A Navigator-Delivered Model to Enhance Early Palliative Care Access for Women of Color with Advanced Breast Cancer.

1. Identify key barriers and facilitators of early palliative care access for women of color with advanced breast cancer. 2. Identify at least one important element a social and culturally sensitive early palliative care model should include. The goal of this study is to develop a socio-culturally sensitive, community-based, early palliative care intervention to mitigate disparities in distress and symptom burden and improve early palliative care access for Black and Latina women with advanced breast cancer. The resulting intervention - 'ACCESS' - will be evaluated for preliminary impact through an upcoming pilot randomized controlled trial. Black and Latina women with advanced breast cancer (ABC) experience more severe distress and report more significant barriers in palliative care (PC) access relative to non-Latina, White women. Patient-centric care models are needed to address and mitigate these disparities in PC access and outcomes. One-on-one interviews evaluating a) early PC experiences and b) perspectives on a navigator delivered PC model were conducted with Black and Latina women with ABC (N=30), their care partners (N=10), and interdisciplinary providers (N=20). Participants were recruited from urban PC and oncology clinics, federally qualified health centers, and community organizations. Utilizing inductive coding and thematic analysis, transcripts were reviewed and analyzed by an interdisciplinary team of investigators. Member checking was conducted by community scientists and community advisory board members. Barriers and facilitators of PC access were first identified. Barriers included a) inadequate communication between oncology, PC, and primary care teams, b) PC stigma among patients and non-PC providers, c) health literacy learning curves, and d) structural racism, including implicit bias and lack of diverse racial/ethnic representation in the supportive care workforce. Facilitators included a) patient-to-patient referrals, b) support groups breaking cultural stigma, c) referrals from trusted providers, and d) community organization's abilities to overcome challenges related to social determinants of health. These findings, in addition to participant feedback on the intervention outline, were utilized to develop the final version of ACCESS – a culturally and linguistically concordant navigator led intervention that will address social determinants of health, provide tailored psycho-educational discussions of PC, and conduct linkage to community and clinical resources. These formative evaluations led to the development of ACCESS – a socio-culturally sensitive, community-based, early palliative care intervention, which will be evaluated for preliminary impact on PC utilization and distress through an upcoming pilot randomized controlled trial. Diversity, Equity, Inclusion, Belonging, Justice / Models of Palliative Care Delivery [ABSTRACT FROM AUTHOR]