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Black and Latinx individuals, and in particular women, comprise an essential health care workforce often serving in support roles such as nursing assistants and dietary service staff. Compared to physicians and nurses, they are underpaid and potentially undervalued, yet play a critical role in health systems. This study examined the impact of the coronavirus disease 2019 (COVID-19) pandemic from the perspective of Black and Latinx health care workers in support roles (referred to here as HCWs). From December 2020 to February 2021, we conducted 2 group interviews (n = 9, 1 group in English and 1 group in Spanish language) and 8 individual interviews (1 in Spanish and 7 in English) with HCWs. Participants were members of a high-risk workforce as well as of communities that suffered disproportionately during the pandemic. Overall, they described disruptive changes in responsibilities and roles at work. These disruptions were intensified by the constant fear of contracting COVID-19 themselves and infecting their family members. HCWs with direct patient care responsibilities reported reduced opportunities for personal connection with patients. Perspectives on vaccines reportedly changed over time, and were influenced by peers’ vaccination and information from trusted sources. The pandemic has exposed the stress endured by an essential workforce that plays a critical role in healthcare. As such, healthcare systems need to dedicate resources to improve the work conditions for this marginalized workforce including offering resources that support resilience. Overall working conditions and, wages must be largely improved to ensure their wellbeing and retain them in their roles to manage the next public health emergency. The role of HCWs serving as ambassadors to provide accurate information on COVID-19 and vaccination among their coworkers and communities also warrants further study.

Background Cancer advocacy groups engage patients, families and caregivers in navigating the cancer landscape, with a focus on early detection/screening and providing psychosocial and financial support during and after treatment. These groups are influential among their communities, funders and policymakers. Objective We wished to understand perceptions of breast cancer advocacy group leaders on primary care's role in breast cancer survivorship care, given limited primary care engagement despite endorsement by the National Cancer Institute (NCI). Methods As part of a larger NCI‐funded study, we used purposive sampling to select leaders from a diversity of patient advocacy groups for in‐depth interviews (n = 9). After obtaining consent, interviews were conducted and recorded on Zoom, professionally transcribed, and analysed using an established immersion–crystallisation process to identify themes and patterns. Results We interviewed leaders (n = 9) from two local, three regional and four national advocacy groups, five of whom had personal experiences with breast cancer. These advocates emphasised that transitions away from the safety of oncology to primary care are difficult for patients. They felt patients with a history of breast cancer have unique and complex needs that are different from the standards of care found within primary care settings, and primary care clinicians are not adequately prepared to address these. In reflecting on the ideal role of primary care, they highlighted listening to patients, identifying issues and referring patients to appropriate specialists, but ultimately stressed that patients needed to advocate for themselves in the current healthcare environment. Conclusions Advocacy groups typically start as grass root efforts motivated by perceptions of inadequate support and care for cancer patients. As such, there is potential for advocacy groups to shape the conversation to improve collaboration between oncology and primary care by articulating and advocating for better primary care involvement in survivorship care. Patient or Public Contribution The project's steering committee included cancer survivors and cancer advocacy group leaders who provided feedback on the project design and made recommendations for people to interview. Steering committee retreats were later held after the completion of interviews to reflect on emerging findings and plan dissemination strategies. The study team included a cancer survivor and several members whose immediate family members had a history of cancer. They were actively engaged in the design, analysis and manuscript writing.

Background: Despite calls for an enhanced role for primary care for individuals with a history of cancer, primary medical care’s role in adult survivorship care continues to be marginal. Methods: We conducted in-depth interviews with 8 medical oncologists with interest in cancer survivorship from 7 National Cancer Institute designated comprehensive cancer centers to understand perspectives on the role of primary care in cancer survivorship. Results: Two salient overarching thematic patterns emerged. (1) Oncologist’s perspectives diverge on if, how, and when primary care clinicians should be involved in survivorship, ranging from involvement of primary care throughout treatment to a standardized hand-off years post-therapy. (2) Oncologist’s lack understanding about primary care’s expertise and subsequent value in survivorship care. Conclusion: As oncology continues to be overwhelmed by rising numbers of aging cancer survivors with multi-morbidities, NCI-designated cancer centers should take a leadership role in integrating primary care engaged cancer survivorship.

