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Strayhorn JC, Vanness DJ, Collins LM. Optimizing Interventions for Equitability: Some Initial Ideas. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:384-396. [PMID: 38294614 PMCID: PMC11239304 DOI: 10.1007/s11121-024-01644-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 02/01/2024]
Abstract
Interventions (including behavioral, biobehavioral, biomedical, and social-structural interventions) hold tremendous potential not only to improve public health overall but also to reduce health disparities and promote health equity. In this study, we introduce one way in which interventions can be optimized for health equity in a principled fashion using the multiphase optimization strategy (MOST). Specifically, we define intervention equitability as the extent to which the health benefits provided by an intervention are distributed evenly versus concentrated among those who are already advantaged, and we suggest that, if intervention equitability is acknowledged to be a priority, then equitability should be a key criterion that is balanced with other criteria (effectiveness overall, as well as affordability, scalability, and/or efficiency) in intervention optimization. Using a hypothetical case study and simulated data, we show how MOST can be applied to achieve a strategic balance that incorporates equitability. We also show how the composition of an optimized intervention can differ when equitability is considered versus when it is not. We conclude with a vision for next steps to build on this initial foray into optimizing interventions for equitability.
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Affiliation(s)
- Jillian C Strayhorn
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, USA.
| | - David J Vanness
- Department of Health Policy and Administration, Pennsylvania State University, Pennsylvania, USA
| | - Linda M Collins
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, USA
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2
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Igwe J, Wangdak Yuthok TY, Cruz E, Mueller A, Lan RH, Brown‐Johnson C, Idris M, Rodriguez F, Clark K, Palaniappan L, Echols M, Wang P, Onwuanyi A, Pemu P, Lewis EF. Opportunities to Increase Science of Diversity and Inclusion in Clinical Trials: Equity and a Lack of a Control. J Am Heart Assoc 2023; 12:e030042. [PMID: 38108253 PMCID: PMC10863780 DOI: 10.1161/jaha.123.030042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
The United States witnessed a nearly 4-fold increase in personal health care expenditures between 1980 and 2010. Despite innovations and obvious benefits to health, participants enrolled in clinical trials still do not accurately represent the racial and ethnic composition of patients nationally or globally. This lack of diversity in cohorts limits the generalizability and significance of results among all populations and has deep repercussions for patient equity. To advance diversity in clinical trials, robust evidence for the most effective strategies for recruitment of diverse participants is needed. A major limitation of previous literature on clinical trial diversity is the lack of control or comparator groups for different strategies. To date, interventions have focused primarily on (1) community-based interventions, (2) institutional practices, and (3) digital health systems. This review article outlines prior intervention strategies across these 3 categories and considers health policy and ethical incentives for substantiation before US Food and Drug Administration approval. There are no current studies that comprehensively compare these interventions against one another. The American Heart Association Strategically Focused Research Network on the Science of Diversity in Clinical Trials represents a multicenter, collaborative network between Stanford School of Medicine and Morehouse School of Medicine created to understand the barriers to diversity in clinical trials by contemporaneous head-to-head interventional strategies accessing digital, institutional, and community-based recruitment strategies to produce informed recruitment strategies targeted to improve underrepresented patient representation in clinical trials.
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Affiliation(s)
- Joseph‐Kevin Igwe
- Department of MedicineStanford University, School of MedicineStanfordCA
- Department of MedicineMorehouse School of MedicineAtlantaGA
- American Heart Association Strategically Focused Research Network on the Science of Diversity in Clinical Trials Research FellowDurhamNC
| | | | - Erin Cruz
- Department of MedicineStanford University, School of MedicineStanfordCA
| | - Adrienne Mueller
- Department of MedicineStanford University, School of MedicineStanfordCA
| | - Roy Hao Lan
- Department of MedicineStanford University, School of MedicineStanfordCA
| | | | - Muhammed Idris
- Department of MedicineMorehouse School of MedicineAtlantaGA
| | - Fatima Rodriguez
- Department of MedicineStanford University, School of MedicineStanfordCA
| | - Kira Clark
- Department of MedicineStanford University, School of MedicineStanfordCA
| | - Latha Palaniappan
- Department of MedicineStanford University, School of MedicineStanfordCA
| | - Melvin Echols
- Department of MedicineMorehouse School of MedicineAtlantaGA
| | - Paul Wang
- Department of MedicineStanford University, School of MedicineStanfordCA
| | | | - Priscilla Pemu
- Department of MedicineMorehouse School of MedicineAtlantaGA
| | - Eldrin F. Lewis
- Department of MedicineStanford University, School of MedicineStanfordCA
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3
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Katz NT, Alpert AB, Aristizabal MP, McDaniels-Davidson C, Sacks BH, Sanft T, Chou CL, Martinez ME. Partnering With Patients and Caregivers in Cancer Care: Lessons From Experiences With Transgender, Hispanic, and Pediatric Populations. Am Soc Clin Oncol Educ Book 2023; 43:e397264. [PMID: 37200592 DOI: 10.1200/edbk_397264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
A cancer diagnosis thrusts patients and caregivers into a foreign world of health care with systems, protocols, and norms that can leave little room for individual needs and circumstances. Quality and efficacious oncology care requires clinicians to partner with patients and caregivers to understand and incorporate their needs, values, and priorities into information sharing, decision making, and care provision. This partnership is necessary for effective patient- and family-centered care and access to individualized and equitable information, treatment, and research participation. Partnering with patients and families also requires oncology clinicians to see that our personal values, preconceived ideas, and established systems exclude certain populations and potentially lead to poorer care for all patients. Furthermore, inequitable access to participation in research and clinical trials can contribute to an unequal burden of cancer morbidity and mortality. Leveraging the expertise of the authorship team with transgender, Hispanic, and pediatric populations, this chapter provides insights and suggestions for oncology care that are applicable across patient populations to mitigate stigma and discrimination and improve the quality of care for all patients.
