Mita: How We Can Break Down Barriers to CareSeptember 14, 2015
Mita Goel has dedicated her medical career to understanding and breaking down barriers to care for women facing breast cancer, especially those from low-income communities.
Mita became interested in primary and longitudinal care while still in medical school. Through a fellowship research project, she found that Asian women with breast cancer, especially those born abroad, were more likely to have mastectomies instead of lumpectomies which led to further questions around why different populations receive different qualities of care.
It’s a question that has fueled Mita’s research for over a decade, and cuts to the heart of many complex issues of racial, socio-economic and class disparities.
Today, as an assistant professor at Northwestern University’s Feinberg School of Medicine and clinician at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Mita also works closely with the Erie Family Health Center, a federally qualified community health center with a local Spanish-speaking patient population who are predominantly Central and South American. When she moved to Chicago ten years ago, she was struck that the rate of mammography at Erie Family Health was about 50%. Her work with the center is geared towards increasing mammography rates and access to quality preventative care, and it is now up over 70%.
Mita is also a survivor herself. She was diagnosed with breast cancer after having her second child, and experienced first hand what’s it like to go through treatment as a patient. In the process, she gained new insight around the importance of personal touch and the value of a supportive community for patients.
We spoke with Mita to pinpoint the barriers to care that the people she works with encounter and the changes we need to make so that both patients and doctors can work to better overcome these issues.
“From my experience as a patient, I have learned to slow down when talking with my own patients, provide a little bit of information at a time, make sure it’s understood, and leave the door open for additional conversations throughout the treatment period.”
1. We need to increase the linkages between patient and provider.
One of the biggest barriers is access to, and use of, routine healthcare services. This requires linking women in the community with a local health center, so they have a primary care doctor or healthcare provider they can see regularly. This helps improve use of preventative health care, such as mammography.
Mita explained that if women only go to the doctor when they have a problem, “they may not see a healthcare provider they have a relationship with, and the provider might only focus on whatever issue is bothering them at that moment, and not have the conversation about their overall health.”
She also explained that patients struggle to make the connection between getting a referral for a mammogram from their provider and completing the mammogram. To combat this, she’s helped to create closer linkages between Erie Family Health Center and Northwestern University, so that if a woman is referred, health navigators can effectively facilitate bringing women in for their appointments in a way that had not previously been possible.
2. We need to encourage active and proactive participation in healthcare.
Mita and Erie Family Health are currently utilizing an online patient portal to proactively reach out to patients and assess their risk of breast cancer. She and Erie Family Health are also working to address communication and language barriers. One example of their efforts is a free educational video in both English and Spanish that provides patients with simple, non-confrontational language to start talking with their doctors about getting a mammogram, which has helped increase rates of referral.
3. We need to ensure technology innovations in healthcare are reaching everyone.
The online patient portal allows patients to look at their lab results, send secure messages to their providers, view medication lists, and sometimes schedule future appointments. This technology also enables doctors and patients to have a relationship outside of the clinical setting through a more open line of communication. Women can write follow-up questions for doctors to answer via the portal or by phone, allowing the care conversation to continue after the appointment ends.
However, while technology presents many opportunities for improving care, Mita also explained how innovations in technology can also be a barrier, in that e-health isn’t reaching certain populations, further stratifying access to quality care.
“What we’ve seen in research is that when patients are offered electronic access to their health records, African American and Latino patients are less likely to take the opportunity. On the flip side, however, African American and Latino populations are very likely to use tech in their daily lives, particularly on mobile devices.”
Mita’s goal is to reach diverse populations and engage them in their health using technology by bringing the clinical setting out to the patient instead of the other way around. “This is an opportunity to meet people where they are, particularly if we understand how they use technology, what motivates them to use technology, and what might motivate them to use technology for their health. It has the power to provide information in a way that’s tailored to an individual person.”
“As medical professionals, we need to make sure to acknowledge fear, and yet gently provide women the information and support they need.”
4. We need to improve understanding among doctors.
Through her own experience as a patient, Mita learned how overwhelming the time after receiving a breast cancer diagnosis can be. “There’s a lot of information being given at the time of diagnosis, and given how scary it feels just to hear the word ‘cancer’, it’s very difficult to take in all of the information at once.”
Women are asked to participate in a number of big decisions soon after diagnosis, such as choosing a lumpectomy versus a mastectomy, or removing a healthy breast as a preventative measure, and it can be difficult and overwhelming for women to weigh their options. “I understand the feelings these women have and how much of a role fear can play,” said Mita. “From my experience as a patient, I have learned to slow down when talking with my own patients, provide a little bit of information at a time, make sure it’s understood, and leave the door open for additional conversations throughout the treatment period.”
Her advice to other doctors is this: “As medical professionals, we need to make sure to acknowledge fear, and yet gently provide women the information and support needed to make decisions that will work best for them in the long-run.”
To learn more about patient navigation, check out the rest of our Heroes in Pink!