Facilitating equity-oriented cancer care in organizations delivering cancer services: insights from a qualitative...

People experiencing structural marginalization often have advanced cancer diagnoses and higher cancer-related mortality resulting, in part, from poor access to care. A key pathway to addressing health outcome disparities includes integrating equity-oriented approaches to cancer care (EOCC). Implementing equity-oriented approaches can help address access to care and quality of care gaps, however little is known about the organizational factors required to support the delivery of EOCC; our study addressed this gap.

We employed a critical ethnographic approach, guided by critical and intersectional theories, and participatory knowledge translation approaches. We conducted interviews with health and social service providers and key informants, observations of service providers in oncology settings, and interviews and focus groups with people experiencing structural marginalization. Data analysis followed an interpretive descriptive approach, informed by critical ethnographic methodology and critical and intersectional theories.

Our findings point to three dynamic and intertwined dimensions within organizations delivering cancer services that support an equity-oriented approach to care. First, identifying core values for creating an equity-oriented culture included values of relationality, cultural safety, adaptability, and trust-building as foundational for EOCC. Second, building a shared commitment to EOCC meant dedicated resources and investments, such as time, money, leadership, and partnerships. Finally, taking action towards EOCC underscores the importance of accountability and highlights tangible strategies for organizations to enact EOCC.

Cancer care organizations are increasingly recognized as critical sites for advancing health equity. Our findings highlight the important role of shared organizational values and formalized commitments to equity, providing direction for integrating EOCC at the organizational level. Findings also emphasize the importance of attending to organizational contexts as key in supporting clinicians to provide tailored, person-centred, and culturally safer care.