Background: Equity in cancer is a global priority, with many countries making commitments to improve outcomes, including Australia. Despite being a burgeoning field of inquiry, research to date has been largely exploratory, with a focus on identifying disparities rather than actively promoting equity. There is currently a lack of high quality guidance for health systems to respond to cancer inequities through research, policies, or quality improvement activities.
Aims: We aimed to design a guiding process framework for health services to support the promotion of equity in cancer.
Methods: The Equity Process Framework (EPEK) was developed across a three-phase mixed method study, using a sequential, explanatory design in a large tertiary hospital in metropolitan Queensland, Australia. Findings were used from a systematic scoping review, a cohort study (n=523), and qualitative interviews with clinicians (n=21). Key constructs were identified to develop the theory to inform this framework.
Results: The Equity Process Framework has three-steps. Firstly, potential cancer inequities are identified, using routinely collected, reproducible and validated measures. Secondly, an exploration of social, environmental, and structural determinants within the health service and population context. Finally, articulate current strengths that can directly address inequities, and also opportunities to eliminate or reduce causal structures that are responsible. Practically, this can be achieved by identifying current procedures and interventions already in place, and those that can be used. Cycles of continuous evaluation around these three steps are essential to assess effectiveness. Evaluation is tailored to local requirements, and aims to facilitate the responsible use of resources, the discontinuation of ineffective policies and promotes transparency regarding the services’ progress towards health equity.
Conclusions: The Equity Process Framework may support health services with evidence-based, solution-focused guidance to inform cancer equity research, policies, and quality improvement initiatives. Future directions include validation of the framework in a variety of settings.