Clinical Perspectives on Cancer and Palliative Care Access among Native Hawaiian/Pacific Islander Veterans

Outcomes 1. Along with understanding sources for rising cancer prevalence among Veterans of Native Hawaiian/Pacific Islander heritage, participants will be able to identify strategies to address geographic, logistical, and financial challenges, as well as effects of historical trauma, that may be exacerbating cancer health disparities.2. By using an indigenous framework to health, participants will learn to culturally adapt clinical practices to address mistrust and build a therapeutic relationship with Veterans of Native Hawaiian/Pacific Islander heritage. Key Message Cancer health disparities experienced by Veterans who are Native Hawaiian/Pacific Islander (NH/PI) can be related to socioeconomic disadvantages, exposures, and lifestyle. Disparities may be perpetuated by present-day geographic, logistic, and financial barriers, as well as historical trauma. VHA clinicians suggested strategies to culturally adapt care, and we can use an indigenous health framework to promote equitable cancer and palliative care. Introduction Veterans of Native Hawaiian/Pacific Islander (NH/PI) heritage have a high risk of developing cancer and related complications which may be amplified by barriers to cancer and palliative care. Methods This ongoing study applies a mixed method, community-based participatory research approach to understanding healthcare needs of Veterans with cancer who are NH/PI. The study is guided by a community advisory board. Through snowball sampling and outreach, we targeted recruitment to ethnically diverse, multidisciplinary clinicians in a major Veterans Health Administration (VHA) medical center in Northern California and ambulatory clinics in the US-affiliated Pacific Islands (USAPI) between 3/2023-9/2023. Participants completed 45-minute semi-structured interviews to assess barriers and facilitators to cancer care and palliative care. Interviews were transcribed verbatim, de-identified, and deductively then inductively analyzed using rapid analysis matrices and dual coder review in Atlas.ti v23. Results Participants included 15 physicians, nurses, social workers, and clinical psychologists specializing in primary care, palliative care, and oncology, self-identifying as White, Asian American, NH/PI, and Multiracial. Preliminary analyses demonstrate the following barriers to accessing cancer and palliative care: 1) geographic, logistical, and financial challenges arranging long distance travel over an ocean with a “patient [who] needs to fly” that may get “ill on the flight”; 2) problems managing pain due to stoicism, misinformation as “people are still very anxious about” opioids, and constraints among VHA specialty care clinicians in the USAPI, 3) broadband infrastructure limitations leading to poor telehealth access; and 4) trauma, mistrust, and “tension from how Hawai'i [and other islands were] acquired by the United States.” Conclusions VHA clinicians discussed systemic, cultural, and historical barriers to cancer and palliative care while highlighting Veteran resilience and the promise of telehealth. An indigenous framework for health can help culturally adapt clinical practice and promote access to equitable health services for Veterans of NH/PI heritage. Keywords Diversity, Equity, Inclusion, Belonging, Justice Scientific Research