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Affiliation(s)
- Naomi T Katz
- Victorian Paediatric Palliative Care Program, Royal Children's Hospital, Melbourne, VIC, Australia
- Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Palliative Care Service, Alfred Health, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- Murdoch Children's Research Insitute, Melbourne, VIC, Australia
| | - Ash B Alpert
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI
- Department of Health Services Policy & Practice, Brown University School of Public Health, Providence, RI
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
| | - M Paula Aristizabal
- Department of Pediatrics, Division of Hematology, University of California and Peckman Center for Cancer and Blood Disorders, Rady Children's Hospital San Diego, CA
- Moores Cancer Center, University of California, San Diego, CA
| | - Corinne McDaniels-Davidson
- Moores Cancer Center, University of California, San Diego, CA
- School of Public Health, San Diego State University, San Diego, CA
| | - Bronwyn H Sacks
- Victorian Paediatric Palliative Care Program, Royal Children's Hospital, Melbourne, VIC, Australia
- Murdoch Children's Research Insitute, Melbourne, VIC, Australia
| | - Tara Sanft
- Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Calvin L Chou
- Department of Medicine, University of California, San Francisco, San Francisco, CA
- Veterans Affairs Helathcare System, San Francisco, CA
| | - Maria Elena Martinez
- Moores Cancer Center, University of California, San Diego, CA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA
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4
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Barry D, Steinberg JR, Towner M, Barber EL, Simon M, Roque DR. Enrollment of Racial and Ethnic Minoritized Groups in Gynecologic Oncology Clinical Trials: A Review of the Scope of the Problem, Contributing Factors, and Strategies to Improve Inclusion. Clin Obstet Gynecol 2023; 66:22-35. [PMID: 36657045 PMCID: PMC9869456 DOI: 10.1097/grf.0000000000000765] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Racial inequities are well-documented across the gynecologic oncology care continuum, including the representation of racial and ethnic minoritized groups (REMGs) in gynecologic oncology clinical trials. We specifically reviewed the scope of REMG disparities, contributing factors, and strategies to improve inclusion. We found systematic and progressively worsening under-enrollment of REMGs, particularly of Black and Latinx populations. In addition, race/ethnicity data reporting is poor, yet a prerequisite for accountability to recruitment goals. Trial participation barriers are multifactorial, and successful remediation likely requires multi-level strategies. More rigorous, transparent data on trial participants and effectiveness studies on REMG recruitment strategies are needed to improve enrollment.
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Affiliation(s)
- Danika Barry
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jecca R Steinberg
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mary Towner
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Emma L Barber
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Melissa Simon
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Dario R Roque
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
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5
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Nouvini R, Parker PA, Malling CD, Godwin K, Costas-Muñiz R. Interventions to increase racial and ethnic minority accrual into cancer clinical trials: A systematic review. Cancer 2022; 128:3860-3869. [PMID: 36107740 PMCID: PMC10456972 DOI: 10.1002/cncr.34454] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/27/2022] [Accepted: 08/02/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Racial and ethnic minorities (REMs) continue to be underrepresented in clinical trials despite the 1993 National Institutes of Health's Revitalization Act mandating the representation of women and underrepresented minority groups in clinical trials. Although Blacks represent 15% and Hispanics 13% of the cancer population, their clinical trial enrollment rates are disproportionately low at 4% to 6% and 3% to 6%, respectively. A systematic review exploring interventions aimed at improving cancer clinical trial (CCT) enrollment for REMs was conducted. METHODS A systematic search of PubMed, Cochrane CENTRAL, and Ovid PsycINFO was conducted for English-language studies since 1993. Inclusion criteria included peer-reviewed, US-based studies with interventions aimed to recruit underrepresented minority adult patients into cancer clinical trials. REM groups were defined as Black, Hispanic, Asian, American Indian, and Native Hawaiian/other Pacific Islander. RESULTS The systematic search identified 3123 studies, of which nine met inclusion criteria. Interventions included patient navigation/coaching (n = 4), a clinical trial educational video (n = 2), institutional research infrastructure changes (n = 1), a relationship building and social marketing recruitment model (n = 1), and cultural competency training for providers (n = 1). A statistically significant improvement in accrual was shown in three of the patient navigation interventions, one of the clinical trial educational videos and an institutional research infrastructure change. CONCLUSIONS This systematic review illustrates several potential mechanisms by which to increase CCT recruitment for patients of REM backgrounds in various clinical settings. More randomized controlled trials are needed to further explore the benefits of these interventions for REMs.
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Affiliation(s)
- Rosa Nouvini
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | | | - Kendra Godwin
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Chowdhury-Paulino IM, Ericsson C, Vince R, Spratt DE, George DJ, Mucci LA. Racial disparities in prostate cancer among black men: epidemiology and outcomes. Prostate Cancer Prostatic Dis 2022; 25:397-402. [PMID: 34475523 PMCID: PMC8888766 DOI: 10.1038/s41391-021-00451-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/09/2021] [Accepted: 08/20/2021] [Indexed: 11/09/2022]
Abstract
Prostate cancer has the widest racial disparities of any cancer, and these disparities appear at every stage of the cancer continuum. This review focuses on the disparities in prostate cancer between Black and White men, spanning from prevention and screening to clinical outcomes. We conduct an expansive review of the literature on racial disparities in prostate cancer, interpret the findings, and discuss areas of unmet need in research. We provide an overview of epidemiologic concepts necessary to understanding the current state of prostate cancer disparities, discuss the complexities of studying race, and review potential drivers of disparities in incidence and mortality. We argue that the cause of this disparity is multifactorial and due to a combination of social and environmental factors. The path forward needs to focus on enrolling and retaining Black men in prostate cancer clinical trials and observational studies and identifying potential interventions to improve prevention and clinical outcomes in Black men.
