As a nursing student, rather than working in a medical clinic or hospital, Harding opted to work in neighborhoods. She provided free health screenings and insurance referrals to members of underserved communities, many of whom were immigrants and people of color, who often had problems navigating the healthcare system. She felt uniquely able to help. Harding is a bilingual (she speaks Spanish) and biracial woman herself, the child of two immigrants. Her mother is from Nicaragua and her father is from Barbados. She understood early on that her experience, which could never be taught in a classroom, gave her a unique ability to connect with people who had encountered racism within the healthcare system, had faced language barriers, or had reasons to mistrust the healthcare system. Though she was a nursing student, patients would often share information with her that they wouldn’t share with other health providers who didn’t look like them or speak their language, she says. “If I can speak to a patient in a language they understand without using an interpreter, that builds a bond, a trust.” After graduating from Northeastern, Harding worked in Connecticut, conducting home visits for elderly patients and ensuring they had the assistance they needed. She liked her job, but when a recruiter presented the opportunity to move back to Boston as a patient care navigator and member of the Cancer Care Equity Program at Dana-Farber Cancer Institute in Boston, Harding immediately knew it was a good fit. The program’s main goal is to bridge the nation’s gap in cancer health disparities.
Catching Lung Cancer Early
Black Americans have the highest death rates from cancer in the nation, despite having the same rates as white Americans for many cancers. These inequities are stark among people diagnosed with lung cancer. According to the American Lung Association (ALA), due to systemic issues that create and perpetuate health disparities, Black Americans are nearly 20 percent less likely to be diagnosed with lung cancer at an early stage, when they have more options for treatment, compared with white Americans. Once diagnosed, they are 23 percent less likely to receive surgical treatment and nearly 10 percent more likely to not receive any treatment at all. Black Americans are also 20 percent less likely to be living five years after their lung cancer diagnosis compared with white Americans. “A lot of times patients fall through the cracks,” says Harding. “That’s what our program is trying to change. We’re working in marginalized communities where a lot of people are immigrants — a lot of them work three jobs and there are socioeconomic and language barriers to care. Many are homeless or on the verge of being homeless.” With the Cancer Care Equity Program, Harding focuses on building trust with minoritized communities and getting them access to lung cancer screenings. She also works with patients who need help accessing programs, such as quitting smoking. The program helps high-risk patients referred by local clinics to access lung cancer screenings annually. Harding’s first approach is to put patients at ease. “We have a lot of patients that are very worried. I like to ask them first if they know why they were referred to us,” says Harding. “I like to say, ‘Dr. so-and-so has referred you to us because you’ve smoked for 30 years and you’ve never had a chest CT [computerized tomography scan] or X-ray of your lungs.” Then she explains that just because they are getting screened for lung cancer does not mean they have the disease, but if something does come up suspicious, that they are in the right hands. “Once I have that conversation with the patients, I kind of hear that sigh of relief because I am actually taking the time to explain the situation,” she says.
Building Trust, One Patient at a Time
When working within a system that makes it difficult for BIPOC (Black, Indigenous, and people of color) and underserved communities to access adequate treatment, Harding says communication is at the root of creating equitable healthcare. “Being able to communicate properly with patients, listen to what their concerns are, and then also do something about it, is fundamental,” she says. Harding makes herself accessible to patients, but if she can’t provide specific help, she puts them in contact with someone who can. It’s an essential piece of the trust-building that systematically oppressed people need in order to get the healthcare they deserve, says Harding. “I’ve had quite a few patients express they have an overall mistrust of the medical system because of the way they were treated in the past — things weren’t explained, there wasn’t any follow-up.” When that happens, she works to build a bond and tries to earn their trust, she says. If a patient is diagnosed with lung cancer, Harding and her team offer support, informing patients where they can get treatment even if it’s not Dana Farber. Oftentimes patients don’t realize they have options and can go where their insurance is accepted. “They feel heard. That’s what I was told by one of my patients,” Harding says. “That is a super rewarding experience, knowing that me doing something as simple as listening makes a difference to them.”
Breaking Barriers
Harding and her team also work on other barriers to care that aren’t directly healthcare related. “Transportation is one of the biggest barriers that we’ve encountered. A lot of times people miss appointments because they can’t get there, so we offer them a ride to the appointment and a ride home after,” she says. Even after she’s worked with patients, Harding keeps in touch to make sure they are still getting the care they need. The Cancer Care Equity Program also refers patients for screenings and treatments for other cancers, including breast cancer. “It requires a lot of follow-through with these patients when they are diagnosed with cancer. We don’t just hand them off,” she says. “I continue to support them, to make sure transportation is available, get them appointment reminders, and figure out if they qualify for other assistance like gift cards for groceries.” The long-term goal is to expand the program throughout Massachusetts, and then across the nation. “Our program is patient-centered and we focus on building trust with our patients,” says Harding. “A program like this would be a game changer if implemented throughout the United States."
