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Luningham JM, Akpan IN, Alkhatib S, Taskin T, Desai P, Vishwanatha JK, Thompson EL. COVID-19 clinical trial participation and awareness in Texas. Hum Vaccin Immunother 2024; 20:2340692. [PMID: 38658140 PMCID: PMC11057562 DOI: 10.1080/21645515.2024.2340692] [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] [Received: 08/28/2023] [Accepted: 04/04/2024] [Indexed: 04/26/2024] Open
Abstract
The COVID-19 pandemic required the rapid development of COVID-19 vaccines and treatments, necessitating quick yet representative clinical trial enrollment to evaluate these preventive measures. However, misinformation around the COVID-19 pandemic and general concerns about clinical trial participation in the U.S. hindered clinical trial enrollment. This study assessed awareness of, willingness to participate in, and enrollment in COVID-19 vaccine and treatment clinical trials in Texas. A quota sample of 1,089 Texas residents was collected online from June - July 2022. Respondents were asked if they were aware of, willing to participate in, and had enrolled in clinical trials for COVID-19 vaccines or treatments. Overall, 45.8% of respondents reported being aware of clinical trials for COVID-19 treatments or vaccines, but only 21.7% knew how to enroll and only 13.2% had enrolled in a COVID-19 clinical trial. Respondents with bachelor's or graduate degrees were more likely to be aware of clinical trials, more likely to have enrolled in trials, and more willing to participate in treatment trials. Women were less willing to participate and less likely to have enrolled in COVID-19 clinical trials than men. Respondents aged 55 years and older were more willing to participate, but less likely to have enrolled in COVID-19 clinical trials than 18-to-24-year-olds. Common reasons given for not participating in clinical trials included concerns that COVID-19 treatments may not be safe, government distrust, and uncertainty about what clinical trial participation would entail. Substantial progress is needed to build community awareness and increase enrollment in clinical trials.
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Affiliation(s)
- Justin M. Luningham
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, USA
| | - Idara N. Akpan
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, USA
| | - Sarah Alkhatib
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, USA
| | - Tanjila Taskin
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, USA
| | - Palak Desai
- Institute for Health Disparities, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, USA
| | - Jamboor K. Vishwanatha
- Institute for Health Disparities, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, USA
| | - Erika L. Thompson
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, USA
- Institute for Health Disparities, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, USA
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Fortunato MP, Girard A, Coratti S, Farraday D, Norton L, Rareshide C, Zhu J, Chokshi N, Szymczak JE, Klaiman T, Russell LB, Small DS, Patel MS, Volpp KGM, Fanaroff AC. Investigating racial and gender disparities in virtual randomized clinical trial enrollment: Insights from the BE ACTIVE study. Am Heart J 2024; 276:120-124. [PMID: 39182941 DOI: 10.1016/j.ahj.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/11/2024] [Accepted: 06/11/2024] [Indexed: 08/27/2024]
Abstract
Randomized clinical trials (RCTs) often suffer from a lack of representation from historically marginalized populations, and it is uncertain whether virtual RCTs (vRCTs) enhance representativeness or if elements of their consent and enrollment processes may instead contribute to underrepresentation of these groups. In this study, we aimed to identify disparities in enrollment demographics in a vRCT, the BE ACTIVE study, which recruited patients within a single health system. We discovered that the proportions of eligible patients who were randomized differed significantly by gender and race/ethnicity (men 1.2%, women 2.0%, P < .001; White 1.8%, Black 1.3%, Hispanic 0.7%, Asian 0.9%; P < .001), and compared with White patients, non-White patients were less likely to have a valid email address on file and were less likely to click on the email link to the study webpage and begin enrollment.
