Roshan Bastani

Background: Systematic collection of patient-reported outcomes via electronic health records can improve symptom assessment and supportive care delivery in oncology, yet implementation is often hindered by inadequate attention to end-user needs and organizational context. Guided by an implementation science framework, we conducted a formative evaluation to inform design and implementation planning of an electronic patient-reported outcome supportive care screening system in ambulatory oncology care, using head and neck cancer as a use case. Methods: A prospective mixed-methods observational study was conducted using semi-structured interviews as part of a pre-implementation formative evaluation. Eligible participants were target users of the proposed supportive care screening system, including (1) clinical staff and (2) patients with head and neck cancer from a single health care system. Using the Consolidated Framework for Implementation Research as a guiding framework, we elicited user feedback through interview and prototype engagement. Quantitative measures included patient symptom burden and validated pre-implementation measures of acceptability, appropriateness, feasibility, and usability. For data analyses, we used directed content analysis and matrix analysis for qualitative data, and descriptive and comparative statistics for quantitative assessments. Results: Forty-six target users (20 clinical staff, 26 patients) participated. Both groups expressed strong tension for change, recognizing many inadequacies of the current approach to symptom assessment. Clinical staff described current practices as “haphazard,” while patients recounted missed opportunities for support and preventable harm. Electronic health record integration enhanced perceived compatibility, though time constraints and alert fatigue emerged as potential barriers. Clinical staff emphasized the need for clear symptom thresholds and actionable referral criteria; patients emphasized that their sustained engagement depended on evidence of clinicians using the data in their care. Pre-implementation scores indicated strong readiness across both groups: acceptability (clinical staff 4.47/5, patients 4.21/5), appropriateness (4.46/5, 4.24/5), feasibility (4.41/5, 4.35/5), and usability (82.2/100, 85.6/100). Findings informed key design priorities and implementation strategies. Conclusions: Systematic pre-implementation formative evaluation revealed important barriers, facilitators, and contextual insights that shaped both intervention design and implementation approach. High scores on leading indicators suggest strong organizational readiness and perceived value. This user-informed development process provides a replicable model for optimizing electronic patient-reported outcome systems before deployment.

The unique culture and languages of Indigenous Mexican immigrants to the United States, a substantial portion of the nation’s agricultural workforce, has limited participation of this population in tobacco and other health related research. Our established community-academic team [Mixteco Indigena Community Organizing Project (MICOP) and UCLA] developed and conducted a community survey ( n = 200) from February – October 2024, in Spanish ( n = 145), English ( n = 10) or Mixteco ( n = 45), aimed to understand tobacco use and knowledge among adults in this population. Participants (mean age 26 years; 71% married; 48% female; 43% ≤ elementary education) reported considerable tobacco use and second-hand exposure. Results illustrate gaps in knowledge regarding tobacco’s health harms and limited experience with tobacco prevention or control programming. Our findings suggest that prevention programs may provide greatest benefits for recent immigrants who rely exclusively on their native Indigenous language, and that cessation resources may be most needed by community members who have been in the US longer, have some Spanish proficiency and greater exposure to industry marketing. This work adds to the limited literature regarding this marginalized population’s health needs and will serve as a guide for our ongoing community-academic efforts to develop, implement, evaluate and disseminate culturally and linguistically tailored tobacco prevention and control programming for the Indigenous Mexican agricultural worker community in California and beyond.

Cox model stratified by ‘Treatment Site’, three category model

Specified rates of misdiagnosis given to patients with gastric adenocarcinoma

Comparison of the Kaplan Meier curves for overall survival and disease specific survival for patients with gastric adenocarcinoma.

Cox model stratified by ‘Misdiagnosed’

Definitions of study variables

Background:Various population-based studies have shown Hispanic/Latino ethnicity is a risk factor for worse survival in patients with gastric cancer linked to disparate access to care. We aimed to address whether Hispanic patients treated within safety-net hospital systems continue to experience this survival deficit compared to non-Hispanic patients.Methods:We performed a retrospective cohort study comparing survival between Hispanic and non-Hispanic patients diagnosed with gastric adenocarcinoma between January 1, 2016, and December 31, 2020, within Los Angeles County’s safety-net hospital system. Gastric cancer–specific survival was compared between the two cohorts using the Kaplan–Meier estimate and Cox proportional-hazards regression model.Results:In total, 448 patients who received care from five medical centers were included; 348 (77.7%) patients self-identified as Hispanic and 100 (22.3%) as non-Hispanic. Mean follow-up time was 2.0 years (median 0.91 years, IQR, 0.34–2.5 years). Hispanic patients were found to be diagnosed at a younger age (55.6 vs. 60.7 years, P < 0.01), demonstrate higher state area deprivation index (6.4 vs. 5.0, P < 0.01), and present with metastatic disease (59.8% vs. 45%, P = 0.04). After adjusting social and oncologic variables, Hispanic ethnicity remained an independent risk factor for worse survival [HR 1.56, (95% CI, 1.06–2.28); P = 0.02].Conclusions:Hispanic patients treated within a large, multicenter safety-net hospital system experience worse survival compared to non-Hispanic patients. This suggests ethnic disparities exist within safety-net hospital systems, independent of known clinicopathologic factors.Impact:Improving outcomes for Hispanic patients with gastric cancer requires future efforts aimed at defining and addressing these unidentified barriers to care.See related In the Spotlight, p. 12