Multilevel barriers and supportive care preferences of metastatic breast cancer patients and their caregivers: a mixed-methods analysis.

Purpose: The diagnosis of metastatic breast cancer (MBC) marks a transition from curative to palliative care, bringing significant psychosocial challenges, often exacerbated by racial and ethnic disparities. This mixed-methods study, grounded in the socioecological model, sought to examine distress levels among MBC patients and caregivers across academic and safety-net healthcare settings and to explore how individual, interpersonal, and system-level factors-shaped by intersecting identities such as race/ethnicity and socioeconomic status-influence unmet supportive care needs and intervention preferences.

Methods: Surveys and interviews were conducted with a racially and ethnically diverse group of MBC patients (N = 27) and caregivers (N = 19), recruited from a comprehensive cancer center with academic practice and safety-net hospital affiliates.

Results: Quantitative analyses found no significant differences in distress levels between patients at safety-net and academic hospitals or between patients and caregivers. Qualitative analysis identified six categories of supportive care needs: personalized supportive care, comprehensive health and symptom management, emotional and psychosocial support, interpersonal and family support, sexual health and intimacy support, and equitable access to care-with patients and caregivers strongly preferring targeted, multilevel interventions to address these needs.

Conclusion: Findings underscore the multifaceted nature of MBC care needs and the importance of developing targeted interventions to address the individual, interpersonal, and systemic challenges faced by patients and caregivers.