Project Summary: The long-term objective of this K08 application is to develop Dr. Resmi Charalel's capacity to discover practical solutions to achieve equitable outcomes for small hepatocellular carcinoma (HCC) patients, a cancer population where there is currently a large gap in care delivery from diagnosis to treatment. During the K08 award period, the proposed training activities will support Dr. Charalel in four educational and training objectives that will allow Dr. Charalel to develop into an independent investigator who is able to implement barriers and facilitators analyses, as well as stakeholder-engaged intervention development for timely small HCC treatment and ultimately, increase appropriate treatment utilization for small HCCs. First, Dr. Charalel will develop knowledge in qualitative research methods in order to investigate the barriers and facilitators to treatment for small HCCs using reliable and reproducible methods. Second, she will develop expertise in health equity research to better understand how to reduce inequities in the care delivery pathway and deliver culturally sensitive healthcare. Third, Dr. Charalel will develop expertise in implementation science by completing a rigorous certificate in Implementation Science including training in advanced trial methods important to test the efficacy of interventions as an independent investigator. Finally, Dr. Charalel will pursue professional development opportunities, specifically geared towards grant writing and collaboration. The three research aims of this project proceed as follows: Aim 1 will identify barriers and facilitators of treatment for small HCCs (less than 5 cm) using qualitative research methods. Specifically, Dr. Charalel will use focus groups of patients who did not receive timely treatment (within 3 months) and semi-structured interviews with providers and staff to develop a comprehensive understanding of the modifiable factors that contribute to treatment utilization. Aim 2 will focus on iterative development of a multilevel intervention to facilitate timely care to small HCC treatment in conjunction with a stakeholder advisory board. The multi-level intervention will address patient-level, provider/staff-level and system-level factors that contribute to inequities and inefficiencies in care delivery. Aim 3 will consist of a single arm, pilot feasibility and acceptability test of our multi-level intervention in two hospitals including a tertiary care center and a community hospital to ensure broad reproducibility. We will also obtain preliminary effectiveness data by comparing treatment rates and time to treatment between our interventional cohort and historical controls. Together, the proposed research will provide foundational work needed to conduct a randomized controlled trial testing the novel, multi-level intervention developed in this proposal to assess its efficacy in providing timely treatment to curable, small HCC patients and expanding cancer care delivery to this undertreated population. Thus, the outlined study aims are aligned with the NCI's cancer moonshot goal to improve access to current and new standards of HCC cancer care and thus reduce disparities in cancer care delivery.

Project Narrative: Hepatocellular carcinoma (HCC) is one of the deadliest cancers worldwide; but when detected early, it is readily curable. Unfortunately, despite diagnosis, many patients do not receive the recommended curative treatment and some do not receive treatment at all. Our study will examine barriers and facilitators to treatment and develop a novel, multi-level intervention to improve access to timely small HCC treatment in order to reduce inequities in HCC care delivery.