Background Primary care physicians face multiple challenges in integrating clinical cancer genetics into routine care. Most studies of genomic medicine come from countries with well-developed primary healthcare systems, while research on the integration of clinical genetics in primary care remains limited in Japan and Asia. In Japan, where family medicine is still emerging as a specialty, no prior studies have examined Japanese family physicians’ engagement with clinical cancer genetics, including genetic counseling and referral. This study investigates Japanese family physicians’ knowledge, attitudes and practices regarding hereditary cancer syndromes. Methods This is mixed methods research employing an explanatory sequential design with survey data collection followed by qualitative interviews. First, a quantitative survey assessed Japanese family physicians’ knowledge, attitudes, and practices regarding genetic counseling and referrals for hereditary cancer syndromes. We then explored their practices and perspectives in relation to the quantitative findings through semi-structured individual interviews with a subset of the family physicians. Finally, we integrated both findings in a joint display table and generated conclusions or metainferences. Results A total of 149 family physicians completed a survey (response rate: 26.7%), with 11 who did not have experience in genetic counseling or referrals participating in follow-up qualitative interviews. Survey responses found that only 6% of respondents provided genetic counseling, and 5% referred patients to genetic professionals. Most family physicians (64–73%) demonstrated limited knowledge of hereditary cancer syndrome, leading to difficulty interpreting family history and assessing cancer risk in clinical practice. While many family physicians (71–94%) conceptually acknowledged the benefits of clinical genetics in the survey, interviews highlighted concerns about the potential harm of genetic testing. Interviews helped explain the reasons for low engagement rates. Family physicians were uncertain about the clinical utility of genetic interventions and about the psychological impact discussing cancer genetics might have on patients. Further, the term “heredity” carries negative connotations, which made family physicians hesitant to initiate such conversations. Conclusion Japanese family physicians encounter challenges in applying clinical cancer genetics. Further research is needed to explore effective approaches that support family physicians in addressing these challenges while enhancing their role in clinical cancer genetics.

Background Community engagement is widely recognized as critical to successful and equitable implementation of evidence-based practices, programs, and policies. However, there are no clear guidelines for community involvement in data collection and analysis in implementation research. Methods We describe three specific methods for engaging community members in data collection and analysis: concept mapping, rapid ethnographic assessment, and Photovoice. Common elements are identified from a case study of each method: 1) selection and adaptation of evidence-based strategies for improving adolescent HPV vaccine initiation rates in disadvantaged communities, 2) strategies for implementing medication for opioid use disorders among low-income Medicaid enrollees during natural disasters, and 3) interventions to improve the physical health of adults with severe mental illness living in supportive housing. Results In all three cases, community members assisted in participant recruitment, provided data, and validated preliminary findings created by researchers. In the Photovoice case study, community members participated in both data collection and analysis, while in the concept mapping, community members also participated in the initial phase of organizing and prioritizing evidence-based strategies during the data analysis. Conclusions Community involvement in implementation research data collection and analysis contributes to greater engagement and empowerment of community members and validation of study findings. Use of methods that exhibit both scientific rigor and community relevance of implementation research also contributes to greater community investment in successful implementation outcomes. Nevertheless, the case studies point to the importance and efficiency of the division of labor embedded in community-engaged implementation research. Building capacity for community members to assume greater roles in obtaining and organizing data for preliminary analysis prior to interpretation is recommended.

ObjectivesThe rapid onset and progressive course of the COVID-19 pandemic challenged primary care practices to generate rapid solutions to unique circumstances, creating a natural experiment of effectiveness, resilience, financial stability and governance across primary care models. We aimed to characterise how practices in Melbourne, Australia modified clinical and organisational routines in response to the pandemic in 2020–2021 and identify factors that influenced these changes.DesignProspective, qualitative, participatory case study design using constant comparative data analysis, conducted between April 2020 and February 2021. Participant general practitioner (GP) investigators were involved in study design, recruitment of other participants, data collection and analysis. Data analysis included investigator diaries, structured practice observation, documents and interviews.SettingThe cases were six Melbourne practices of varying size and organisational model.ParticipantsGP investigators approached potential participants. Practice healthcare workers were interviewed by social scientists on three occasions, and provided feedback on presentations of preliminary findings.ResultsWe conducted 58 interviews with 26 practice healthcare workers including practice owners, practice managers, GPs, receptionists and nurses; and six interviews with GP investigators. Data saturation was achieved within each practice and across the sample. The pandemic generated changes to triage, clinical care, infection control and organisational routines, particularly around telehealth. While collaboration and trust increased within several practices, others fragmented, leaving staff isolated and demoralised. Financial and organisational stability, collaborative problem solving, creative leadership and communication (internally and within the broader healthcare sector) were major influences on practice ability to negotiate the pandemic.ConclusionsThis study demonstrates the complex influences on primary care practices, and reinforces the strengths of clinician participation in research design, conduct and analysis. Two implications are: telehealth, triage and infection management innovations are likely to continue; the existing payment system provides inadequate support to primary care in a global pandemic.

Population health in the United States continues to lag behind other wealthy nations. Primary care has the promise of enhancing population health; however, the implementation of a population health approach within primary care deserves further consideration. Clinicians and staff from a national sample of 10 innovative primary care practices participated in a working conference to reflect upon population health approaches in primary care. A series of small- and large-group discussions were recorded, transcribed, and coded through an immersion/crystallization approach. Two prominent themes emerged: (1) Transitioning to a population health focus generally develops through stages, with early implementation focusing on risk stratification and later, more advanced stages focusing on community health; and (2) Several inherent barriers confront implementation of a population health approach, including tensions with patient-centered care, and limitations of health information technology. A broader conceptualization of population health in terms of community health could more effectively allow partnerships among primary care, large health care systems, public health organizations, patients, and other partners in the community.

