A Community-Engaged Process for Adapting a Proven Community Health Worker Model to Integrate Precision Cancer Care Delivery for Low-income Latinx Adults With Cancer

• Published in: Health promotion practice Vol. 24; no. 3; pp. 491 - 501
• Main Authors: Wood, Emily H., Leach, Maria, Villicana, Gerardo, Goldman Rosas, Lisa, Duron, Ysabel, O’Brien, Dale G., Koontz, Zachary, Patel, Manali I.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01.05.2023; SAGE PUBLICATIONS, INC
• Subjects: Adult; Adults; Advance directives; Cancer; Caregivers; Community; Community Health Workers; Community Participation; Delivery of Health Care; Grounded theory; Health care; Hispanic or Latino; Humans; Integrated care; Interagency collaboration; Intervention; Interviews; Low income groups; Neoplasms - therapy; Oncology; Precision medicine; Primary care; Stakeholder Participation; goals of care; precision cancer care; community care; underserved; community health worker; Community engagement; Latinx; adaptation; cancer care delivery; oncology; personalized medicine; lay health worker; REAIM framework; advance care planning; CBPR
• ISSN: 1524-8399; 1552-6372
• DOI: 10.1177/15248399221096415

Introduction Disparities in precision cancer care delivery among low-income Latinx adults are well described. In prior work, we developed a community health worker-led goals of care and cancer symptom assessment intervention. The objective of this study was to adapt this intervention for a community setting, incorporating precision cancer care delivery. Methods We used a two-phased systematic approach to adapt an evidence-based intervention for our community. Specifically, we used the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to identify barriers and facilitators to precision cancer care delivery via 1-hr interviews with Latinx adults with cancer, Latinx caregivers, community leaders, primary care and oncology clinicians, and community health workers. Interviews were recorded, transcribed, and analyzed using the constant comparative method and grounded theory analysis. Phase 2 involved interviews with key community advisors using the Expert Panels Method to decide on final adaptations. Results Using this community-engaged approach, we identified specific intervention adaptations to ensure precision cancer care delivery in a community setting, which included: (a) expansion of the intervention inclusion criteria and mode of delivery; (b) integration of low-literacy precision cancer care intervention activities in Spanish in collaboration with community-based organizations; (c) ensuring goals reflective of patient and community priorities. Conclusions This systematic and community-engaged approach to adapt an intervention for use in delivering precision cancer care strengthened an evidence-based approach to promote the needs and preferences of patients and key community stakeholders.