EP1061 - A Qualitative Review of Barriers to Optimal Colorectal Cancer Surgical Care in a Diverse Urban Community.

Purpose/Background: Disparities in colorectal cancer outcomes are driven by patient, provider, and system-level barriers that disproportionately affect patient minorities and socioeconomically vulnerable populations. Currently, large databases do not capture barriers from the patient and provider perspectives. Using qualitative interviews and focus groups, this study aims to more comprehensively identify perioperative barriers that may impact colorectal surgery outcomes.

Methods/Interventions: We conducted semi-structured interviews with five patients and focus groups with eight providers, including social workers, patient navigators, nurses, and physician assistants. Participants were recruited from NewYork-Presbyterian Queens. Patients were adults (>18 years old) who had undergone oncologic resection for colorectal cancer within 5 years. Interviews and focus groups sessions were recorded and transcribed. Transcripts were analyzed using an inductive thematic and content approach. This study was approved by NYPQ’s Institutional Review Board and supported by the Center for Social Capital (SoCa) funded by the National Cancer Institute.

Results/Outcomes: Stakeholders (n=8) identified the most prominent barriers were as: care coordination and system navigation, health literacy and understanding of illness, patient education methods and communication styles, medication adherence and preoperative instructions, presence of protective factors (such as language-concordance, cultural concordance), financial and insurance barriers, patient anxiety/fear/emotional reactions, and gaps in community and social resources such as support groups. Patients (n=5) described several facilitators to care, including high prevalence of health literacy and active information seeking, trust in their medical team and communication, effective preoperative education and surgical preparation and strong caregiver and family support. Additional facilitators included the use of technology and AI to better understand their diagnosis and treatment, as well as reliance on spirituality to cope with the process. Patients also noted several barriers, such as emotional and mental burden of diagnosis and treatment, and insufficient education on continuity of care after surgery, particularly in areas such as ostomy and bowel management, as well as nutrition and dietary guidance.

Conclusion/Discussion: Colorectal cancer patients and stakeholders identified many modifiable barriers, including the need for continuity of care, postoperative education, and psychosocial resources such as peer support groups and mental health services. Notably, perceptions of health literacy differed between stakeholders who viewed patients as having limited understanding of their diagnosis and treatment, and patients who described themselves as active information seekers who understood their care instructions and were engaged in preparation. Further studies are needed to better understand this observed disconnect. Our findings will inform future tailored programs which will focus on psychosocial needs, optimizing patient education, and enhancing continuity of care to improve preoperative preparedness and postoperative outcomes.