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Affiliation(s)
| | - Anthony Girard
- University of Pennsylvania Center for Health Incentives and Behavioral Economics, Philadelphia, PA
| | - Samantha Coratti
- University of Pennsylvania Center for Health Incentives and Behavioral Economics, Philadelphia, PA
| | - David Farraday
- University of Pennsylvania Center for Health Incentives and Behavioral Economics, Philadelphia, PA
| | - Laurie Norton
- University of Pennsylvania Center for Health Incentives and Behavioral Economics, Philadelphia, PA; Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA
| | - Charles Rareshide
- University of Pennsylvania Center for Health Incentives and Behavioral Economics, Philadelphia, PA
| | - Jingsan Zhu
- University of Pennsylvania Center for Health Incentives and Behavioral Economics, Philadelphia, PA; Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA; Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Neel Chokshi
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA; Penn Center for Digital Cardiology, University of Pennsylvania, Philadelphia, PA
| | - Julia E Szymczak
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Tamar Klaiman
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA; Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Louise B Russell
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA; Penn Center for Digital Cardiology, University of Pennsylvania, Philadelphia, PA
| | - Dylan S Small
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA; The Wharton School, University of Pennsylvania, Philadelphia, PA
| | | | - Kevin G M Volpp
- University of Pennsylvania Center for Health Incentives and Behavioral Economics, Philadelphia, PA; Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA; Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA; The Wharton School, University of Pennsylvania, Philadelphia, PA
| | - Alexander C Fanaroff
- University of Pennsylvania Center for Health Incentives and Behavioral Economics, Philadelphia, PA; Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA; Penn Center for Digital Cardiology, University of Pennsylvania, Philadelphia, PA.
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3
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Hawke LJ, Nelson E, O'Brien P, Crossley KM, Choong PF, Bunzli S, Dowsey MM. Influences on clinical trial participation: Enhancing recruitment through a gender lens - A scoping review. Contemp Clin Trials Commun 2024; 38:101283. [PMID: 38456181 PMCID: PMC10918492 DOI: 10.1016/j.conctc.2024.101283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/05/2024] [Accepted: 02/28/2024] [Indexed: 03/09/2024] Open
Abstract
Background Suboptimal clinical trial recruitment contributes to research waste. Evidence suggests there may be gender-based differences in willingness to participate in clinical research. Identifying gender-based differences impacting the willingness of trial participation may assist trial recruitment. Objectives To examine factors that influence the willingness of men and women to participate in clinical trials and to identify modifiable factors that may be targeted to optimise trial participation. Material and methods Electronic databases were searched with key words relating to 'gender', 'willingness to participate' and 'trial'. Included studies were English language and reported gender-based differences in willingness to participate in clinical trials, or factors that influence a single gender to participate in clinical trials. Studies were excluded if they described the demographic factors of trial participants or if the majority of participants were pregnant. Extracted data were coded, categorized, analysed thematically and interpreted using Arksey and O'Malley's framework. Results Sixty-three studies were included. Two main themes were identified: trial characteristics and participant characteristics. A number of gender-based differences moderating willingness to participate were observed although only one, 'concern for self' was found to influence actual trial participation rates between genders. Conclusion The relationship between factors influencing willingness to participate in clinical trials is complex. The influence of gender on willingness to participate, while important, may be moderated by other factors including socioeconomic status, ethnicity and health condition. Exploring factors that influence willingness to participate specific to a study cohort likely offers the most promise to optimise trial recruitment of that cohort.
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Affiliation(s)
- Lyndon J. Hawke
- University of Melbourne, Department of Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Elizabeth Nelson
- University of Melbourne, Department of Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Penny O'Brien
- University of Melbourne, Department of Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Kay M. Crossley
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Peter F. Choong
- University of Melbourne, Department of Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Samantha Bunzli
- School of Health Sciences and Social Work, Griffith University, Nathan Campus, Queensland, Australia
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Michelle M. Dowsey
- University of Melbourne, Department of Surgery, St Vincent's Hospital, Fitzroy, Victoria, Australia
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Martin-Willett R, Stanger M, James W, Bryan AD, Bidwell LC. Effects of historical inequity and institutional power on cannabis research: Moving toward equity and inclusion. PNAS NEXUS 2023; 2:pgad383. [PMID: 38089600 PMCID: PMC10715194 DOI: 10.1093/pnasnexus/pgad383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/29/2023] [Indexed: 12/23/2023]
Abstract
Given historical inequities in cannabis laws and policies, there is an obligation on the part of researchers and policy makers to actively work toward improving equity in cannabis research at a time when the field is rapidly expanding. We wish to propose a way forward for cannabis research that acknowledges this history of discrimination and misuse of institutional power and embraces equity and inclusion. This article provides a brief perspective on historical drug policy, recent legalization trends that have disproportionately benefitted some groups over others, and the repercussions of those trends for the cannabis research enterprise. In addition, it proposes five key actions in both policy and research domains that are necessary to move the field of cannabis research, and perhaps biomedical research in substance use more broadly, forward in a productive and inclusionary way. Specifically, recommendations focus on equity-focused legislation and policy, supporting the entry and retention of scientists of color into the field, engaging in more ethical research practices, and practicing intentionally inclusive recruitment of participants will help to move the field of cannabis research forward. These efforts will ensure that scientific gains are shared equitably moving forward.
