Addressing multi-level determinants of endometrial cancer diagnosis in Black women

Black women experience inequity in access to timely endometrial cancer (EC) diagnosis, with patient-provider communication likely playing an important role. The objective of this dissertation research was to address multilevel determinants of patient-provider communication influencing timely EC diagnosis in Black women, and develop a system-strengthening intervention to attend to these determinants.First, I identified determinants of patient-provider communication influencing timely diagnosis of EC in Black women by interviewing 13 Black patients with EC, and 9 clinicians who are able to refer or diagnose these patients. I found determinants of patient-provider communication present at multiple levels with three prominent themes: use of social and professional networks to access care (patients) and provide referrals (clinicians), misunderstanding/disorientation of the EC diagnosis care sequence, and discomfort in engaging with white health care providers as a Black woman seeking care.Next, I examined and mapped the multi-level determinants of patient-provider communication contributing to timely EC diagnosis in Black women, to inform the development of a two-part system strengthening intervention prototype. Following the development of the intervention, a team of clinicians, patient advocate, and implementation scientist partners provided feedback on intervention functions, content, format, and delivery. Partner feedback facilitated adaptations of 4 evidenced based interventions by advising on core and peripheral functions. A resulting patient-facing and clinician-facing intervention was developed to include several evidence-based interventions responding to the determinants identified.Lastly, I evaluated useability of the patient-facing prototype of the system-strengthening intervention with Black women with EC. I gathered feedback from patient participants in three rounds with changes made to the prototype after each round. Key changes included modification of language in the intervention, discussion on core functions of the intervention, and format of delivery of intervention (e.g., online, in-person).Together, this study highlights the presence of determinants of patient-provider communication influencing timely EC diagnosis at multiple levels. Implications for practice and policy include dissemination of the prototypes through various mechanisms, adaptation of implementation strategies for varying context, clarification of provider roles in the EC diagnostic pathway in existing guidelines, and targeting coverage policies around diagnostic test and financial resources.