Strategies for Expanding Access
Today, Dana-Farber is working with community advocacy groups and implementing internal department strategies to address these inequities that have only been further illuminated by COVID-19.
Expanding access to patients within historically marginalized groups, and providing them with resources they need, is the main goal for Contreras's team. A new pilot program called Patient Navigation, part of the Cancer Care Equity Program,
aims to proactively engage vulnerable patients across Institute sites at the point of cancer detection and screening — eliminating barriers that might slow down care. This pilot program launched in October 2021 in the gastrointestinal treatment centers
at two Dana-Farber locations.
"The Institute has had a patient navigator program for more than two decades," Contreras says. "Building on that foundation, we've been
able to develop a program to specifically address the needs of marginalized patients and patients with other access barriers. We want marginalized people to have the same positive outcomes that many of our patients at Dana-Farber experience."
As part of this pilot, Dana-Farber patient navigators call new patients before their first appointment to complete an assessment in order to understand any barriers that patient may be facing, particularly those that would prevent them from attending
that initial appointment. During the phone call, patients can ask questions about their upcoming appointment, and the navigator can begin connecting them with relevant Dana-Farber services. That might include resource specialists who can help find
accommodation and transportation for the patient, as well as social workers who can provide clinical psychosocial assessments for patients and loved ones. A patient that may have a history of alcohol or drug abuse, for example, may be put in touch
with a member of Dana-Farber's social work team, who can assist in monitoring their needs.
Persons in Massachusetts looking to come to Dana-Farber without insurance are also connected to the financial team to coordinate enrollment in MassHealth, the state's Medicaid program. Other resources include interpreter ambassadors.
Patient navigators will also meet patients at Dana-Farber for their first appointments to serve as a guide before, during, and especially after their consultation.
"Ideally, they will be there to help make sure that there is open communication between the care team and the patient," Contreras explains. "This will help to ensure that patients not only begin their care here, but also that they won't fall through the
cracks and be lost to follow-up."
Using Legislative Advocacy
Kate Audette, MSW, MBA
Through work led by Kate Audette, MSW, MBA, director of the Government Affairs program, Dana-Farber is also committed to making change through legislative action.
When she joined the team in 2019, one of Audette's first priorities was making telehealth (virtual) appointments available to residents of Massachusetts. Before then, telehealth appointments were not allowed in the state of Massachusetts. Advocates like
Audette sought to change that.
"Everything that I do takes on an equity lens," Audette says. "Telehealth is an important tool to drive equity in healthcare access. For example, it improves access to care for hourly wage workers, who might normally forgo care due to an inability to
take the time off work, or time away from their family to be able to commute to an in-person appointment," Audette said. "That is not even to mention that scenario that we are facing today with the pandemic which required innovation solutions to addressing
healthcare access for everyone."
Setting a legislative agenda in 2019 that was centered on equity meant that Audette was prepared to advocate for policy solutions that addressed the longstanding inequities that were exacerbated by the pandemic, like promoting housing stability by ensuring
that Massachusetts residents had access to legal counsel when facing eviction.
"If our patients are unhoused, how can we expect them to come to appointments?" Audette notes. "Landlords almost always have a lawyer during the eviction process, and many tenants simply can't afford legal representation. Since the onset of COVID-19,
longstanding economic inequities have been exacerbated which has resulted in greater rates of housing instability, especially in BIPOC communities across the Commonwealth We can alleviate that by making sure tenants facing eviction have a right to
People who are unhoused, or face housing insecurity, experience high levels of economic and emotional stress. Cancer outcomes can be significantly harmed as a result: Multiples studies conducted under the direction of Dana-Farber pediatric physician and researcher Kira Bona, MD, MPH, have shown that exposure to material economic hardship can significantly affect outcomes for children with cancer
even when they receive care at large academic facilities like Dana-Farber.
Dana-Farber's Legislative Action Network (LAN) is a grassroots community of volunteer advocates working to advance equity-focused policy solutions. In addition to advocating for
improved access to care and social determinants of health, the LAN advocates for improved cancer prevention and early detection, strengthening funding for cancer research, and eliminating disparities in cancer care and clinical trials.
Investing in Communities
Dana-Farber's Community Health and Benefits program has used its analyses to invest in areas of Boston hit hardest by health inequities. In November 2021, Dana-Farber committed $4 million to support long-lasting community health improvement and help make existing health and support services more accessible.
It also provided grants to 12 community organizations, such as GreenRoots, which is measuring air quality in Chelsea and East Boston to attempt to address air pollution, and FamilyAid Boston, which supports families and children facing homelessness.
"Funding these innovative projects in Greater Boston is consistent with our mission, as Dana-Farber seeks to address the root causes of cancer and other chronic conditions, while helping to advance health equity," Contreras notes. "By partnering with
local community organizations and working upstream together, we will increase access to services and create the conditions that promote health for everyone.
"We have a unique understanding of how individuals and communities are affected by healthcare," she says. "Our goal is not only to improve care for the individual patient, but also for the greater society."