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Affiliation(s)
- Renée Martin-Willett
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO 80309, USA
| | - Madeline Stanger
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO 80309, USA
| | - Wanda James
- University of Colorado Board of Regents, 1st Congressional District, Denver, CO 80203, USA
| | - Angela D Bryan
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO 80309, USA
| | - L Cinnamon Bidwell
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO 80309, USA
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO 80309, USA
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Miller YM, Bakhtary S, Chou ST, Hailu B, Reik RA, Richard RH, Spencer BR, Witherspoon R, Delaney M. Involvement of Diverse Populations in Transfusion Medicine Research. Transfus Med Rev 2023; 37:150766. [PMID: 37993382 PMCID: PMC11032214 DOI: 10.1016/j.tmrv.2023.150766] [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] [Received: 05/19/2023] [Revised: 08/22/2023] [Accepted: 09/01/2023] [Indexed: 11/24/2023]
Abstract
Communities of color and diverse communities (eg, race, socioeconomic status, language, sexual orientation etc.) have not been recruited and enrolled equitably to participate in research studies in transfusion medicine. The exclusion of diverse communities in transfusion research can lead to health disparities lack of access to approved therapeutics and unequal allocation of interventions, resulting in missed opportunities to optimize health for individuals and communities. Involvement of diverse populations in research goes beyond inclusion as research subjects. Strategies should include specific studies on health conditions of importance to diverse communities with stable funding sources and specific funding announcements to develop projects led by diverse researchers, mentorship of diverse researchers, and openness to various ways of communicating research plans. Qualitative approaches and interdisciplinary collaboration should be supported to enhance inclusivity.
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Affiliation(s)
| | - Sara Bakhtary
- Transfusion Medicine, Department of Laboratory Medicine, University of California San Francisco, USA
| | - Stella T Chou
- Division of Transfusion Medicine, The Children's Hospital of Philadelphia University of Pennsylvania School of Medicine, USA
| | | | | | - Raven Hardy Richard
- National Institutes of Health (NIH) National Human Genome Research Institute (NHGRI), USA
| | | | | | - Meghan Delaney
- Division of Pathology & Laboratory Medicine Children's National Hospital, The George Washington University, USA
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Small SS, Lau E, McFarlane K, Archambault PM, Longstaff H, Hohl CM. Research recruitment and consent methods in a pandemic: a qualitative study of COVID-19 patients' perspectives. BMC Med Res Methodol 2023; 23:113. [PMID: 37170077 PMCID: PMC10173898 DOI: 10.1186/s12874-023-01933-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 04/25/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Virtual data collection methods and consent procedures adopted in response to the COVID-19 pandemic enabled continued research activities, but also introduced concerns about equity, inclusivity, representation, and privacy. Recent studies have explored these issues from institutional and researcher perspectives, but there is a need to explore patient perspectives and preferences. This study aims to explore COVID-19 patients' perspectives about research recruitment and consent for research studies about COVID-19. METHODS We conducted an exploratory qualitative focus group and interview study among British Columbian adults who self-identified as having had COVID-19. We recruited participants through personal contacts, social media, and REACH BC, an online platform that connects researchers and patients in British Columbia. We analyzed transcripts inductively and developed thematic summaries of each coding element. RESULTS Of the 22 individuals recruited, 16 attended a focus group or interview. We found that autonomy and the feasibility of participation, attitudes toward research about COVID-19, and privacy concerns are key factors that influence participants' willingness to participate in research. We also found that participants preferred remote and virtual approaches for contact, consent, and delivery of research on COVID-19. CONCLUSIONS Individuals who had COVID-19 are motivated to participate in research studies and value autonomy in their decision to participate, but researchers must be sensitive and considerate toward patient preferences and concerns, particularly as researchers adopt virtual recruitment and data collection methods. Such awareness may increase research participation and engagement.
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Affiliation(s)
- Serena S Small
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, 828 West 10th Ave, 7th Fl, Vancouver, BC, Canada
| | - Erica Lau
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, 828 West 10th Ave, 7th Fl, Vancouver, BC, Canada
| | | | - Patrick M Archambault
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada
- Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Holly Longstaff
- Provincial Health Services Authority, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Corinne M Hohl
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, 828 West 10th Ave, 7th Fl, Vancouver, BC, Canada.
