Purpose: The purpose of this quality improvement project was to determine barriers to cancer care in an urban, largely African-American veteran sample at the Washington DC Veterans Affairs Medical Center (DCVA). The DCVA veteran population has several characteristics associated with challenges in accessing cancer care, including a large African-American population and patients with mental health diagnoses.
Methods: Veterans completed an anonymous survey assess barriers to care as part of a larger survey examining veteran needs in cancer care. Descriptive statistics were conducted on the current responders (n = 128) with an ongoing recruitment goal of 150 survey completers.
Results indicated both logistical and psychosocial barriers, with trouble with transportation or parking (32%) and nancial dif culties (20%) most frequently reported. Nearly half of the sample (45%, n = 55) reported having a psychiatric or mental health diagnosis. A signi cant percentage of this subsample reported that their mental health symptoms caused them to avoid or delay cancer screening (18%), stop cancer treatment (13%), or delay follow-up visits after nishing cancer treatment (17%). Moreover, 62% of this sub-sample stated their mental health symptoms were worsened by their cancer care. The most common reported exacerbators were undergoing imaging (eg, MRI or PET scan) (35%), radiation therapy (33%), and attending follow-up visits (33%).
Conclusion: Logistical barriers are currently being addressed through expanding provider knowledge of transportation resources and opening of an expanded parking garage. Findings of transportation and parking barriers likely reflect specific construction projects at the DCVA and may not be generalizable to other settings. Further quality improvement work based on the results of this project include incorporating screening for mental health diagnoses and targeted interventions for patients identifying concerns related to mental health symptom stressors with the goal of increasing timeliness of care.