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Affiliation(s)
| | - Caroline Ericsson
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston MA
| | - Randy Vince
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Daniel E. Spratt
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH,Department of Radiation Oncology, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Daniel J. George
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Lorelei A. Mucci
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston MA
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Oyer RA, Hurley P, Boehmer L, Bruinooge SS, Levit K, Barrett N, Benson A, Bernick LA, Byatt L, Charlot M, Crews J, DeLeon K, Fashoyin-Aje L, Garrett-Mayer E, Gralow JR, Green S, Guerra CE, Hamroun L, Hardy CM, Hempstead B, Jeames S, Mann M, Matin K, McCaskill-Stevens W, Merrill J, Nowakowski GS, Patel MI, Pressman A, Ramirez AG, Segura J, Segarra-Vasquez B, Hanley Williams J, Williams JE, Winkfield KM, Yang ES, Zwicker V, Pierce LJ. Increasing Racial and Ethnic Diversity in Cancer Clinical Trials: An American Society of Clinical Oncology and Association of Community Cancer Centers Joint Research Statement. J Clin Oncol 2022; 40:2163-2171. [PMID: 35588469 DOI: 10.1200/jco.22.00754] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
A concerted commitment across research stakeholders is necessary to increase equity, diversity, and inclusion (EDI) and address barriers to cancer clinical trial recruitment and participation. Racial and ethnic diversity among trial participants is key to understanding intrinsic and extrinsic factors that may affect patient response to cancer treatments. This ASCO and Association of Community Cancer Centers (ACCC) Research Statement presents specific recommendations and strategies for the research community to improve EDI in cancer clinical trials. There are six overarching recommendations: (1) clinical trials are an integral component of high-quality cancer care, and every person with cancer should have the opportunity to participate; (2) trial sponsors and investigators should design and implement trials with a focus on reducing barriers and enhancing EDI, and work with sites to conduct trials in ways that increase participation of under-represented populations; (3) trial sponsors, researchers, and sites should form long-standing partnerships with patients, patient advocacy groups, and community leaders and groups; (4) anyone designing or conducting trials should complete recurring education, training, and evaluation to demonstrate and maintain cross-cultural competencies, mitigation of bias, effective communication, and a commitment to achieving EDI; (5) research stakeholders should invest in programs and policies that increase EDI in trials and in the research workforce; and (6) research stakeholders should collect and publish aggregate data on racial and ethnic diversity of trial participants when reporting results of trials, programs, and interventions to increase EDI. The recommendations are intended to serve as a guide for the research community to improve participation rates among people from racial and ethnic minority populations historically under-represented in cancer clinical trials. ASCO and ACCC will work at all levels to advance the recommendations in this publication.
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Affiliation(s)
- Randall A Oyer
- Penn Medicine Lancaster General Health Ann B Barshinger Cancer Institute, Lancaster, PA
| | | | - Leigh Boehmer
- Association of Community Cancer Centers, Rockville, MD
| | | | - Kathryn Levit
- American Society of Clinical Oncology, Alexandria, VA
| | - Nadine Barrett
- Duke Clinical and Translational Science Institute, Raleigh, NC
| | - Al Benson
- Northwestern University, Evanston, IL
| | | | - Leslie Byatt
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | | | | | - Kyle DeLeon
- American Cancer Society Cancer Action Network, Washington, DC
| | - Lola Fashoyin-Aje
- US Food and Drug Administration Oncology Center of Excellence, Silver Spring, MD
| | | | | | - Sybil Green
- American Society of Clinical Oncology, Alexandria, VA
| | - Carmen E Guerra
- University of Pennsylvania Raymond and Ruth Perelman School of Medicine, Philadelphia, PA
| | - Leila Hamroun
- ChristianaCare Oncology Patient Advocates for Clinical Trials, Newark, DE
| | - Claudia M Hardy
- University of Alabama at Birmingham O'Neal Comprehensive Cancer Center, Birmingham, AL
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Eddy S Yang
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
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8
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Rencsok EM, Bazzi LA, McKay RR, Huang FW, Friedant A, Vinson J, Peisch S, Zarif JC, Simmons S, Hawthorne K, Villanti P, Kantoff PW, Heath E, George DJ, Mucci LA. Diversity of Enrollment in Prostate Cancer Clinical Trials: Current Status and Future Directions. Cancer Epidemiol Biomarkers Prev 2020; 29:1374-1380. [PMID: 32503813 PMCID: PMC7334076 DOI: 10.1158/1055-9965.epi-19-1616] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 03/03/2020] [Accepted: 04/07/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Although there are considerable racial and ethnic disparities in prostate cancer incidence and mortality in the United States and globally, clinical trials often do not reflect disease incidence across racial and ethnic subgroups. This study aims to comprehensively review the reporting of race and ethnicity data and the representation of race and ethnicity across prostate cancer treatment-, prevention-, and screening-based clinical trials. METHODS Seventy-two global phase III and IV prevention, screening, and treatment prostate cancer clinical trials with enrollment start dates between 1987 and 2016 were analyzed in this study, representing a total of 893,378 individual trial participants. Availability and representation of race and ethnicity data by trial funding type, temporal changes in the racial/ethnic diversity of participants, and geographic representation of countries were assessed. RESULTS Of the 72 trials analyzed, 59 (81.9%) had available race data, and 11 (15.3%) of these trials additionally reported ethnicity. Of the trials reporting data, participants were overwhelmingly white men (with the highest proportion in U.S. nonpublicly funded trials), comprising over 96% of the study population. The proportion of white participants in prostate cancer clinical trials has remained at over 80% since 1990. Geographically, Africa and the Caribbean were particularly underrepresented with only 3% of countries included. CONCLUSIONS Trial participants continue to be majority white despite the known racial disparities in prostate cancer clinical outcomes. IMPACT Current and future trials must use novel recruitment strategies to ensure enrollment of underrepresented men. Targeting the inclusion of African and Caribbean medical centers is crucial to achieve equity in representation.
