Addressing Health Disparities

Now more than ever, we are being made aware of our country’s health disparities. An individual’s health could be at risk because of where they live, lack of insurance, inability to communicate in English, fear of test results, unawareness of warning signs and behavior factors that contribute to cancer, unemployment, and more.

If your healthcare facility’s area conducts a tri-annual community needs assessment, you can take advantage of that opportunity to directly learn and understand what the pitfalls are in your geographic region. It is also a great way to assess residents living in rural areas, far away from treatment centers, and what their cancer statistics look like.

As members of the multidisciplinary care team, we, oncology nurse and patient navigators, must undo the myths and instill the facts. Inequities don’t go away after attending one health fair; this requires meeting consumers in their own geographic location where they live, work, worship, or have children in school. It requires repetition. Saying it once won’t result in a flood of people calling to get on the mammogram schedule or get a colonoscopy.

Remember that your baseline information from the community needs assessment informs you how things look now, and your team needs to determine an action plan to improve these statistics over time. The goal is reducing mortality from cancer, getting patients in for screenings so cancer can be identified early which usually results in higher survival rates, promote adherence to treatments, create partnerships with community organizations to create these goals as shared goals, and measure the results over time.

We continue to deal with unconscious bias and this must stop. Oncology navigators should never make assumptions about someone’s personal situation as to why they haven’t gotten in for screening or treatment. I hope that your healthcare facility is taking extra steps to require learning modules be completed by all employees related to unconscious bias so we can break this habit, whether thought of consciously or unconsciously.

For example, I learned a great lesson at the age of 17, soon after I started nursing school. I was rotating for 3 months in the ER and saw all the usual things that roll through the ER doors—from auto accidents to MIs, broken bones, high fevers, lacerations, and some incredibly odd ones (like when a naked man came in wrapped up in a blanket in terrible pain, escorted by his very angry wife who was carrying their vacuum cleaner. You can probably guess the rest of that story)! When it was time for me to begin my rotation on the night shift, I saw different types of ER visitors—accidental drug overdoses, and attempted suicides.

One night, at 12:30 am, a 17-year-old girl was brought in for an attempted suicide on the night the junior prom was held. She was still in her evening gown, accompanied by her parents, who prayed she could be saved. The usual steps were taken to rid her of the overdose of narcotics. She had a handwritten note safety-pinned to the front of her dress that said she didn’t want to live anymore because no boys like her the way they liked other girls in her school. The note said she was a failure at everything and didn’t want to live anymore.

Once we knew she was going to survive, a seasoned nurse and myself were given the task to get her out of her evening gown and into a hospital gown. She was to spend the night and be seen by psychosocial work in the morning. The seasoned nurse was quite out of sorts. The patient was still unconscious at this point when they nurse said, “I wish if these young girls were going to try to take their life they would do it right and not leave us with their mess to clean up.” I said nothing in response. One month later, on my last night shift in the ER, I saw this young girl again being brought in followed by their hysterical parents. She died from an overdose. Again, there was a note safety-pinned to her t-shirt. The note was quite different than the one she left for us to read before. The note said, “This time I did it right.”

The seasoned nurse who had made the inappropriate statements a month ago was not on duty that night, but I conveyed to the charge nurse what had happened 4 weeks ago and what had happened tonight. I never saw that nurse again. I have not and never will forget that 17-year-old girl. The seasoned nurse had a personal opinion about kids that try to overdose and felt it was just a way to get attention and nothing more than that. She was very wrong.

Health disparities come in all shapes and sizes. It is part of our job as oncology nurse and patient navigators to look beyond ourselves and figure out how to reverse what is causing them. We must partner with organizations that residents in the community trust, and develop strategies that enable these partnerships to create shared goals. What you can accomplish when passion and purpose come together is always amazing.

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