Evaluating, Preparing, and Responding to Care Disruptions and Health Outcomes Among Patients with Breast Cancer Following Severe Storms

Project Summary/Abstract Severe storms, whether hurricanes or other storms with significant wind/precipitation, affect millions of Americans each year, disrupt the delivery of healthcare, and increase the risk for health complications. While severe storms may impact the care and outcomes of any cancer, addressing its impact on patients with breast

cancer, a highly prevalent cancer with a good overall survival when treated with high-quality care, is of high public health significance. The primary research objective of this proposal is to recognize treatment disruption and adverse health outcomes experienced by patients with breast cancer and to identify and prioritize

strategies to respond to health needs. In this study, we employ a mixed methods framework to accomplish the following aims: (Aim 1) To assess the impact of severe storms on breast care, acute care services, and mortality among patients with breast cancer, identify the most vulnerable populations, and evaluate potential

mediators for the three outcomes; (Aim 2) To describe disruptions in breast cancer care, community concerns, perceived care barriers, and strategies to mitigate care disruptions and respond to health needs following storms using depth interviews of key stakeholders; (Aim 3) To identify and prioritize targeted interventions to

mitigate disruptions in breast cancer care and respond to post-storm health needs through Delphi methods and community engagement. I am supported by a mentorship team with expertise in oncology, climatology, health services research, geospatial analysis, mixed methods, and disaster preparedness. I will link storm data,

including wind speed, flooding, and power outage, with breast databases to quantify the impact of severe storms on the care and outcomes, identify mediators on the causal pathway and create geospatial maps to identify impacted communities and health systems. Then I will conduct depth interviews with diverse

stakeholders in cancer care and disaster preparedness. Intervention mapping framework will be used to identify strategies, which are then are assessed and prioritized by stakeholders during Delphi and a community engagement working group. Through mentored training, education, and carrying-out this research proposal, I

will accomplish my training goals related to applying new quantitative methods, acquiring skills in qualitative analysis and mixed methods, developing knowledge in implementation science and community engagement to prepare strategies for intervention studies, and developing the skills and network for career independence as a

physician scientist. This proposal will provide the foundation for my independent physician-scientist career in health services research focusing on environmental health threats and cancer care and outcomes. By identifying vulnerable subgroups and potential mediators in Aims 1 and describing and prioritizing strategies in

Aims 2 and 3, this proposal will support the implementation and evaluation of the most promising strategies in a future R01.