Healthcare delivery interventions to reduce cancer disparities worldwide

Table 3 Randomized trails from the United States examining technology interventions to improve outcomes in cancer care for historically marginalized populations

	Ref.	Population	Cancer type	Technology	Time point	Outcome	Result (intervention vs control)	Location
Screening	Miller et al[120] (2005)a	African American (70% of n = 194)	CRC	Educational multimedia computer program vs nurse instruction on using FOBT card	1 mo	Completed FOBT kit	62% vs 63% (P = 0.89)	Winston Salem, NC (urban)
	Dignan et al[121] (2005)a	Native American (n = 157)	Breast	Lay navigator on phone vs lay navigator in person	12 mo	Screening rate	42% vs 45% (P = 0.83)	Denver, CA (urban)
	Champion et al[62] (2006)a	African Americans (n = 344)	Breast	Interactive educational computer program vs video vs pamphlet	6 mo	Mammography rate	40% vs 25% (video) vs 32% (pamphlet) (P = 0.037)	Indianapolis, IN (urban)
	Russell et al[63] (2010)a	African American (n = 181)	Breast	Interactive educational computer program + monthly lay navigation vs pamphlet	6 mo	Mammography rate	51% vs 18% (P < 0.001)	Indianapolis, IN (urban)
	Miller et al[122] (2011)a	African American (75% of n = 264)	CRC	Web-based decision aid vs usual care	6 mo	Completion of CRC screening	19% vs 14% (P = 0.25)	Winston Salem, NC (urban)
	Greiner et al[64] (2014)a	Low income (n = 470)	CRC	Computer-delivered information on screening +/- implementation intentions theory-based behavior modification tool	6.5 mo	Completion of CRC screening	54% vs 42%, (P < 0.01)	Kansas City, KS (urban)
	Fernandez et al[123] (2015)b	Hispanic (n = 665)	CRC	Interactive educational multimedia on a tablet vs video vs none	6 mo	Completion of CRC screening	10% vs 14% (video) vs 11% (none) (P = 0.46)	Lower Rio Grande Valley in Texas (rural)
	Valdez et al[124] (2019)a	Hispanic (n = 943)	Cervical	Kiosk delivered education versus pamphlet	6 mo	Pap rate	51% vs. 48% (P = 0.35)	Los Angeles, San Jose, and Fresno, CA (urban)
Treatment	Helzlsouer et al[65] (2018)a	African American (n = 101)	Breast	Web-based navigation program versus list of websites	12 mo	Adjuvant treatment completion	94% vs 86% (P = 0.24)	Baltimore, MD (urban)
	Percac-Lima et al[66] (2015)a	Likely to no show (n = 4425)	All	Lay navigator vs usual care	5 mo	No show rate	10% vs 18% (P < 0.001)	Boston, MA (urban)
Palliation	Bakitas et al[77] (2009)a	Rural patients (n = 322)	All	Psycho-educational classes followed by monthly tele-health check-ins with advanced nurse practitioner vs usual care	Death or study completion (5 yr)	Quality of life	Intervention > control for quality of life (P = 0.02) and mood scores (P = 0.03) | ND in symptom intensity (P = 0.24)	Vermont (rural)
	Kroenke et al [75] (2010)a	Low income (n = 405)	All	Telecare management with automated home-based symptom monitoring by interactive voice recording or internet vs usual care	12 mo	Improvement in pain and depression scales	Intervention > control for pain and depression (P < 0.0001 for both)	Indiana (rural and urban)
	Yanez et al[76] (2015)a	African American (40% of n = 74)	Prostate	Cognitive-behavioral stress management delivered via web/tablet vs generic health information via web/tablet	6 mo	Depression scale change	ND (P = 0.06)	Chicago, IL (urban)
	Anderson et al[125] (2015)a	African American and Hispanic (n = 60)	Breast	Twice weekly automated telephone calls with patient rating of pain. If pain was elevated, e-mail sent to clinician vs usual care	2-2.5 mo	Reduction in pain severity from baseline	Intervention > control (P = 0.015)	Houston, TX (urban)
	Ramirez et al[78] (2020)a	Hispanic (n = 288)	Breast, CRC, and Prostate	Intensified telephone and internet-based patient navigation vs “standard” navigation	15 mo	Change in health-related quality of life score	Intervention > control (P < 0.05) for female CRC patients | Intervention = control (P > 0.05) for breast cancer, male CRC, and prostate	Chicago, IL and San Antonio, TX (urban)

If a study had comparisons at multiple points (i.e., three months and six months) only the final time point in each study is reported.

^aRandomized Controlled Trial.

^bCluster Randomized Trial. FOBT: Fecal occult blood test; CRC: Colorectal cancer; ND: No difference.