Trinh Tackles Health Disparities Through Research, Prostate Cancer Outreach Clinic
When Quoc-Dien Trinh, MD, MBA, urologic oncologist in the Brigham’s Division of Urology, is asked what it means to build trust with communities of color, he talks about a Sunday afternoon at the Twelfth Baptist Church in Roxbury, meeting people and talking face to face.
“Individual outreach at events organized by grassroots organizations brings us to where people are. When I go to churches, I say it like it is. I acknowledge health care inequities that patients of color face,” Trinh said. “Health care in the United States was conceived and organized around incentivizing care for white, rich people rather than for everyone. But the doctors of today want to make things better. That’s why I’m here at your church — I’m here to tell you that I’m committed to serving you.”
He encourages men to visit the Prostate Cancer Outreach Clinic, which he co-founded with support from Mass General Brigham’s United Against Racism initiative. Working with organizations like Prostate Health Education Network to attend these church events is just one of the many ways Trinh is aiming to re-establish trust in Massachusetts communities of color.
A Vietnamese Canadian Upbringing
Trinh, who is also the co-director of the Dana-Farber/Brigham and Women’s Prostate Cancer Program, is trained in minimally invasive urologic oncology and performs a high volume of robotic prostatectomies. He trained under Mani Menon, MD, a world-renowned pioneer who led the first robotic surgery program in the world as the Director of the Vattikuti Urology Institute.
Originally, these surgeries were only available to higher income, highly educated individuals. Over time, they have become more accessible in hospitals across the country. Now, Trinh tackles health disparities like this through his research and the new clinic, which has already served more than 250 patients. He attributes his initial interest in health disparities to his upbringing in a Vietnamese family in Montreal, Canada.
“A lot of who I am today has to do with the fact that I had access to the same education and health care as my more affluent Canadian neighbors,” Trinh said. “I remember my grandma getting sick and she had access to health care.”
When Trinh moved to the United States at 28, he learned about structural racism and how it can limit the educational, financial and health care opportunities of communities of color. He explains that while individual physicians can be careful and aware of their biases to deliver safe care, ensuring equity requires work at the systems level. He became especially curious about racial differences in access to care for prostate cancer and now pursues a range of research on health disparities.
Research on Health Disparities
With funding through a grant from the American Cancer Society, Trinh leads a group that conducts case studies to analyze methods aiming to eliminate barriers to prostate cancer care.
“We have spoken to a range of stakeholders,” Trinh explained. “Not only insurance companies and health care executives, but also people at the front lines like nurse navigators to understand strategies they use to connect to patients.”
He was also recently awarded a Department of Defense grant to study how transportation is a barrier to reaching clinical care.
“We know the distance patients have to travel can affect the clinical care they receive, but it’s not just about distance,” Trinh said. “It’s also about direction. If you’re driving down Route 9 to the Brigham, it’s easier than if you are coming from the south to the Brigham by public transportation. As it is right now, it’s incredibly difficult to rely on public transportation. We are trying to understand those barriers, how they affect where you get care and your outcomes from that care.”
While Trinh conducts this research on health disparities, he also finds way to alleviate them in practice at his clinic.
Translating Care into Change
“I realized I had done so much in terms of research, but I wanted to be able to translate that into operational efforts,” Trinh said. “I pursued an MBA, and my capstone project was the Prostate Cancer Outreach Clinic that I co-founded. I learned a lot of things and I’ve had a lot of help.”
When establishing the clinic, Trinh received his fair share of pushback from organizations he wanted to partner with as he tried to translate his caring enthusiasm into actionable change.
“The first time some Vietnamese immigrant from Canada comes in and wants to make a difference, people will ask ‘Who is this Brigham physician and what is his angle?’” Trinh explains. “I have no angle. We all need to chip in to address disparities.”
His goal was to get community partners on the same page, framing the clinic’s mission to meet different organizational goals and ensure its financial feasibility. The process took a long time, but he attributes a lot of his efforts and successes to people he knew on a personal level.
“I think one of the challenges is how fragmented our efforts are,” Trinh said. “A lot of people care, including grassroots organizations, community centers, churches, department leadership, hospital leadership, Mass General Brigham leadership, but everybody is doing their own thing.”
Now, the fully operational clinic helps screen and treat patients who do not have proper follow-up care after being screened for prostate cancer. The vast majority are underserved minorities, especially those who do not speak English or are low-income.
“There’s a test for a prostate specific antigen, called PSA, which is a marker to detect prostate cancer,” Trinh explains. “There’s a lot of people who get abnormal results from the PSA test and don’t get appropriate follow-up. We created a workflow where the testing information is sent from the BWH Department of Quality and Safety to our community health worker to ensure these patients are followed up with appropriately.”
In addition to community health workers and physicians, the clinic relies on volunteers who help with efforts ranging from outreach to translation.
An Optimistic Future
One volunteer, Julius Dudley, a retired professor of History from Salem State University, serves as a chaperone for fellow Black men in the community and embodies the spirit of changemakers to Trinh.
“After being treated for prostate cancer, he talks to patients who are nervous or tempted to skip their appointments,” Trinh describes. “He calls them and explains that he was in their shoes. He explains that he trusts the team and knows that cancer can be serious if left untreated.”
Trinh notices that over his ten years at Brigham, more people have become invested in addressing health disparities. Almost all physicians recognize that these differences in health outcomes are not explained by genetics, but rather by inequity and lack of access to health care. The teams he works with are committed to making a difference.
“The United Against Racism campaign is not just a banner, but funds projects that are supported by Mass General Brigham, MGH, and BWH leadership,” Trinh says. “Making changes in health care is tough. It’s a demanding work environment. Everyone who is here really wants to do this.”