Improving virtual cancer care for older Black adults: A qualitative study (Preprint)

BACKGROUND Health systems are rapidly promoting virtual cancer care models to improve cancer care of their populations. However, virtual cancer care can exacerbate inequities in cancer care for communities experiencing social disadvantaged. Older Black cancer patients face unique challenges to accessing and utilizing virtual cancer care. OBJECTIVE This study focused on understanding the virtual cancer care experience of older Black patients, their caregivers and healthcare providers to identify strategies that can better support patient-centered virtual cancer care. METHODS A theory-informed thematic analysis was conducted using data collected from six focus groups (N = 55 participants) conducted across ten Canadian provinces. Data coding and thematic analysis was informed by the Patient Centered Care model and the synergies of oppression conceptual lens. RESULTS Five overarching themes describe the experience of older Black patients, caregivers and health care providers in accessing and utilizing virtual cancer care: i) heightened inequities at the intersection of multiple systems of oppression; ii) shifting caregivers’ dynamics; iii) autonomy of choice and choosing based on the purpose of care; iv) digital accessibility and v) effective digital communication. We identify eight barriers and six facilitators to optimal virtual cancer for older Black adults. Barriers include limited digital literacy, linguistic barriers in traditional African/Caribbean languages, and culturally mediated views of patients; and facilitators include community-based cancer support groups, caregivers support and key features of digital technologies. CONCLUSIONS A multipronged approach that simultaneously focuses on addressing barriers and leveraging community strengths can improve access and utilization of virtual cancer care. A redesign of virtual cancer care programs, tailored to the needs of most structurally marginalized groups like older Black adults can enhance the virtual care experience for all population groups. Public policies and organizational practices that address issues like availability of internet in remote areas, resources to support linguistic barriers or culturally sensitive training are important in responding to the complexity of access to virtual cancer care. These findings have implications for other structurally marginalized and underserved communities that have suboptimal access and utilization of virtual care. CLINICALTRIAL N/A