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Affiliation(s)
- Emily M Rencsok
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
- Harvard-MIT Division of Health Sciences and Technology, Harvard Medical School, Boston, Massachusetts
| | - Latifa A Bazzi
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Rana R McKay
- Department of Oncology, University of California San Diego Moores Cancer Center, La Jolla, California
| | - Franklin W Huang
- Department of Hematology and Oncology, University of California San Francisco, San Francisco, California
| | - Adam Friedant
- Prostate Cancer Clinical Trials Consortium, New York, New York
| | - Jake Vinson
- Prostate Cancer Clinical Trials Consortium, New York, New York
| | - Samuel Peisch
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jelani C Zarif
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | - Philip W Kantoff
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elisabeth Heath
- Department of Oncology, Wayne State University Karmanos Cancer Institute, Detroit, Michigan
| | | | - Lorelei A Mucci
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Niranjan SJ, Durant RW, Wenzel JA, Cook ED, Fouad MN, Vickers SM, Konety BR, Rutland SB, Simoni ZR, Martin MY. Training Needs of Clinical and Research Professionals to Optimize Minority Recruitment and Retention in Cancer Clinical Trials. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:26-34. [PMID: 28776305 PMCID: PMC5797508 DOI: 10.1007/s13187-017-1261-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The study of disparities in minority recruitment to cancer clinical trials has focused primarily on inquiries among minority patient populations. However, clinical trial recruitment is complex and requires a broader appreciation of the multiple factors that influence minority participation. One area that has received little attention is minority recruitment training for professionals who assume various roles in the clinical trial recruitment process. Therefore, we assessed the perspectives of cancer center clinical and research personnel on their training and education needs toward minority recruitment for cancer clinical trials. Ninety-one qualitative interviews were conducted at five U.S. cancer centers among four stakeholder groups: cancer center leaders, principal investigators, referring clinicians, and research staff. Interviews were recorded and transcribed. Qualitative analyses focused on response data related to training for minority recruitment for cancer clinical trials. Four prominent themes were identified: (1) Research personnel are not currently being trained to focus on recruitment and retention of minority populations; (2) Training for minority recruitment and retention provides for a specific focus on factors influencing minority research participation; (3) Training on cultural awareness may help to bridge cultural gaps between potential minority participants and research professionals; (4) Views differ regarding the importance of research personnel training designed to focus on recruitment of minority populations. There is a lack of systematic training for minority recruitment. Many stakeholders acknowledged the benefits of minority recruitment training and welcomed training that focuses on increasing cultural awareness to increase the participation of minorities in cancer clinical trials.
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Affiliation(s)
| | | | | | - Elise D Cook
- University of Texas M.D. Anderson Cancer Center, Bastrop, TX, USA
| | - Mona N Fouad
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | | | - Michelle Y Martin
- Center for Innovation in Health Equity Research (CIHER): A Community Cancer Alliance for Transformative Change, Department of Preventive Medicine, University of Tennessee Health Science Center, 467 Doctors Office Building, 66 North Pauline Street, Memphis, TN, 381632181, USA.
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10
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Kelpin SS, Ondersma SJ, Weaver M, Svikis DS. Representativeness of patients enrolled in a primary care clinical trial for heavy/problem substance use. Subst Abus 2018; 39:469-475. [PMID: 30373488 DOI: 10.1080/08897077.2018.1526843] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The extent to which participants in randomized clinical trials (RCTs) resemble their broader target groups is of particular concern when studying stigmatized conditions such as substance use disorders (SUDs). The present study compared patients who enrolled in a 4-arm clinical trial of SBIRT (screening, brief intervention, and referral to treatment) with eligible patients who declined study participation. METHODS Participants (N = 1338) were primary care patients who anonymously completed a computer-delivered health survey and screened positive for heavy/problem alcohol or drug use. Those who consented to the RCT (n = 713) were compared with those who declined (n = 625) on a variety of demographic, substance use, and psychosocial characteristics. Variables significant at P < .20 in univariate analyses were then examined using multivariate logistic regression to determine their combined effect. RESULTS The sample was 60% female and 76% African American, with a mean age of 45.2 years. Patients who consented to participate differed from those who declined on 34 (60%) of the 57 variables studied. The most parsimonious model by multivariate regression found that those who consented were older, more likely to be unemployed, and more likely to endorse prescription drug misuse, problems related to drug use, family history of alcohol problems, trouble falling asleep, and a health professional recommendation to lose weight. CONCLUSION Patients consenting to the RCT reported a greater number and more severe psychosocial and mental health problems than those who declined study participation. If the higher level of risk among study participants was found in other studies as well, it would raise questions regarding the generalizability of RCT results to broader clinic samples.
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Affiliation(s)
- Sydney S Kelpin
- a Department of Psychology , Virginia Commonwealth University , Richmond , Virginia , USA
| | - Steven J Ondersma
- b Merrill-Palmer Skillman Institute and Department of Psychiatry & Behavioral Neurosciences , Wayne State University , Detroit , Michigan , USA.,c Department of Obstetrics & Gynecology , Wayne State University , Detroit , Michigan , USA
| | - Michael Weaver
- d Center for Neurobehavioral Research on Addiction , The University of Texas Health Science Center at Houston , Houston , Texas , USA
| | - Dace S Svikis
- a Department of Psychology , Virginia Commonwealth University , Richmond , Virginia , USA.,e Institute for Women's Health , Virginia Commonwealth University , Richmond , Virginia , USA
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11
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Radecki Breitkopf C, Williams KP, Ridgeway JL, Parker MW, Strong-Simmons A, Hayes SN, Halyard MY. Linking Education to Action: A Program to Increase Research Participation Among African American Women. J Womens Health (Larchmt) 2018; 27:1242-1249. [PMID: 29975586 DOI: 10.1089/jwh.2017.6791] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Underrepresentation of African American women as research participants contributes to health disparities. Contemporary studies have focused on clinical trial (CT) participation; epidemiologic and genetic studies utilizing medical records and/or biological samples have received less attention. In partnership with The Links, Incorporated (The Links), a national service organization of professional African American women, this study sought to examine attitudes regarding chart review (CR) studies, genetic studies/biobanking (GEN), and CTs; develop; and evaluate an online education-to-action program. METHODS In phase 1, focus groups were convened with members of The Links to inform the content and format of the program. Phases 2 and 3 involved designing and evaluating the program, respectively. RESULTS Thirty-four women across three focus groups shared attitudes and perceptions regarding research and provided guidance for program development. Subsequently, 244 women completed the program (77% response rate), including pre- and post-assessments. Participants indicating that they "definitely" or "probably" (responses combined) intend to participate in research increased from 36.5% to 69.3% (pre/post-program). Agreement with the statement "research in the U.S. is ethical" increased (52.9% to 74.4%) as did factual knowledge regarding each of the study types. There was a decrease in reporting "little or no understanding" of study types (Pre/Post: GEN: 66%/24.9%, CR: 62.9%/18.4%, CTs: 40.7%/15.5%). Pre-program, few were "very positive" about the study types (14.3% GEN, 15.0% CR, 28.6% CTs); post-program ratings increased and equalized (42.8% GEN, 43.0% CR, 42.5% CTs). CONCLUSIONS An online education-to-action program targeting professional African American women improved knowledge, perceptions of ethics, and intent to participate in biomedical research.
