eP282 - A Conceptual Framework for Exploring Racial and Ethnic Disparities in Colorectal Cancer Care and Clinical Outcomes

Purpose/Background: Despite ongoing efforts to improve health equity, racial and ethnic disparities remain in both treatment and clinical outcomes for patients with colorectal cancer. Current efforts to close these gaps are limited by a lack of high-quality data and an incomplete understanding of the underlying mechanisms involved. Our aim was to develop a conceptual framework for exploring racial and ethnic disparities in care and clinical outcomes for colorectal cancer patients with a focus on identifying potential causal pathways. In addition, we sought to test the practicality of this framework for evaluating available data on health inequities by using it to conduct a systematic review.Methods/Interventions: We began by identifying established models for healthcare utilization, shared decision-making, and health equity in cancer care. Next, we convened a working group of health disparities researchers and colorectal surgeons to review the identified models and iteratively adapt them to better reflect the real-world care of colorectal cancer. Domains of our working framework were evaluated based on their content validity, ability to capture diverse elements of social and cultural context, and potential as targets for intervention. After refining our model, we assessed its functionality by using it to guide a systematic review. We searched PubMed for articles that either reported the prevalence of racial and ethnic disparities or data related to potential underlying mechanisms. Findings were classified based on our conceptual framework. We plan to use meta-regression to generate pooled estimates of specific disparities in care or clinical outcome. Given the expected heterogeneity, we will also perform a narrative synthesis of data regarding potential mechanisms.Results/Outcomes: After reviewing multiple prior works as a group, we selected a model on shared decision-making in cancer care from Mead et al. 2013 as the basis of our framework. Based on feedback from our team, we made four significant adaptations (Figure). First, we simplified the community by focusing on two sub-domains: the patient and other important people who may influence the patient’s decisions. Second, we placed the healthcare provider within the greater context of the health system. Third, we identified the clinical encounter as the site at which contextual and individual influences intersect with a direct effect on treatment decisions. Fourth, we identified two groups of intermediate outcomes (utilization of care and quality of care) along the causal pathway toward eventual outcomes of colorectal cancer. Using our framework as a guide, we searched PubMed for articles that would inform our domains. Our initial search yielded 1,763 titles that are currently being screened for inclusion.Conclusion/

Discussion: Our conceptual model provides a practical framework for exploring racial and ethnic disparities in colorectal cancer care and clinical outcomes based on their potential mechanisms. Our long-term goal is to use our framework to promote more effective research into racial and ethnic disparities in care and, eventually, to develop targeted interventions to improve health equity.Figure. Conceptual Framework for Exploring Racial and Ethnic Disparities in Care and Clinical Outcomes of Colorectal Cancer.This framework summarizes the prevalent themes and potential underlying mechanisms that is the basis for our systematic review.