- Emergency Department, Vancouver General Hospital, Vancouver, BC, Canada.
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7
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Liebowitz A, Spielman DB, Schlosser RJ, Stewart MG, Gudis DA. Demographic Disparities in the Federal Drug Approval Process for Allergic Rhinitis Medications. Laryngoscope 2023; 133:755-763. [PMID: 35394648 DOI: 10.1002/lary.30129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/17/2022] [Accepted: 03/21/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Demographic minorities are underrepresented in clinical trials. For the approval of new drug applications (NDAs), the Food and Drug Administration (FDA) has asserted that clinical trial enrollment should represent the demographics of patients likely to receive the trial drug. The aim of this study is to assess the demographics of clinical trials included in NDAs and biologics license applications (BLAs) approved by the FDA since 1990 for allergic rhinitis (AR), a condition whose demographic prevalence mirrors the US population. METHODS Federal Freedom of Information Act requests were submitted to the US government to obtain documents related to all relevant NDAs and BLAs. The Drugs@FDA database was queried for all clinical trial documentation. Demographic data were extracted from clinical trials used to inform FDA approval for AR pharmacotherapies. Demographics were analyzed relative to national US Census data. RESULTS Since 1990, 22 drugs have been approved for AR. The racial, ethnic, and sex composition of all included study populations differed significantly (p < 0.05) from the demographics of AR and from US Census data. Most NDAs and BLAs included overrepresentation of White participants and underrepresentation of Black, Asian, Pacific Island, Native American, and Hispanic participants. CONCLUSION The patients enrolled in clinical trials used to inform FDA approval for AR pharmacotherapeutics do not represent the demographics of the United States or the demographics of AR. The clinical significance of unrepresentative demography between study and treatment populations has been examined for several medical disorders, but has not been studied for AR. LEVEL OF EVIDENCE 4 Laryngoscope, 133:755-763, 2023.
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Affiliation(s)
- Andi Liebowitz
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, NewYork Presbyterian Hospital, New York, New York, USA
| | - Daniel B Spielman
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, NewYork Presbyterian Hospital, New York, New York, USA
| | - Rodney J Schlosser
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michael G Stewart
- Department of Otolaryngology-Head and Neck Surgery, Weill Medical College, New York, New York, USA
| | - David A Gudis
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Irving Medical Center, NewYork Presbyterian Hospital, New York, New York, USA
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Rambhia PH, Yan BY, Barilla S, Sharon VR. Racial and ethnic diversity in clinical trials of laser treatments for scars. J Am Acad Dermatol 2022; 87:1178-1179. [PMID: 35259452 DOI: 10.1016/j.jaad.2022.02.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/20/2022] [Accepted: 02/15/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Pooja H Rambhia
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Bernice Y Yan
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Steven Barilla
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York
| | - Victoria R Sharon
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York.
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Affiliation(s)
- Dany Habr
- Pfizer OncologyPfizer Inc.New York CityNew YorkUSA
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10
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Cornejo-Torres Y, Boniface E, Lopez E, Gomez-Arboleda K, Darney BG. Willingness to Participate in Health Research: Mexican and Mexican American Women's Perspectives. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2022; 3:785-794. [PMID: 36204480 PMCID: PMC9531884 DOI: 10.1089/whr.2022.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/17/2022] [Indexed: 11/13/2022]
Abstract
Background Lack of racial and ethnic diversity in health research negatively impacts generalizability. We describe Mexican and Mexican American women's willingness to participate in health research in Oregon. Methods We conducted a survey with Mexican-origin Latinas aged 18-49 years. Our primary outcome was willingness to participate in health research; we also asked sociodemographics and barriers and facilitators to participation. We used logistic regression to identify factors associated with willingness to participate. Results Of 500 participants, 41% said that they would be willing to participate in health research, 14% said no, and 45% were unsure. In multivariable analyses, past participation in research and speaking English well were independently associated with willingness to participate. Barriers to participation included language, accessibility, and fear of medical procedures. Facilitators included improving future health care, language, and free medical care. Conclusions Mexican-origin Latinas in Oregon are willing to participate in health research, but many are unsure. Providing study materials in Spanish is a concrete first step to improve recruitment and promote equity and inclusion.