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Affiliation(s)
| | - Karen Patricia Williams
- 2 College of Nursing, The Ohio State University , Columbus, Ohio.,3 The Links, Incorporated, Washington, Distict of Columbia
| | - Jennifer L Ridgeway
- 4 Kern Center for the Science of Health Care Delivery, Mayo Clinic , Rochester, Minnesota
| | - Monica W Parker
- 3 The Links, Incorporated, Washington, Distict of Columbia.,5 Department of Neurology, Emory University , Atlanta, Georgia
| | | | - Sharonne N Hayes
- 6 Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic , Rochester, Minnesota
| | - Michele Y Halyard
- 3 The Links, Incorporated, Washington, Distict of Columbia.,7 Department of Radiation Oncology, Mayo Clinic , Scottsdale, Arizona
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Lee SB, Zak A, Iversen MD, Polletta VL, Shadick NA, Solomon DH. Participation in Clinical Research Registries: A Focus Group Study Examining Views From Patients With Arthritis and Other Chronic Illnesses. Arthritis Care Res (Hoboken) 2017; 68:974-80. [PMID: 26474187 DOI: 10.1002/acr.22767] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 09/16/2015] [Accepted: 10/13/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Patient registries have contributed substantially to progress in clinical research in rheumatic diseases. However, not much is known about how to optimize the patient experience in such registries. We assessed patient views, motivations, and potential barriers towards participation in registry research to better understand how registries can be improved to maximize patient engagement. METHODS Focus groups were held with 23 patients (mean ± SD age 59 ± 13 years) from the Boston area and led by a bilingual moderator trained in focus group methodology, using a semistructured moderator guide. Three separate focus groups were conducted to thematic saturation: patients with rheumatoid arthritis (RA) who had registry experience, patients with any chronic illness, and Spanish-speaking patients with RA or osteoarthritis. Patients in the latter 2 groups had no prior registry experience. Focus groups were audiotaped and transcribed. Four researchers independently analyzed transcripts using open data coding to identify themes. A normative group process was used to consolidate and refine themes. RESULTS Seven major themes were identified, including personalization/convenience of data collection, trust and confidentiality, camaraderie, learning about yourself and your disease, altruism, material motivators, and capturing mental health and other elements of the lived experience. We observed distinct differences in the discussion content of the Spanish-speaking patients compared to the English-speaking patients. CONCLUSION This study identified patient attitudes towards registry research among those with and without prior experience in a registry. The results provide insight into strategies for registry design to maximize patient engagement, which can lead to more robust registry data.
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Affiliation(s)
- Sara B Lee
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Agnes Zak
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Maura D Iversen
- Brigham and Women's Hospital, Northeastern University, and Harvard University, Boston, Massachusetts
| | | | - Nancy A Shadick
- Brigham and Women's Hospital and Harvard University, Boston, Massachusetts
| | - Daniel H Solomon
- Brigham and Women's Hospital and Harvard University, Boston, Massachusetts
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13
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Alexander GL, Dixit-Joshi S, Kushi LH, Coleman LA, Sundaram ME, Clancy HA, Groesbeck M, Potischman NA, Kirkpatrick SI, Zimmerman TP, George SM, Subar AF, Thompson FE. Comparison of recruitment and retention among demographic subgroups in a large diverse population study of diet. Contemp Clin Trials Commun 2017; 6:140-146. [PMID: 28752133 PMCID: PMC5523981 DOI: 10.1016/j.conctc.2017.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective We examined the feasibility of conducting a longitudinal study of diet among diverse populations by comparing rates of response throughout recruitment and retention phases by demographic and other characteristics. Methods Using quota sampling, participants were recruited from 3 geographically and demographically diverse integrated health systems in the United States. Overall, 12,860 adults, ages 20–70, were invited to participate via mail. Participation first required accessing the study's website and later meeting eligibility criteria via telephone interview. Enrollees were asked to provide two 24-h dietary recalls, either interviewer-administered or self-administered on the web, over 6 weeks. Stepped monetary incentives were provided. Results Rates for accessing the study website ranged from 6% to 23% (9% overall) across sites. Site differences may reflect differences in recruitment strategy or target samples. Of those accessing the website, enrollment was high (≥87%). Of the 1185 enrollees, 42% were non-Hispanic white, 34% were non-Hispanic black, and 24% were Hispanic. Men and minorities had lower enrollment rates than women and non-Hispanic whites, partially due to less successful telephone contact for eligibility screening. Once enrolled, 90% provided 1 recall and 80% provided both. Women had higher retention rates than men, as did older compared to younger participants. Retention rates were similar across race/ethnicity groups. Conclusions While study recruitment remains challenging, once recruited most participants, regardless of race/ethnicity, completed two 24-h dietary recalls, both interviewer-administered and self-administered on the web. This study demonstrates the feasibility of collecting multiple 24-h recalls including less expensive automated self-administered recalls among diverse populations.
