A qualitative approach to understanding the drivers of unequal receipt of definitive therapy for Black men with prostate cancer in Massachusetts

• Published in: Cancer 2024-10, Vol.130 (S20), p.3590-3601
• Main Authors: Labban, Muhieddine, Stone, Benjamin V., Steele, Grant L., Salinas, Kevin E., Agudile, Emeka, Katz, Mark H., Rihan‐Porter, Nancy, Reich, Amanda J., Cole, Alexander P., Landers, Stewart, Trinh, Quoc‐Dien
• Format: Article
• Language: English
• Subjects: Ancillary services; barriers to care; Black or African American - statistics & numerical data; Cancer therapies; Community involvement; community outreach; Health care; Health care access; Health services; Health Services Accessibility - statistics & numerical data; Healthcare Disparities - ethnology; Hospitals; Humans; Inequality; Insurance; Male; Massachusetts; Patients; Prostate cancer; Prostatic Neoplasms - ethnology; Prostatic Neoplasms - therapy; Qualitative analysis; Qualitative Research; qualitative study; Race factors; Racial differences; racial disparities; treatment; Urban areas; Urban environments
• ISSN: 0008-543X; 1097-0142; 1097-0142
• DOI: 10.1002/cncr.35366

Background Despite mandated insurance coverage since 2006 and robust health infrastructure in urban settings with high concentrations of minority patients, race‐based disparities in prostate cancer (PCa) treatment persist in Massachusetts. In this qualitative study, the authors sought to identify factors driving inequities in PCa treatment in Massachusetts. Methods Four hospitals offering PCa treatment in Massachusetts were selected using a case‐mix approach. Purposive sampling was used to conduct semistructured interviews with hospital stakeholders. Additional interviews were conducted with representatives from grassroots organizations providing PCa education. Two study staff coded the interviews to identify major themes and recurrent patterns. Results Of the 35 informants invited, 25 participated in the study. Although national disparities in PCa outcomes were readily discussed, one half of the informants were unaware that PCa disparities existed in Massachusetts. Informants and grassroots organization representatives acknowledged that patients with PCa are willing to face transportation barriers to receive treatment from trusted and accommodating institutions. Except for chief equity officers, most health care providers lacked knowledge on accessing or using metrics regarding racial disparities in cancer outcomes. Although community outreach was recognized as a potential strategy to reduce treatment disparities and engender trust, informants were often unable to provide a clear implementation plan. Conclusions This statewide qualitative study builds on existing quantitative data on the nature and extent of disparities. It highlights knowledge gaps in recognizing and addressing racial disparities in PCa treatment in Massachusetts. Improved provider awareness, the use of disparity metrics, and strategic community engagement may ensure equitable access to PCa treatment. Plain Language Summary Despite mandated insurance and urban health care access, racial disparities in prostate cancer treatment persist in Massachusetts. This qualitative study revealed that, although national disparities were acknowledged, awareness about local disparities are lacking. Stakeholders highlighted the importance of ancillary services, including translators, rideshares, and navigators, in the delivery of care. In addition, whereas hospital stakeholders were aware of collected equity outcomes, they were unsure whether and who is monitoring equity metrics. Furthermore, stakeholde