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Affiliation(s)
- Yareli Cornejo-Torres
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
- Portland State University, Portland, Oregon, USA
| | - Emily Boniface
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
| | - Edlyn Lopez
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
- Portland State University, Portland, Oregon, USA
| | - Katherin Gomez-Arboleda
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
- Portland State University, Portland, Oregon, USA
| | - Blair G. Darney
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA
- Department Health Systems and Policy, OHSU-PSU School of Public Health, Portland, Oregon, USA
- Instituto Nacional de Salud Pública (INSP), Centro de Investigación en Salud Poblacional (CISP), Cuernavaca, Morelos, México
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Kumar G, Kim J, Farazi PA, Wang H, Su D. Disparities in awareness of and willingness to participate in cancer clinical trials between African American and White cancer survivors. BMC Cancer 2022; 22:983. [PMID: 36109780 PMCID: PMC9479408 DOI: 10.1186/s12885-022-10082-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 05/31/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cancer clinical trials (CCTs) are essential for cancer care, yet the evidence is scarce when it comes to racial disparities in CCT participation among cancer survivors in the Midwest. This study aimed to 1) assess disparities in the awareness of and willingness to participate in CCTs between African American and White cancer survivors; and 2) compare perceptions about CCTs between the two racial groups. METHODS The study was based on cross-sectional data from the survey "Minority Patient Participation in Cancer Clinical Trials" that collected information from 147 Black and White cancer survivors from Nebraska between 2015 and 2016. Chi-square tests and logistic regressions were used to assess differences between Black and White cancer survivors regarding their awareness, willingness, and perceptions associated with CCT participation. RESULTS After adjusting for the effects of socio-demographic, health status, and psychosocial variables, Black cancer survivors were much less likely than White cancer survivors to be aware of CCTs (AOR 0.26; CI 0.08-0.81), to express willingness to participate in CCTs (AOR 0.03; CI 0.01, 0.32) and to actually participate in CCTs (AOR 0.13; CI 0.04-0.38). Black cancer survivors reported a lower level of trust in physicians and were less likely than White cancer survivors to believe that CCTs make a significant contribution to science. CONCLUSIONS Relative to White cancer survivors, Black cancer survivors had much lower awareness of and willingness to participate in CCTs. Part of these differences might be related to the differential perception of CCTs, psychosocial factors, and trust in physicians between the two groups.
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Affiliation(s)
- Gaurav Kumar
- Center for Reducing Health Disparities, Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, 984340 Nebraska Medical Center, Omaha, NE, 68198-4340, USA
| | - Jungyoon Kim
- Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Paraskevi A Farazi
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Hongmei Wang
- Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Dejun Su
- Center for Reducing Health Disparities, Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, 984340 Nebraska Medical Center, Omaha, NE, 68198-4340, USA.
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Swaby J, Kaninjing E, Ogunsanya M. African American participation in cancer clinical trials. Ecancermedicalscience 2021; 15:1307. [PMID: 34824630 PMCID: PMC8580719 DOI: 10.3332/ecancer.2021.1307] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Indexed: 11/24/2022] Open
Abstract
Background According to the Food and Drug Administration, African Americans (AAs) have been habitually underrepresented in cancer clinical trials (CCTs). This under-enrolment has contributed to cancer disparities despite the implementation of policies to improve AA accrual. This systematic review aimed to determine (1) Why AAs are participating in CCT at lower rates compared to other ethnic/racial groups and (2) Are there any tools that have definitively improved AA participation or addressed the barriers associated with their lack of participation. Methods Searches were carried out in PubMed, Project MUSE and EBSCO which were confined to four databases (BASE, PsycINFO, CINAHL and MEDLINE). Literature published between 2010 and 2020 were filtered with the inclusion and exclusion criteria and then a mixed methods appraisal tool was used to check the quality of the articles. Studies were separated into two categories to extract and synthesise data based on the emerging themes. Results Frequent reasons for a lack of participation involved provider related issues, family concerns, health literacy and trust among others. Interventions cited as successful in improving AA participation or addressing a barrier often revolved around community-based participatory research and educational CCT videos/tools. Recommendations/Conclusion Educating AA patients about the biomedical research process, addressing concerns about CCTs, building trust with community members and improving communication with healthcare providers could improve AA participation in CCTs. Future interventions should consider the effect of diversified healthcare teams in addressing trust deficit in CCTs among AAs. Healthcare practitioners seeking to consent AA into CCTs and biomedical research could consider incorporating cultural competence into their practice for effective interaction with this population and to address their questions about biomedical research.
