Community-engaged adaptation of ACCESS: A navigator-led early palliative care intervention for Black and Latina women with advanced breast cancer

Abstract

Introduction

Disparities in early palliative care (PC) access for Black and Latina women with advanced breast cancer (ABC) persist. This study elicited qualitative feedback from patients with ABC and health professionals to adapt a community navigator-led early PC program called ACCESS to improve PC access and supportive care outcomes for Black and Latina women with ABC.

Methods

This was a formative evaluation study using a community-engaged approach. Guided by a community advisory board, qualitative interviews were conducted with Black and Latina women with ABC (N = 20) and interdisciplinary health professionals and patient navigators (N = 20) to elicit feedback on the content, delivery, and format of ACCESS, a navigator-delivered early PC intervention to improve PC access and outcomes. Thematic analysis was conducted using inductive coding followed by deductive analysis using the Consolidated Framework for Implementation Research framework to guide intervention adaptation.

Results

Findings indicate that ACCESS addresses the early PC needs of Black and Latina women with ABC, yet needs to embed flexibility per patient preferences. Additionally, PC should be introduced as supportive care to enhance acceptability. Navigators emphasized fostering awareness and access to resources, which are crucial for patients' well-being. Strong interdisciplinary relationships and care coordination are essential for embedding ACCESS. Recognizing patient individuality, addressing historical and cultural factors, and ensuring navigators are empathetic, well-trained, and culturally aligned with patients were highlighted as pivotal for the intervention's success.

Conclusions

These findings will inform the adaptation of ACCESS for feasibility and preliminary efficacy testing.