Introduction Existing approaches in cancer survivorship care delivery have proven to be insufficient to engage primary care. This study aimed to identify stakeholder‐informed priorities to improve primary care engagement in breast cancer survivorship care. Methods Experts in U.S. cancer survivorship care delivery were invited to participate in a 4‐round online Delphi panel to identify and evaluate priorities for defining and fostering primary care's engagement in breast cancer survivorship. Panelists were asked to identify and then assess (ratings of 1–9) the importance and feasibility of priority items to support primary care engagement in survivorship. Panelists were asked to review the group results and reevaluate the importance and feasibility of each item, aiming to reach consensus. Results Respondent panelists (n = 23, response rate 57.5%) identified 31 priority items to support survivorship care. Panelists consistently rated three items most important (scored 9) but with uncertain feasibility (scored 5–6). These items emphasized the need to foster connections and improve communication between primary care and oncology. Panelists reached consensus on four items evaluated as important and feasible: (1) educating patients on survivorship, (2) enabling screening reminders and monitoring alerts in the electronic medical record, (3) identifying patient resources for clinicians to recommend, and (4) distributing accessible reference guides of common breast cancer drugs. Conclusion Role clarity and communication between oncology and primary care were rated as most important; however, uncertainty about feasibility remains. These findings indicate that cross‐disciplinary capacity building to address feasibility issues may be needed to make the most important priority items actionable in primary care.

Background Multiple evidence-based strategies (EBS) for promoting HPV vaccination exist. However, adolescent HPV vaccination rates remain below target levels in communities at high risk for HPV-associated cancers and served by safety-net clinics. Participatory engaged approaches are needed to leverage the expertise of community and clinical partners in selecting EBS relevant to their local context. We engaged concept mapping as a method to inform the adoption and adaptation of EBS that seeks to empower implementation partners to prioritize, select, and ultimately implement context-relevant EBS for HPV vaccination. Methods Using 38 EBS statements generated from qualitative interviews and national HPV vaccine advocacy sources, we conducted a modified concept mapping activity with partners internal to safety-net clinics and external community members in two study sites of a larger implementation study (Greater Los Angeles and New Jersey), to sort EBS into clusters and rate each EBS by importance and feasibility for increasing HPV vaccination within safety-net clinics. Concept mapping findings (EBS statement ratings, ladder graphs and go-zones) were shared with leaders from a large federally qualified health center (FQHC) system (focusing on three clinic sites), to select and implement EBS over 12 months. Results Concept mapping participants (n=23) sorted and rated statements, resulting in an eight-cluster solution: 1) Community education and outreach; 2) Advocacy and policy; 3) Data access/quality improvement monitoring; 4) Provider tracking/audit and feedback; 5) Provider recommendation/communication; 6) Expanding vaccine access; 7) Reducing missed opportunities; and 8) Nurse/staff workflow and training. The FQHC partner then selected to intervene on eight of 17 EBS statements in the “go-zone” for action, with three from “reducing missed opportunities,” two from “nurse/staff workflow and training,” and one each from “provider tracking/audit and feedback,” “provider recommendation/communication,” and “expanding vaccine access,” which the research team addressed through the implementation of three multi-level intervention strategies (e.g., physician communication training, staff training and workflow assessment, audit and feedback of clinic processes). Conclusions Concept mapping provided a powerful participatory approach to identify multilevel EBS for HPV vaccination relevant to the local safety-net clinic context, particularly when several strategies exist, and prioritization is necessary. This study demonstrates how a clinic system benefited directly from the ratings and prioritization of EBS by multilevel clinic and community partners within the broader safety-net clinic context to identify and adapt prioritized solutions needed to advance HPV vaccine equity.

focused Rapid Assessment Process (fRAP) 2.0 is a community engagement approach combining geospatial mapping with rapid qualitative assessment in cyclical fashion within communities to capture multifactorial and multilevel features impacting primary care problems. fRAP 2.0 offers primary care researchers a methodology framework for exploring complex community features that impact primary healthcare delivery and outcomes. The fRAP 2.0 study design expands the fRAP from a sequential design to a cyclical process of geospatial mapping and rapid qualitative assessment in search of modifiable contextual factors. Research participants are stakeholders from various socioecological levels whose perspectives inform study outcomes that they may use to then become the agents of change for the very problems they helped explore. Here, we present a proof-of-concept study for fRAP 2.0 examining disparities in cervical cancer mortality rates among Hispanic women in Texas. The primary outcomes of interest are features at the community level, medical health system level and regional government policy levels that offer opportunities for collaborative interventions to improve cervical cancer outcomes. In this study, geospatial mapping of county and ZIP code-level variables impacting postdiagnosis cervical cancer care at community, medical and policy levels were created using publicly available data and then overlaid with maps created with Texas Cancer Registry data for cervical cancer cases in three of the largest population counties. Geographically disparate areas were then qualitatively explored using participant observation and ethnographic field work, alongside 39 key informant interviews. Roundtable discussion groups and stakeholder engagement existed at every phase of the study. Applying the fRAP 2.0 method, we created an action-oriented roadmap of next steps to improve cervical cancer care disparities in the three Texas counties with emphasis on the high disparity county. We identified local change targets for advocacy and the results helped convene a stakeholder group that continues to actively create on-the-ground change in the high-disparity county to improve cervical cancer outcomes for Hispanic women.