Abstract A029: Multilevel barriers and facilitators to gynecologic oncology care: A stakeholder analysis

Abstract Introduction: Disparities in oncology care exist that disproportionately impact Black Americans. Incidence and mortality rates of endometrial cancer are highest in the nation’s capital, with 30.1 new cases and 10.2 deaths (per 100,000), compared to 27.4 new cases and 5.1 deaths (per 100,000). Patient navigation is an evidence-based intervention that can address disparities across the care continuum, yet its’ application to endometrial cancer has not been widely seen or implemented. The goal of this study was to identify addressable barriers and facilitators to timely diagnosis and management of endometrial cancer among a sample of stakeholders. Methods: We employed a qualitative design, using semi-structured interviews to identify barriers and facilitators to care among a sample of stakeholders (N = 23). An initial list of stakeholders was generated by the last author. Study invitations were sent via email, and consent procedures were completed via Docusign. Interviews were conducted via audiovisual web conferencing platform and lasted one hour. Interview domains included: multi-level barriers and facilitators to timely diagnosis and management of endometrial cancer. Participants were compensated for interview completion. Interviews were transcribed verbatim by audiovisual platform transcription feature and cleaned by trained research assistants. A preliminary coding structure was developed a priori using the NIMHD Research Framework and the Social Ecological Model. The coding structure was revised iteratively during data analysis process. Two trained coders achieved acceptable intercoder agreement (Cohen’s Kappa = .60). Transcripts were thematically analyzed by identifying thought units and inductively categorizing units into a relevant code. Code frequencies were observed to develop code summaries. Higher order themes were developed by assessing similarities and distinctions across code summaries. Thematic analysis was supported by Dedoose Qualitative Software. Results: Participants were physicians (n = 3), advanced care providers (n = 2), patient navigators (n =10), office staff (n = 2), patients/caregivers (n = 3), and other (n = 3), which represented 7 different healthcare/health-adjacent organizations. Participants noted several barriers including: bureaucratic procedures and complicated referral systems (hospital); limited focus on social determinants of health amongst providers, suboptimal patient-provider relationships (provider), knowledge, and transportation (patient). Facilitators included: Community partnerships and collaborative care (hospital); diverse workforce (provider); and social support, and health literacy (patient). Conclusion: Stakeholders involved in endometrial cancer detection report several systemic, provider, and patient level barriers to care that can be addressed with a patient navigator program. Meaningful health navigator program development has the potential to streamline care for patients affected by endometrial cancer. Citation Format: Danyel I . Smith, Melissa Wu, Madeline Karsten, Lucile Adams-Campbell, Charlotte Gamble. Multilevel barriers and facilitators to gynecologic oncology care: A stakeholder analysis [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr A029.