Department of Population and Public Health Sciences at Keck School of Medicine of USC lockup

Cancer Care Equity Lab

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Current Projects

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Advancing the Implementation of Evidence-Based Strategies for HPV Vaccination in Safety-Net Primary Care Settings

This four-year National Cancer Institute funded study (NCI/NIH R37 CA242541; PI Tsui) aims to identify and understand multilevel factors at the provider, clinic, and system levels that impact the implementation of evidence-based strategies (EBS) to improve adolescent HPV vaccination in safety-net settings. Through qualitative interviews, we identify how diverse clinic and community partners in Los Angeles and New Jersey view and prioritize EBS for safety-net settings serving medically underserved and marginalized communities and examine how local policies and recent pandemic disruptions have impacted feasibility and innovations in EBS. In the current phase of the study, we are conducting an implementation of EBS in partnership within a large multi-site FQHC system in Los Angeles to understand factors that impact adoption and adaptation requirements. Findings from this mixed methods study will enhance understanding of the relationship of primary care context and local capacity to adopt, implement, and sustain evidence-based strategies for HPV vaccination among adults.

HPV prevention starts at age 9
Infographic from The HPV Vaccination Roundtable
speaker gives a talk
Dr. Sam Garcia conducting a staff training at an FQHC site on HPV vaccination
researcher presents poster at poster session
Dr. Michelle Shin presenting findings from our R37 project at the Annual Conference on the Science of Dissemination and Implementation, co-hosted by the NIH and AcademyHealth
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Assessing Cervical Cancer Healthcare Inequities in Diverse Populations: The ACHIEVE Study

This ACHIEVE Study, a five-year National Institute of Minority Health and Health Disparities funded study (NIH/NIMHD R01 MD018250; MPI Llanos/Tsui) is a multi-site project based at USC and Columbia University, and seeks to examine upstream indicators of structural racism as contributors to inequities in receipt of guideline-concordant cervical cancer treatment and survival in a diverse population-based study. Guided by the NIMHD research framework and socio-structural models, this mixed-methods study will leverage two NCI population-based Surveillance, Epidemiology, and End Results Program registries (New Jersey State Cancer Registry and Los Angeles Cancer Surveillance Program), to prospectively examine the impact of micro- mezzo-, and macro-level factors on receipt of guideline concordant treatment for and survival from cervical cancer. The goal is to identify intervention strategies that address social and structural patient risks, and health system level factors to improve the delivery of equitable cancer care. The goal of the study is to develop actionable system-level practice and policy change to address the persistent cervical cancer inequities among marginalized groups. To learn more, visit our project website at www.theachievestudy.org.

Photo of a group of smiling people in front of a presentation screening with Zoom attendees at the ACHIEVE Study's 2024 Annual Research Retreat
The ACHIEVE Study held their 2024 Annual Research Retreat at USC Norris Comprehensive Cancer Center

Evaluation of the DHS Cancer Navigation Program to Inform Scale-up and Long-term Sustainability

This two-year Southern California Clinical and Translational Science Institute (PI Tsui) funded study aims to evaluate and inform the optimization and long-term sustainability of the Department of Health Services (DHS) Cancer Navigation Program. Collaborating with DHS staff, we will use quantitative electronic health record data to evaluate the effectiveness of the Cancer Navigation Program on improving cancer care, access, quality, equity, and patient experience among DHS patients. Through qualitative interviews, we will assess the implementation outcomes of the DHS Cancer Navigation Program. With the qualitative data findings, we will identify core components and practices needed to enhance sustainability, optimization, and scale-up of the Cancer Navigation Program. Findings from this mixed-methods study will contribute to our understanding of best practices and effective strategies for oncology navigation within one of the largest county municipal health systems and inform the development of a larger NIH R01 or PCORI proposal.

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Promoting Equitable Access to Cervical Cancer Screenings, Referrals, and Treatment for Chinese and Latina Women in Central Los Angeles

This HRSA supported project (HRSA H8ICS46988) is a USC Norris Comprehensive Cancer Center and Chinatown Service Center (CSC) Los Angeles partnership award focused on addressing disparities in cervical cancer screening, referrals, and follow-up for patients in community health centers.  As one of 11 “first-of-its-kind” partnerships funded via the HRSA Accelerating Cancer Screening (AxCS) award and part of the Biden Cancer Moonshot, to advance the capacity of CSC providers, staff, and community health workers to educate CSC patients and families on cervical cancer screening and follow-up, increase screening and follow-up to abnormal screening results, increase access to follow-up care, deploy trained outreach specialists to support community outreach in CSC service areas, and develop referral pathways for patients needing follow-up care. With USC Norris Cancer Center Support, our team has also simultaneously conducted a mixed methods assessment of existing clinic screening and follow-up processes. These data and the HRSA Improving Cervical Cancer Prevention, Screening, and Management: A Toolkit to Build Provider Capacity are currently being used to inform the co-design phase of identifying needed and feasible multilevel clinic strategies to improve for implementation for a larger research study.

researcher in front of poster at poster session
Kathy Lui presenting findings from her research rotation on patterns of cervical cancer screening and abnormal follow-up at CSC at the North American Primary Care Research Group (NAPCRG) 2023 Annual Meeting
group picture of team at Chinatown Service Center
Chinatown Service Center (CSC) and USC Norris Cancer Center teams meet at CSC's Chinatown branch
CSC Health at community fair
USC COE and CSC table at the Allied Pacific Summer Fair
CSC Health at community fair
USC COE and CSC table at an AAPI Senior Health and Information Fair

Perspective of Healthcare Providers and Parents to Increase American Indian and Alaska Native Adolescent HPV Vaccinations to Support a Multilevel System Approach within FQHCs

This one-year Cancer Care Delivery and Implementation Science (CCD/IS) pilot study (PI: Claradina Soto, Co-I: Tsui) aims to understand American Indian and Alaska Native (AIAN) parents’ attributes, values, norms, and behaviors as they relate to HPV vaccination for their children/adolescents. AIAN people experience a disproportionately high incidence of HPV-related cancers and mortality. We partner with Riverside San Bernardino County Indian Health Clinic (RSBCIHC) team members in a community advisory board to recruit parents for focus groups, ensure material is culturally appropriate, and for ongoing collaboration with the study. We will conduct two focus groups with AIAN caregivers to understand their perspectives on HPV vaccination. Additionally, we will conduct interviews with providers and staff of RSBCIHC to understand clinic-level perspectives on HPV vaccination.  
 

Assessment of Current Processes, Facilitators, and Barriers to Clinical Trials to Improve Accrual and Equity for Clinical Trials at Norris Comprehensive Cancer Center

This Cancer Care Delivery and Implementation Science (CCD/IS) pilot study (PI: Syma Iqbal, Co-I: Tsui) aims to assess the current processes, facilitators, and barriers to clinical trials across  Norris Comprehensive Cancer Center’s disease teams and clinic sites (Norris/Keck satellite sites). We use mixed methods to examine existing facilitators and barriers to clinical trials enrollment at Norris Comprehensive Cancer Center. Using the Implementation Research Logic Model (IRLM), we conduct one-on-one in-depth interviews with oncologists to comprehensively assess determinants and potential strategies to implement multilevel approaches to improve clinical trials enrollment across Norris Comprehensive Cancer Center.