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Affiliation(s)
- Gwen L Alexander
- Henry Ford Health System, Department of Public Health Sciences, 1 Ford Place, Detroit, MI 48202, USA
| | - Sujata Dixit-Joshi
- Health Studies Section, Westat, 1600 Research Boulevard, Rockville, MD, USA
| | - Lawrence H Kushi
- Kaiser-Permanente, Division of Research, 2000 Broadway, Oakland, CA, USA
| | - Laura A Coleman
- Marshfield Clinic Research Foundation, Epidemiology Research Center, 1000 North Oak Avenue, Marshfield, WI, USA
| | - Maria E Sundaram
- Marshfield Clinic Research Foundation, Epidemiology Research Center, 1000 North Oak Avenue, Marshfield, WI, USA
| | - Heather A Clancy
- Kaiser-Permanente, Division of Research, 2000 Broadway, Oakland, CA, USA
| | - Michelle Groesbeck
- Henry Ford Health System, Department of Public Health Sciences, 1 Ford Place, Detroit, MI 48202, USA
| | - Nancy A Potischman
- National Cancer Institute, Division of Cancer Control and Population Sciences, 9609 Medical Center Drive, Rockville, MD, USA
| | - Sharon I Kirkpatrick
- National Cancer Institute, Division of Cancer Control and Population Sciences, 9609 Medical Center Drive, Rockville, MD, USA
| | - Thea P Zimmerman
- Health Studies Section, Westat, 1600 Research Boulevard, Rockville, MD, USA
| | - Stephanie M George
- National Cancer Institute, Division of Cancer Control and Population Sciences, 9609 Medical Center Drive, Rockville, MD, USA
| | - Amy F Subar
- National Cancer Institute, Division of Cancer Control and Population Sciences, 9609 Medical Center Drive, Rockville, MD, USA
| | - Frances E Thompson
- National Cancer Institute, Division of Cancer Control and Population Sciences, 9609 Medical Center Drive, Rockville, MD, USA
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14
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Stein MA, Shaffer M, Echo-Hawk A, Smith J, Stapleton A, Melvin A. Research START: A Multimethod Study of Barriers and Accelerators of Recruiting Research Participants. Clin Transl Sci 2015; 8:647-54. [PMID: 26643413 DOI: 10.1111/cts.12351] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Under-recruitment into clinical trials is a common and costly problem that undermines medical research. To better understand barriers to recruitment into clinical trials in our region, we conducted a multimethod descriptive study. We initially surveyed investigators who had conducted or were currently conducting studies that utilized an adult or pediatric clinical research center (n = 92). We then conducted focus groups and key informant interviews with investigators, coordinators, and other stakeholders in clinical and translational research (n = 32 individuals). Only 41% of respondents reported that they had or were successfully meeting recruitment goals and 24% of the closed studies actually met their targeted recruitment goals. Varied reasons were identified for poor recruitment but there was not a single investigator or study "phenotype" that predicted enrollment outcome. Investigators commonly recruited from their own practice or clinic, and 29% used a manual electronic medical record search. The majority of investigators would utilize a service that provides recruitment advice, including feasibility assessment and consultation, easier access to the electronic health record and assistance with institutional review board and other regulatory requirements. Our findings suggest potential benefits providing assistance across a range of services that can be individualized to the varied needs of clinical and translational investigators.
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Affiliation(s)
- Mark A Stein
- Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | - Michele Shaffer
- Seattle Children's Research Institute, University of Washington, Seattle, Washington, USA
| | - Abigail Echo-Hawk
- Institute of Translational Health Sciences, University of Washington, Institute of Translational Health Sciences, Seattle, Washington, USA
| | - Jody Smith
- Institute of Translational Health Sciences, University of Washington, Institute of Translational Health Sciences, Seattle, Washington, USA
| | - Ann Stapleton
- Institute of Translational Health Sciences, University of Washington, Institute of Translational Health Sciences, Seattle, Washington, USA
| | - Ann Melvin
- Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
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15
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Yanez B, McGinty HL, Mohr DC, Begale MJ, Dahn JR, Flury SC, Perry KT, Penedo FJ. Feasibility, acceptability, and preliminary efficacy of a technology-assisted psychosocial intervention for racially diverse men with advanced prostate cancer. Cancer 2015; 121:4407-15. [PMID: 26348661 DOI: 10.1002/cncr.29658] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/20/2015] [Accepted: 08/03/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND The utility of psychosocial interventions in reducing symptom burden and improving health-related quality of life (HRQOL) for men with localized prostate cancer has been demonstrated. However, studies have yet to demonstrate the efficacy of interventions in advanced prostate cancer (APC). This study examined the feasibility, acceptability, and preliminary efficacy of a technology-assisted, 10-week, group-based psychosocial intervention for diverse men with APC. METHODS The participants were 74 men (mean age, 68.84 years; non-Hispanic white, 57%; black, 40.5%) who were randomized to a cognitive-behavioral stress management (CBSM) treatment or health promotion (HP) attention-control condition. The participants were assessed at the baseline, weekly throughout the 10-week program, and 6 months after the baseline. Outcomes were assessed with the Patient-Reported Outcomes Measurement Information System along with established measures of HRQOL, CBSM intervention targets (eg, relaxation skills), and patient-reported acceptability. RESULTS Feasibility was demonstrated through good retention rates (>85%) and acceptable average attendance rates (>70%), and acceptability was demonstrated through very favorable weekly session evaluations (mean score, 4/5) and exit surveys (mean score, 3.6/4). Men randomized to the CBSM condition reported significant reductions (P < .05) in depressive symptoms and improvements in relaxation self-efficacy (P < .05) at the 6-month follow-up. CBSM participants reported trends for improvement in distress and functional well-being (P < .08) in comparison with those in the HP condition. Effect sizes ranged from medium (0.54) to large (1.87) and, in some instances, were clinically meaningful. CONCLUSIONS Technology-based CBSM interventions among diverse men with APC may be feasible, acceptable, and efficacious.
