Quality Cancer Care Includes Recognizing Underrepresented Patients
For oncology nurses, quality cancer care isn’t just about individualizing care for your patients, following local and national guidelines to the letter, or educating patients and family members to get them through their cancer diagnosis. Those are critical components to great cancer care, but tangible and intangible elements impact oncology as well.
Underrepresented populations require support when seeking quality cancer care and face distinct challenges not seen in other groups in oncology. Recognizing, understanding, and including the nuances of underrepresented groups will only lead to better care for all patients, regardless of any other defining characteristics.
The question remains: what differentiates underrepresented populations from those that are underserved? Although the two groups may share some similarities, they have stark differences as well.
“Underserved populations can be anyone,” Maggie Smith, DNP, MSN/Ed, RN, OCN®, director-at-large on the ONS Board of Directors, said. “Things like race, cultural beliefs, religion, et cetera. Typically, these individuals don’t have access to certain resources that individuals in the general population would. Underrepresented populations are patients who fall into minority or overlooked groups. Although both groups are vulnerable, individuals in underrepresented populations may have the access to resources that underserved populations lack, but they don’t necessarily feel comfortable or accepted. They aren’t called upon to be represented in the general population, which can lead to feeling like outcasts in health care.”
Representation in Oncology and Beyond
Underrepresentation in medicine is an issue pervasive in all medical specialties, not just oncology. According to recent U.S. Census Bureau information (https://www.census.gov/quickfacts/fact/table/US/RHI325216#viewtop), the U.S. population is 17.8% Hispanic, 13.3% black or African American, 5.7% Asian, and 1.3% American Indian or Alaskan Native. However, only 9% of all physicians (https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2429534) were identified as underrepresented individuals in medicine.
In oncology, only 2.3% of practicing oncologists self-identified (https://www.asco.org/practice-guidelines/cancer-care-initiatives/diversity-oncology-initiative/facts-figures-diversity) as black or African American and only 5.8% self-identified as Hispanic. Clearly, workforce disparities continue to exist, and Smith—alongside oncology organizations like ONS and the American Society of Clinical Oncology (ASCO)—is working to bring attention to underrepresentation in oncology to help close the gap.
“I served on the ASCO Health Disparities Committee,” Maggie noted. “I helped them develop language and strategies so they could address underrepresented individuals in both the patient community and in oncology workforce recruitment. Through that work, I was able to bring some further insight to the ONS Board as we were discussing our position statement on Access to Quality Cancer Care.”
Adding New Language to ONS’s Statement on Access to Quality Cancer Care
At the October 2017 ONS Board of Directors meeting, Smith and her colleagues discussed adding new language to the ONS position statement on Access to Quality Cancer Care (https://www.ons.org/advocacy-policy/positions/policy/access) that included recognizing underrepresented populations. Rather than identifying specific patient populations that have been historically considered underrepresented, the decision was made to keep the terminology general.
The newly amended position statement reads, “All people should have access to comprehensive, affordable healthcare without discrimination, including populations who are at risk, vulnerable, underserved, or underrepresented.”
“Not calling out or identifying one group or another allows the position statement to cover everyone who falls into the category of underrepresented and underserved,” Smith says. “Though the two terms are not synonymous, they help to incorporate the entire gamut of the population—and because terminology changes all the time, it allows us to stay current.”
The Board’s October meeting produced changes to three other ONS position statements including Education of the Nurse Who Administers and Cares for the Individual Receiving Chemotherapy, Targeted Therapy, and Immunotherapy (https://www.ons.org/advocacy-policy/positions/education/chemotherapy-biotherapy), Cancer Pain Management (https://www.ons.org/advocacy-policy/positions/practice/pain-management), and Oncology Certification for Nurses (https://www.ons.org/advocacy-policy/positions/education/certification). The Board and ONS leadership will continue to revisit issues in oncology to provide the most current, up-to-date information and resources for members. The revised position statements can be found at the ONS website (https://www.ons.org/advocacy-policy/positions).