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Affiliation(s)
- Jordan Swaby
- Department of Health Sciences, University of Central Florida, 4000 Central Florida Blvd, Orlando, FL 32816, USA
| | - Ernie Kaninjing
- Department of Health Sciences, School of Health & Human Performance, Georgia College and State University, 231 W Hancock St, Milledgeville, GA 31061, USA
| | - Motolani Ogunsanya
- Department of Pharmacy, Clinical & Administrative Sciences, The University of Oklahoma Health Sciences Center, 1110 N. Stonewall Ave. Oklahoma City, OK 73117, USA
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Palmer NR, Borno HT, Gregorich SE, Livaudais-Toman J, Kaplan CP. Prostate cancer patients' self-reported participation in research: an examination of racial/ethnic disparities. Cancer Causes Control 2021; 32:1161-1172. [PMID: 34189651 PMCID: PMC8416807 DOI: 10.1007/s10552-021-01463-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/13/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE We examined prostate cancer patients' participation in research and associated factors by race/ethnicity in a multiethnic sample. METHODS Men with a new diagnosis of prostate cancer were identified through the California Cancer Registry. Patients completed a cross-sectional telephone interview in English, Spanish, Cantonese or Mandarin. Multivariable logistic regression models, stratified by race/ethnicity, estimated the associations of patient demographic and health characteristics with participation in (1) any research, (2) behavioral research, and (3) biological/clinical research. RESULTS We included 855 prostate cancer patients: African American (19%), Asian American (15%), Latino (24%), and White (42%). In the overall model of participation in any research, African American men (Odds Ratio (OR) = 2.54, 95% CI 1.63-3.94), and those with two or more comorbidities (OR = 2.20, 95% CI 1.27-3.80) were more likely to report participation. Men 65 years old and older (OR = 0.65, 95% CI 0.47-0.91), those who were married or living with a partner (OR = 0.67, 95% CI 0.45-0.98), and those who completed the interview in Spanish (OR = 0.36, 95% CI 0.15-0.85) were less likely to report participating in any research. Stratified analyses identified racial/ethnic-specific sociodemographic characteristics associated with lower research participation, including Spanish or Chinese language, older age, and lower education. CONCLUSION African American prostate cancer patients reported higher research participation than all other groups. However, recruitment efforts are still needed to overcome barriers to participation for Spanish and Chinese speakers, and barriers among older adults and those with lower education levels.
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Affiliation(s)
- Nynikka R Palmer
- Department of Medicine, Division of General Internal Medicine at Zuckerberg, San Francisco General Hospital, University of California San Francisco, UCSF, 1001 Potrero Avenue, Box 1364, San Francisco, CA, 94143, USA.
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, USA.
| | - Hala T Borno
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, USA
- Department of Medicine, Division of Hematology/Oncology, University of California San Francisco, San Francisco, USA
| | - Steven E Gregorich
- Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, USA
- Multiethnic Research Center, University of California San Francisco, San Francisco, USA
| | - Jennifer Livaudais-Toman
- Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, USA
| | - Celia P Kaplan
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, USA
- Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, USA
- Multiethnic Research Center, University of California San Francisco, San Francisco, USA
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14
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Sheppard VB, Sutton A, Holmes E, Edmonds M, Preston MA, Namoos AM, Wells M, Thomson MD. Recruitment of African Americans into Cancer Clinical Research: Strategies and Outcomes. J Urban Health 2021; 98:149-154. [PMID: 34374033 PMCID: PMC8352149 DOI: 10.1007/s11524-021-00565-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/30/2022]
Abstract
This study utilized data from four cancer-focused research studies that recruited and retained African Americans. Strategies and outcomes across four cancer prevention and control studies were analyzed. Descriptive statistics were used to display participant characteristics. There were 712 African American (Black) participants of which 14.6% were males. Common strategies involved connecting with community stakeholders and identifying study champions. Study recruitment methods might not be generalizable to all populations of African Americans due to geographic locations, study protocols (e.g., risk reduction), target populations (i.e., eligibility criteria), and available resources. Many African Americans have a strong interest in cancer-related research as demonstrated by participation levels. Teams that connect with relevant stakeholders and include diverse teams may be useful to engage larger numbers of minorities in cancer control research to impact morbidity and mortality.