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Affiliation(s)
- Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Heather L McGinty
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David C Mohr
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mark J Begale
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jason R Dahn
- Mental Health and Behavioral Sciences Service, Miami Veterans Affairs Healthcare System, Miami, Florida
| | - Sarah C Flury
- Department of Urology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kent T Perry
- Department of Urology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Frank J Penedo
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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16
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Scalici J, Finan MA, Black J, Harmon MD, Nicolson W, Lankes HA, Brady WE, Rocconi RP. Minority participation in Gynecologic Oncology Group (GOG) Studies. Gynecol Oncol 2015; 138:441-4. [PMID: 26013697 PMCID: PMC4670048 DOI: 10.1016/j.ygyno.2015.05.014] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 05/19/2015] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Participation of minority populations in clinical trials is paramount to understanding and overcoming cancer racial disparities. The goal of this project is to evaluate minority participation in published GOG clinical trials. METHODS GOG publications from 1985 to 2013 were reviewed. Minority enrollment was stratified by tumor site, type of study, and year published. Based on Centers of Disease Control and Prevention (CDC) age-adjusted incidence for race, expected and observed ratios of racial participation were calculated. RESULTS A total of 445 GOG publications involving 67,568 patients were reviewed. Racial breakdown was provided in 170 studies (38%) for a total of 45,259 patients: 83% White (n=37,617); 8% Black (n=3,686), and 9% Other (n=3,956). The majority of studies were Ovarian (n=202) and Phase 2 (n=290). When evaluating the quartiles of publication year, a steady decline in the proportion of Black patients enrolled was seen. Race was not reported in any publication prior to 1994. Compared to years 1994-2002, a 2.8-fold lower proportion of black enrollment was noted in years 2009-2013 (16% and 5.8%, respectively; p<0.01). Utilizing CDC age-adjusted incidence, observed enrollment of Black patients onto GOG clinical trials was significantly less than expected enrollment. Observed Black enrollment was 15-fold lower than expected for ovarian trials, 10-fold lower for endometrial, 4.5-fold for cervix, and 5.2-fold for sarcoma (each p<0.001). CONCLUSIONS Based on age-adjusted incidence, observed enrollment of Black patients was lower than expected enrollment onto GOG studies. Despite national emphasis on minority enrollment on clinical trials, fewer Black patients were enrolled over time.
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Affiliation(s)
- Jennifer Scalici
- University of South Alabama Mitchell Cancer Institute, Mobile, AL, USA
| | - Michael A Finan
- University of South Alabama Mitchell Cancer Institute, Mobile, AL, USA
| | - Jennifer Black
- University of South Alabama Mitchell Cancer Institute, Mobile, AL, USA
| | | | - William Nicolson
- University of South Alabama Mitchell Cancer Institute, Mobile, AL, USA
| | | | | | - Rodney P Rocconi
- University of South Alabama Mitchell Cancer Institute, Mobile, AL, USA.
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Behrendt CE, Hurria A, Tumyan L, Niland JC, Mortimer JE. Socioeconomic and clinical factors are key to uncovering disparity in accrual onto therapeutic trials for breast cancer. J Natl Compr Canc Netw 2015; 12:1579-85. [PMID: 25361805 DOI: 10.6004/jnccn.2014.0158] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To monitor and address disparity in accrual, patient participation in cancer clinical trials is routinely summarized by race/ethnicity. To investigate whether confounding obscures racial/ethnic disparity in participation, all women with breast cancer treated by medical oncologists at City of Hope Comprehensive Cancer Center from 2004 through 2009 were classified by birthplace and self-reported race/ethnicity, and followed for accrual onto therapeutic trials through 2010. Undetectable on univariate analysis, significantly reduced participation by subjects of African, Asian, Eastern European, Latin American, and Middle Eastern ancestries was revealed after accounting for age, socioeconomic factors, tumor and oncologist characteristics, and intrapractice clustering of patients.
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Affiliation(s)
- Carolyn E Behrendt
- From the Departments of Information Sciences, Medical Oncology, and Diagnostic Radiology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Arti Hurria
- From the Departments of Information Sciences, Medical Oncology, and Diagnostic Radiology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Lusine Tumyan
- From the Departments of Information Sciences, Medical Oncology, and Diagnostic Radiology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Joyce C Niland
- From the Departments of Information Sciences, Medical Oncology, and Diagnostic Radiology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Joanne E Mortimer
- From the Departments of Information Sciences, Medical Oncology, and Diagnostic Radiology, City of Hope Comprehensive Cancer Center, Duarte, California
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Cupertino AP, Saint-Elin M, de Los Rios JB, Engelman KK, Greiner KA, Ellerbeck EF, Nápoles AM. Empowering Promotores de Salud as partners in cancer education and research in rural southwest Kansas. Oncol Nurs Forum 2015; 42:15-22. [PMID: 25542317 PMCID: PMC4349504 DOI: 10.1188/15.onf.15-22] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To describe community-based participatory processes used to develop promotore training on cancer research, and to assess the feasibility of training promotores from rural communities to disseminate cancer research information. DESIGN Prospective, cohort design. SETTING Rural communities in the state of Kansas. SAMPLE 34 Spanish-speaking promotores attended an information session; 27 enrolled and 22 completed training. METHODS With input from a community advisory board, the authors developed a leadership and cancer curriculum and trained Spanish-speaking promotores to disseminate information on cancer research. Promotores completed pretraining and post-training surveys in Spanish to assess demographic characteristics and changes in knowledge of cancer, cancer treatment and cancer research studies, and intent to participate in cancer research. MAIN RESEARCH VARIABLES Cancer knowledge, awareness of cancer clinical trials, interest in participating in cancer clinical research studies. FINDINGS Compared to pretraining, after training, promotores were more likely to correctly define cancer, identify biopsies, describe cancer stages, and report ever having heard of cancer research studies. CONCLUSIONS Completion rates of the training and willingness to participate in cancer research were high, supporting the feasibility of training promotores to deliver community-based education to promote cancer research participation. IMPLICATIONS FOR NURSING Nursing professionals and researchers can collaborate with promotores to disseminate cancer education and research among underserved rural Latino communities in Kansas and elsewhere. Members of these communities appear willing and interested in improving their knowledge of cancer and cancer clinical trials.
