Refining research on access to gynecologic cancer care: The DIMeS framework

Despite its importance, there is no consensus definition of access to care, and several fundamental philosophical questions about access remain unanswered. Lack of clarity impedes interventional research designed to develop and test methods of correcting barriers to access. To help remedy this problem, we propose a conceptual framework to help guide empirical research about access to gynecologic cancer care. Relevant philosophical and empirical literature was reviewed and analyzed to highlight key elements needed to refine research on access to care. The DIMeS framework involves 1) choice and justification of a Definition of access to cancer care that will guide research; 2) Identification of essential gynecologic cancer care services for which access disparities are ethically unacceptable; 3) quantitative MEasurement of specific parameters that affect access to care; and 4) Selection of a target threshold on measured parameters above which access is acceptable. The DIMeS framework provides clarity and reproducibility for investigators seeking to develop and test interventions to improve cancer health equity. This framework should be considered for use in research on access to gynecologic cancer care. •There is no consensus definition of access to care, and fundamental philosophical questions about access remain unanswered.•A common, robust methodology is needed for interventional research to correct inequities in access to gynecologic cancer care.•The DIMeS framework provides a clear structure for the study of access to care and cancer health inequity.