Patients with cancer often face barriers to optimal care, and Devon Check, PhD, a second-year Delivery Science Fellow in the Kaiser Permanente Division of Research, seeks to understand these hurdles inside and out.
“We know that gaps and disparities exist in cancer care delivery,” she says, “but rather than simply documenting or quantifying apparent gaps, how do we understand them well enough to be able to act upon them?”
Detailed data analysis is key. During her PhD work in health policy and management at the University of North Carolina (UNC) at Chapel Hill, Check analyzed vast sets of medical claims data to find gaps in cancer care quality, especially between black and white women. It was important work, but she knew she wasn’t getting the whole picture.
At Kaiser Permanente, Check has been able to access and analyze rich datasets, while learning how to effectively engage many stakeholders in a large healthcare system so that her research can help improve cancer care.
“Our program is one of few in the country that specifically focuses on delivery research embedded within a health care system,” says Richard W. Grant, MD, MPH, director of the Delivery Science Fellowship Program. “Dr. Check’s work is a shining example of what’s possible in this unique setting.”
Digging into disparities
Most recently, Check led an analysis of detailed data from the Pathways study, Kaiser Permanente’s long-term effort to track breast cancer outcomes for thousands of women (Pathways is a National Cancer Institute-funded study led by Lawrence Kushi, ScD, at the Division of Research). Her team found that patients who are racial/ethnic minorities, including black, Hispanic and Asian patients, were more likely than white patients to report a high burden of side effects during treatment.
Check presented her new findings last weekend at the 2017 Palliative and Supportive Care in Oncology Symposium in San Diego, Calif. Her attendance there was supported by a Merit Award presented by the Conquer Cancer Foundation of the American Society of Clinical Oncology (ASCO).
The analysis also examined quality of communication between patients and their doctors, as rated by the patients. “Interestingly, Asian women were consistently the most likely of all racial/ethnic groups to rate communication with their providers unfavorably,” Check says.
For Asian women, worse communication with doctors appeared to somewhat explain side effect disparities. This suggests that better, more culturally sensitive communication strategies may help to address side effect disparities for this group. However, such a link was not found for other racial groups, hinting that other factors are in play.
“We want to look at additional modifiable factors captured in the Pathways study that are potentially linked with side effect disparities, to help inform future interventions,” Check says. “These include social support and health literacy, for example.”
Check’s collaborators on the project were Isaac J. Ergas, MPH, Janise M. Roh, MPH, MSW, Lawrence Kushi, ScD, and Marilyn L. Kwan, PhD, of the Kaiser Permanente Northern California Division of Research; Tatjana Kolevska, MD, of the Kaiser Permanente Northern California Vallejo Medical Center, and Neetu Chawla, PhD, MPH, of the Veterans Affairs Greater Los Angeles Healthcare System.
Laying foundations for a meaningful career
While cancer care delivery is Check’s current focus, it has not always been on her radar. As an undergraduate at the University of Virginia (UVA), she majored in history and Spanish.
“In my last year at UVA, I started taking some health policy classes and became very interested in health services research,” Check says. Fueled by her new interest, she began working as a research assistant at Duke Clinical Research Institute and went on to earn her PhD in Health Policy and Management at UNC.
Around the time she started her PhD work in 2012, ASCO published a new guideline recommending that people with advanced cancer receive palliative care early in the treatment process—not just as an end-of-life measure. Since then, Check has been interested in understanding barriers to implementing early palliative care.
“I’m now partnering with both operations and clinical leaders at Kaiser Permanente to understand what implementation of that guideline looks like in our system,” she says. “We’re hoping to identify specific patient, provider, or facility-level factors associated with increased or decreased use that can help inform best practices.”
While she pursues this research, Check is also planning the next steps in her career. After her two-year Fellowship ends, she hopes to land a position that will enable her to continue conducting research in an applied setting, where she can “answer relevant questions in an impactful way.”