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Affiliation(s)
- Ana Paula Cupertino
- Department of Preventive Medicine and Public Health, Kansas University Medical Center (KUMC)
| | | | | | | | | | | | - Anna M Nápoles
- Department of Medicine, University of California, San Francisco
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Braun KL, Stewart S, Baquet C, Berry-Bobovski L, Blumenthal D, Brandt HM, Buchwald DS, Campbell JE, Coe K, Cooper LC, Espinoza P, Henry-Tillman R, Hargreaves M, James A, Salmon Kaur J, Viswanath K, Ma GX, Mandelblatt J, Meade C, Ramirez A, Scarinci I, Park Tanjasiri S, Thompson B, Vines AI, Dignan M. The National Cancer Institute's Community Networks Program Initiative to Reduce Cancer Health Disparities: Outcomes and Lessons Learned. Prog Community Health Partnersh 2015; 9 Suppl:21-32. [PMID: 26213401 PMCID: PMC4698458 DOI: 10.1353/cpr.2015.0017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND We describe reach, partnerships, products, benefits, and lessons learned of the 25 Community Network Programs (CNPs) that applied community-based participatory research (CBPR) to reduce cancer health disparities. METHODS Quantitative and qualitative data were abstracted from CNP final reports. Qualitative data were grouped by theme. RESULTS Together, the 25 CNPs worked with more than 2,000 academic, clinical, community, government, faith-based, and other partners. They completed 211 needs assessments, leveraged funds for 328 research and service projects, trained 719 new investigators, educated almost 55,000 community members, and published 991 articles. Qualitative data illustrated how use of CBPR improved research methods and participation; improved knowledge, interventions, and outcomes; and built community capacity. Lessons learned related to the need for time to nurture partnerships and the need to attend to community demand for sustained improvements in cancer services. IMPLICATIONS Findings demonstrate the value of government-supported, community-academic, CBPR partnerships in cancer prevention and control research.
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20
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Odulana A, Kim MM, Green M, Taylor Y, Howard DL, Godley P, Corbie-Smith G. Participating in research: attitudes within the African American church. JOURNAL OF RELIGION AND HEALTH 2014; 53:373-81. [PMID: 22886179 PMCID: PMC4419576 DOI: 10.1007/s10943-012-9637-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We assessed associations between pastor and congregant characteristics and congregant attitudes about research participation among African American churches. Respondents shared their attitudes regarding how willing, ready, and confident they were about research participation. The outcome measure, the index of research preparedness, summed responses across the domains of willingness, readiness, and confidence. Pastor age and pastor educational attainment were independently associated with a congregants' higher index of research preparedness. Young and educated pastors were significantly associated with congregant attitudes about participation preparedness, a finding that highlights the importance of the pastor regarding congregant research participation decisions.
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Affiliation(s)
- Adebowale Odulana
- Division of General Medicine & Clinical Epidemiology and Division of General Pediatrics and Adolescent Medicine, University of North Carolina at Chapel Hill, 5034 Old Clinic, CB 7100, Chapel Hill, NC, 27599, USA,
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21
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Ma GX, Tan Y, Blakeney NC, Seals BF, Ma XS, Zhai S, Liu A, Tai Y, Michaels M. The impact of a community-based clinical trial educational intervention among underrepresented Chinese Americans. Cancer Epidemiol Biomarkers Prev 2013; 23:424-32. [PMID: 24092627 DOI: 10.1158/1055-9965.epi-13-0773] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Clinical trials are a critical resource for the discovery of new prevention, diagnostic, and treatment methods for cancer. The most effective prevention and treatment modalities are based on previous clinical trial results. However, participation in clinical trials is underrepresented by racial/ethnic minority populations, Asian Americans in particular. Asian Americans are the least represented of any ethnic groups in clinical trials. The purpose of this study is to develop and evaluate a culturally and linguistically appropriate community-based educational intervention to increase knowledge of and intent to participate in cancer clinical trials among underrepresented Chinese Americans. METHODS Community-Based Participatory Research approach was used to guide the development, cultural tailoring, implementation, and evaluation of clinical trial intervention. First, 22 Asian community representatives were recruited as community health educators (CHE) who received 12-hour training on clinical trial education. Second, 262 members were recruited from 11 Chinese community organizations. Of those recruited, a total of 247 eligible Chinese enrolled and participated in the clinical trial education delivered by trained CHEs. Participants completed pretest before and posttest after the intervention. RESULTS Fifteen of 21 measures of clinical trial knowledge showed significant changes post the intervention (P < 0.05). Education remained the sole demographic factor increasing clinical trial knowledge in multivariate analysis. CONCLUSION Clinical trial education should emphasize both benefits to science and the larger Asian community. This community-based clinical trial intervention demonstrated promising results and has potential to enhance recruitment and participation in clinical trial research among the underrepresented Asian Americans. IMPACT Improving clinical trial participation in the fast-growing Asian American population is key to dissemination of health innovations targeted to diminish health disparities.
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Affiliation(s)
- Grace X Ma
- Authors' Affiliations: Center for Asian Health, Department of Public Health, College of Health Professions, School of Medicine, Temple University; Asian Health Trilogy, Philadelphia, Pennsylvania; Education Network to Advance Cancer Clinical Trials (NACCT), Bethesda, Maryland; and Boston University School of Public Health, Boston, Massachusetts
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