account income level differences that may exist.

**Source:  Komen San Diego 2015 Community Profile report


While the Black/African American population represents a relatively small number compared to that of the Caucasian and Hispanic/Latino population, it does not justify the lack of relevant attention on this demographic. 

Further, San Diego Health systems, pharmaceutical and insurance companies have access to demographic and health data that may bring about additional insights.  Komen San Diego has limited scope to some of the data but not enough and not consistently.  As a result, we need only to look within our own health care community to understand why we have not yet achieved the depth of change we seek and embrace this opportunity.

Forward looking, Komen San Diego Affiliate shall dive deeper into breast health promotion and driving behavior change at the system level, while seeking answers to the following questions.

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Provider/Patient Communication

Clinical Trial Education & Participation

Outreach to Black women under 45

How can we best work with providers in addressing disconnect reported by San Diego women?

How can we obtain demographic data on clinical trial recruitment, enrollment and participation?

What are the perceptions of this demographic and experiences about breast cancer?

Are there opportunities to provide provider feedback and cultural education?

Are there opportunities for collaboration with these centers on providing education to Black/African American women?

How can we best support this demographic in providing relevant education and resources that they perceive as valuable? 

Priority #1

Improve Provider-Patient Communication

Resources & Inputs

  • Local SD provider & community health organizations
  • Data & surveillance on Black female patients in SD & California
  • Literature review on research (past 5 years) on BC, Black women, & provider-patient communication (CDC, OMH, ACS, etc
  • Komen Community Profiles, and other SD orgs focused on breast cancer and Black women
  • Black female breast cancer survivors and patients.

Strategies & Activities

  • Hold educational webinars & community educational workshops targeting providers and community health organizations
  • Facilitate provider interviews
  • Facilitate focus groups (patients)

Outputs

  • # of partnerships developed with clinics, universities, sororities, local orgs, and other groups
  • # Focus group participants
  • # of informational workshops
  • Survey results on Health Equity Luncheon

Short-Term Outcomes

  • Established patient-centered approaches used by providers.
  • Increased knowledge of cultural elements in the Black community.
  • Increased self-advocacy by Black women.

Long-Term Outcomes

  • Increased reporting of provider behavior change & authentic engagement with Black female patients.
  • Increase in overall patient attitude & trust in SD provider medical community.
Priority #2

Increase Clinical Trial Education & Participation

Resources & Inputs

  • Diagnosis, enrollment & participation rates for clinical trials in SD
  • Recruitment efforts and Referral process of clinical trials in SD
  • Incentives/available support for participation in SD
  • Existing cultural sensitivity workshops for clinical trials team
  • Pharmaceutical & Insurance companies
  • Patient navigators
  • Breast cancer survivors/patients

Strategies & Activities

  • Collect CT participation by ethnicity from at least CT facilities i.e. UCSD, Scripps, Sharp, etc., pharma & insurance companies
  • Conduct interviews w/ at least  PN at the medical centers currently enrolling for BC CT (UCSD, Scripps and Sharp)
  • Hold at least focus groups and at least education events
  • Utilize social media & Komen database for marketing campaign

Outputs

  • Clinical trial enrollment and participation rates in SD
  • # of available clinical trials in SD for eligible patients
  • # of pharma partners
  • #of insurance partners
  • # of clinical trial education workshops completed
  • # of stakeholder interviews
  • # of focus groups
  • Survey results on Health Equity Luncheon

Short-Term Outcomes

  • Patient-centered approaches to encourage participation & retention.
  • Patient participation in clinical trial education workshops. Increase of shared BC data.

Long-Term Outcomes

  • More effective clinical trial team engagement & accountability, flexible research protocols for patients.
  • Increased trust for the medical community and acknowledgment of benefits of clinical trials.
  • Increase of Black female patient participation in clinical trials.
Priority #3

Outreach & Education to Black Women < 45

Resources & Inputs

  • Literature review on research findings (CDC, OMH, ACS, etc) on BC and Black women under 45, perceptions, level of awareness
  • Clinics, Universities, Sororities, Local orgs, Meetups, Facebook groups
  • San Diego Black women

Strategies & Activities

  • Create partnerships with clinics, universities, sororities, and/or other groups
  • Survey YBW women through focus groups/surveys/individual interviews
  • Hold aeducational events/informational workshops (including Health Equity Luncheon) targeting YBW & Community organizations

Outputs

  • # of partnerships developed with clinics, universities, sororities, local orgs, and other groups
  • # Focus group participants
  • # of informational workshops

Short-Term Outcomes

  • Improved knowledge on the need for breast cancer screening
  • Increased self-awareness & access to resources

Long-Term Outcomes

  • Increased use of breast health resources
  • Increased health-seeking & healthy lifestyle behaviors to reduce BC risk
  • Increased use of breast health resources
  • Increased health-seeking & healthy lifestyle behaviors to reduce BC risk
Priority #4

Improve Provider-Patient Communication

Resources & Inputs

  • Health systems
  • Cancer centers
  • US Census Bureau
  • Pharmaceutical organizations
  • Insurance companies
  • San Diego Black women

Strategies & Activities

  • Create buy-in and partnerships with SD health systems, breast cancer centers, pharmaceutical organizations and insurance companies
  • Interview above partners and all SD health systems to gain understanding of why this barrier exists and opportunities for behavior change.
  • Host at least one educational forum on the importance of data transparency for Black women

Outputs

  • # partner interviews
  • # of post partner surveys

Short-Term Outcomes

  • Increased sharing of SD data & statistics on Black female breast cancer patients and survivors

Long-Term Outcomes

  • Established and maintained systems for patient surveillance

Terminology Defined

Health and health care disparities refer to differences in health and health care between population groups. Disparities occur across many dimensions, including race/ethnicity, socioeconomic status, age, location, gender, disability status, and sexual orientation. Disparities in health and health care not only affect the groups facing disparities, but also limit overall gains in quality of care and health for the broader population and result in unnecessary costs. Addressing health disparities is increasingly important as the population becomes more diverse.

Health Equity Luncheon:  a panel discussion of industry experts and advocates on breast cancer health disparity impacting Black women in San Diego. Scheduled for December 7th and hosted by Komen San Diego affiliate.

Patient navigators are individuals who provide guidance to patients to help overcome barriers to care.  They explain treatment options, schedule appointments and provide psychological and social support.