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Beyond the patient: how providers perceive and experience non-medical barriers in gastrointestinal cancer care
Trisha Lal1,2, Daria Moody2, Rishi Chiratanagandla2
1Division of Surgical Oncology, University Hospitals, Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
Purpose:
Gastrointestinal (GI) cancer care requires coordination across specialties and is sensitive to non-medical barriers like insurance, transportation, and health literacy. Prior survey work at our institution identified these barriers as most prominent during initial treatment planning and as consuming substantial provider time. This qualitative study represents the second phase of a larger effort to inform the development of a transdisciplinary care model designed to address non-medical determinants of care.
Methods:
We conducted semi-structured interviews with purposively sampled multidisciplinary providers involved in GI cancer care at a large academic health system in the USA. Interviews explored patient- and system-level barriers and opportunities to improve care coordination. Transcripts underwent inductive thematic analysis with double coding. Pearson correlation coefficients assessed covariation among themes and informed the construction of a directed acyclic graph illustrating hypothesized causal relationships among barrier domains.
Results:
We interviewed 30 providers, including physicians (n = 7), advanced practice providers (n = 2), nurses (n = 5), dietitians (n = 7), social workers (n = 6), and a care coordinator (n = 1). Seven interconnected themes emerged: health system, financial, access and logistics, provider capacity, patient knowledge and engagement, social and emotional, and communication and coordination. Structural and financial barriers operated as upstream drivers influencing workflow and access, while logistical and social barriers translated these pressures into downstream inefficiencies and provider strain. Providers consistently supported a transdisciplinary care model to centralize navigation and support.
Conclusion:
Non-medical barriers in GI cancer care undermine patient care, provider capacity, and health system efficiency. These findings provide an actionable framework for developing equitable, efficient, and sustainable cancer care models.
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