INTRODUCTION: Minority patients requiring a complex surgical procedure (CSP) experience disparities throughout their continuum of care. These disparities contribute to worse outcomes after surgery when compared to non-Hispanic white patients. The objective of this study was to identify modifiable barriers to care experienced by minority patients who require a complex surgical procedure.

METHODS: A convergent mixed-methods prospective study began in June 2021. Patients requiring an abdominal transplant or the diagnosis of a hepatic, pancreatic, biliary, or thoracic malignancy requiring resection were enrolled. Qualitative semi-structured interviews and quantitative survey instruments were utilized to investigate the patient-experience and identify physician-based modifiable barriers to care. Factors investigated included the disease process, hurdles or barriers experienced, physician interactions, the decision-making process, and the role of gender, ethnicity, and race in their care. Iterative thematic assessment was performed after data collection.

RESULTS: Fourteen patients, 8 (57%) male and 6 (43%) female, were enrolled during the study period with a median age of 58 (IQR=15). Eight (57%) patients identified as black and 6 (43%) identified as white. Eight (57%) patients presented with end stage renal disease (ESRD) and 6 (43%) with thoracic malignancies. Socioeconomic data collected from the social needs survey is shown in Table 1. Five (35.7%) patients were identified as low income and housing instability was observed in 20% of patients. Two (14.3%) patients reported that their race played a role in the medical care they received. The semi-structured interview revealed the following themes as potentially modifiable barriers to care: difficulties with scheduling, lack of reliable transportation, insufficient medical communication, and the need for a reliable support system. In the ESRD population, there was also a perceived loss of autonomy in disease management and treatment decision-making.

CONCLUSIONS: Our findings suggest that modifiable barriers to care exist in minority patient populations requiring a complex surgical procedure. Further work investigating and testing interventions is warranted to improve outcomes in this population.

Contact Information: Azante Griffith, griffaz@mail.uc.edu, 913-626-6354

Key Words/Tags: Surgery, Malignancy, Transplant, Barriers, Modifiable