Team-Based Strategies Could Reduce Racial Disparities in Multiple Myeloma Care

Assessment of multidisciplinary treatment of patients with multiple myeloma (MM) and examination of discordance in point-of-care and optimal care aimed to address inequities in cancer care, according to results from a recent study.

Researchers used data from comparative surveys between the multidisciplinary healthcare team and patients, revealing critical discordances between the groups, which enabled healthcare teams to identify gaps in care and develop ways to improve treatment, including shared decision making. The study findings were published in Professional Case Management.

Multidisciplinary healthcare teams may inadvertently propagate healthcare disparities due to a lack of experience or awareness of individualized, patient-centered goals of care. Significant healthcare disparities continue particularly in Black patients with MM, who are twice as likely to develop the disease and have an earlier age of onset compared with non-Black patients. Additionally, Black patients with MM are less likely to undergo stem cell transplantation, receive timely access to certain therapies, or be enrolled in clinical trials.

In this study, researchers conducted a large-scale, equity-focused initiative that focused on identifying and addressing racial disparities and health inequities in patients with MM. The study implemented quality improvement goals specific to each of the interprofessional cancer care teams via audit-feedback sessions.

Multidisciplinary cancer care teams in 2 large oncology systems and 4 community clinics in Chicago; Washington, DC; Columbus, Ohio; Charlotte, North Carolina; Indianapolis; and Denver participated. Teams consisted of hematologists/oncologists, nurse practitioners/physician assistants, primary care physicians, and case managers/nurse navigators.

Teams evaluated and compared their own beliefs and perspectives with those of their patients to reveal and address discrepancies. Baseline chart audits indicated inequities of care including disparities in clinical practice metrics, treatment history, patient-centered measures, and patient/disease characteristics.

Survey tools revealed significant differences between patients with MM and their healthcare team members. Healthcare teams reported cost of treatment as the biggest challenge (59% vs 9% of patients), whereas patients reported confidence in their treatment plan as the biggest challenge (32% vs 18% of healthcare team members).

Differences between Black/Hispanic patients and White patients were also noted. For example, 63% of healthcare team members and 47% of patients noted length of survival as an important goal of MM care. But racial differences in the importance of this goal of care were noted between Black/Hispanic patients and White patients — 38% vs 56%, respectively, reported length of survival as an important goal of care.

Subsequently, follow-up chart audits at 6 months showed changes in documented clinical behavior. Multidisciplinary teams developed action plans to address sustainable reductions in health disparities in patients with MM to address health equity and overall care.

“Using patient data as well as team-driven data to identify problems and inform strategies for change can assist clinics and their teams in mitigating health disparities, which can improve patient outcomes at the point of care,” the authors concluded in their report.

Reference

Moreo K, Sullivan S, Carter J, Heggen C. Generating team-based strategies to reduce health inequity in cancer care. Prof Case Manag. 2023;28(5):215-223. doi:10.1097/NCM.0000000000000657