Table 1:
Explicit and Implicit Inclusion of Health Equity Content within Cancer Designation Requirements
| Types of Inclusion | Example | ASCO | ASTRO | COC | NCI | |
|---|---|---|---|---|---|---|
| Explicit Terms | ||||||
| Equity | ||||||
| Disparities | Research | NCI:” briefly describe how the cancer research relevant to the catchment area is addressed. This may include, for example, a discussion of research focused on cancer health disparities” | P | |||
| Race | Research | NCI: “Are differences addressed, if applicable, in the intervention effect due to sex/gender and race/ethnicity?” | P | |||
| Rural | Research, plan development for improvement, clinical trial enrollment, criteria exception due to rural location | NCI:” briefly describe how the cancer research relevant to the catchment area is addressed. This may include, for example, a discussion of research focused on cancer health disparities” (e.g……rural)” | S | P, O | P | |
| Vulnerable | ||||||
| Under-represented | Community engagement through community advisory boards/partnerships; funding of personnel (e.g., patient navigators), clinical trial enrollment | NCI: “Centers are expected to engage communities within their catchment area to decrease their cancer burden, particularly among minority and underrepresented populations. To facilitate these activities, Centers establish community advisory board(s) and partnerships with other healthcare delivery systems and state and community agencies and coalitions for dissemination of evidence-based findings.” | P, S | |||
| Disability | Assessment of functional status, processes to identify and communicate with patients with communication barriers | ASCO: ”Assess, document, and address psychosocial needs (i.e., mental illness, cognitive/intellectual capabilities; cultural status; financial wellbeing)” | P | P | ||
| Sexual Orientation | Research focus | NCI:” briefly describe how the cancer research relevant to the catchment area is addressed. This may include, for example, a discussion of research focused on cancer health disparities” (e.g……sexual and gender minorities)” | P | |||
| Minority / Minoritized / Marginalized | Research focus | NCI: ”briefly describe how the cancer research relevant to the catchment area is addressed. This may include, for example, a discussion of research focused on cancer health disparities” (e.g……racial/ethnic minorities)” | P | |||
| Income / Poverty /SES | Research focus, development / implementation of survivorship program in part addressing financial issues, initial psychosocial assessment, including SES), education RE: treatment plan that addresses potential financial barriers), provide information and assessment on cost of radiation therapy | COC: “1) Requires development / implementation of survivorship program, which could include services to address financial support of a cancer survivor.” | P | P | P, S | P |
| Diversity | Diversity of personnel, processes for monitoring and evaluating progress in diversity, inclusion in clinical trial enrollment | NCI: “Each center may also have special opportunities within its catchment area to enhance the diversity of its staff, membership and leadership.” | S, P, O | |||
| Population | Catchment area engagement, partnerships, inclusion in education and training, materials aligned with education/reading needs of patient population | ASCO: “All materials must be culturally sensitive and address the various educational and reading levels of the population.” | P | P | S, P, O | |
| Barriers | Processes to identify barriers to treatment adherence, development of survivorship programs, palliative services that identify and address psychosocial needs, processes to identify and address language and other communication barriers | ASCO: “Practitioners should be reviewing any barriers to medication adherence and for any issues identified, practitioners should clearly document referrals to other practitioners (e.g., financial counselor or social worker)” | P | P | P, S, O | |
| Psychosocial | Policies requiring services that address psychosocial needs | ASCO: “Psychosocial Distress Screening: Requires psychosocial services be available on site or by referral. Requires a policy to monitor distress screening and care (provided/referred).” | P, S | |||
| Immigration Status | Policy exemption for reporting | COC: Registry/Data Follow-Up of Patients: CoC explicitly exempts “residents of foreign countries" from follow-up requirements | P | |||
| Language | Translation services | ASTRO: “The ROP has a process for communication with patients who do not speak English fluently or have other communication barriers.” | P | |||
| Implicit Domains | ||||||
| Community Engagement | Planning and evaluation processes related to center goals, including community engagement, scope/quality/impact of community outreach and engagement, engagement of community members/organizations, | NCI: “Describe how the Center has communicated community needs to Center members and catalyzed research in all areas of science (basic, clinical, translational, and population sciences). Centers … may illustrate with examples of research projects how outreach to and engagement of communities resulted in high-impact science.” | P, S, O | |||
| Cultural Competence | Psychosocial assessment and action including cultural background | ASCO: “Initial psychosocial assessment, with action taken when indicated (This documentation may include the use of cultural background and socioeconomic status)” | P | |||
| Patient Education | Processes for patient education around chemotherapy treatment | ASCO: “A learning assessment will be documented including needs, abilities, preferences and readiness to learn. Patient education materials should be appropriate for the patient’s reading level/literacy and patient/caregiver understanding. Ideally, documentation should include patient feedback reflecting understanding and engagement” | P |
Table 1 reports the results of our qualitative content analysis reviewing how cancer accreditations consider equity. ASCO = American Society of Clinical Oncology. ASTRO = American Society of Radiation. COC = Commission on Cancer. NCI = National Cancer Institute. The “explicit terms” were selected prior to analyzing the accreditations. The “implicit terms” were identified during the content analysis as a relevant topic for promoting equity. We list the types of inclusion and provide an example directly from the accrediting document. Under each organization, we indicate how equity is considered as a requirement for accreditation: P (process), S (structure), or O (outcome). Shaded cells indicate “Not Present”.