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Affiliation(s)
- Vanessa B Sheppard
- Department of Health Behavior and Policy, Office of Health Equity & Disparities Research, Virginia Commonwealth University, 830 East Main Street, PO Box 980149, Richmond, VA, 23298-0149, USA
| | - Arnethea Sutton
- Department of Health Behavior and Policy, Office of Health Equity & Disparities Research, Virginia Commonwealth University, 830 East Main Street, PO Box 980149, Richmond, VA, 23298-0149, USA
| | - Esther Holmes
- Department of Health Behavior and Policy, Office of Health Equity & Disparities Research, Virginia Commonwealth University, 830 East Main Street, PO Box 980149, Richmond, VA, 23298-0149, USA
| | - Megan Edmonds
- Department of Health Behavior and Policy, Office of Health Equity & Disparities Research, Virginia Commonwealth University, 830 East Main Street, PO Box 980149, Richmond, VA, 23298-0149, USA
| | - Michael A Preston
- Department of Health Behavior and Policy, Office of Health Equity & Disparities Research, Virginia Commonwealth University, 830 East Main Street, PO Box 980149, Richmond, VA, 23298-0149, USA
| | - Asmaa M Namoos
- Department of Health Behavior and Policy, Office of Health Equity & Disparities Research, Virginia Commonwealth University, 830 East Main Street, PO Box 980149, Richmond, VA, 23298-0149, USA.
| | - Matthew Wells
- Department of Health Behavior and Policy, Office of Health Equity & Disparities Research, Virginia Commonwealth University, 830 East Main Street, PO Box 980149, Richmond, VA, 23298-0149, USA
| | - Maria D Thomson
- Department of Health Behavior and Policy, Office of Health Equity & Disparities Research, Virginia Commonwealth University, 830 East Main Street, PO Box 980149, Richmond, VA, 23298-0149, USA
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15
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Massett HA, Mitchell AK, Alley L, Simoneau E, Burke P, Han SH, Gallop-Goodman G, McGowan M. Facilitators, Challenges, and Messaging Strategies for Hispanic/Latino Populations Participating in Alzheimer's Disease and Related Dementias Clinical Research: A Literature Review. J Alzheimers Dis 2021; 82:107-127. [PMID: 33998537 DOI: 10.3233/jad-201463] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) disproportionally affect Hispanic and Latino populations, yet Hispanics/Latinos are substantially underrepresented in AD/ADRD clinical research. Diverse inclusion in trials is an ethical and scientific imperative, as underrepresentation reduces the ability to generalize study findings and treatments across populations most affected by a disease. This paper presents findings from a narrative literature review (N = 210) of the current landscape of Hispanic/Latino participation in clinical research, including the challenges, facilitators, and communication channels to conduct culturally appropriate outreach efforts to increase awareness and participation of Hispanics/Latinos in AD/ADRD clinical research studies. Many challenges identified were systemic in nature: lack of culturally relevant resources; staffing that does not represent participants' cultures/language; eligibility criteria that disproportionately excludes Hispanics/Latinos; and too few studies available in Hispanic/Latino communities. The paper also details facilitators and messaging strategies to improve engagement and interest among Hispanics/Latinos in AD/ADRD research, starting with approaches that recognize and address the heterogeneity of the Hispanic/Latino ethnicity, and then, tailor outreach activities and programs to address their diverse needs and circumstances. The needs identified in this article represent longstanding failures to improve engagement and interest among Hispanics/Latinos in AD/ADRD research; we discuss how the field can move forward learning from the experiences of the COVID-19 pandemic.
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Affiliation(s)
- Holly A Massett
- Division of Extramural Activities, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | | | - Sae H Han
- Kelly Government, Kelly Services, Inc., Rockville, MD, USA
| | - Gerda Gallop-Goodman
- Office of Communications and Public Liaison, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Melissa McGowan
- Office of Communications and Public Liaison, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
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16
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McGuire FH, André K, Bradsher ML, Harrison D, Sterling RK, Reddy KR, Serper M, Golin CE, Reau N, Lim JK, Nelson DR, Sarkar S, Evon DM. Willingness to participate in research among black patients with liver disease: A national cross-sectional study. J Viral Hepat 2021; 28:982-993. [PMID: 33665897 DOI: 10.1111/jvh.13493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/16/2021] [Accepted: 02/23/2021] [Indexed: 12/09/2022]
Abstract
In the United States, Black people are disproportionately diagnosed with hepatitis C virus (HCV) compared with White people but are under-represented in HCV studies. In this US-based cross-sectional telephone survey study, we assessed willingness to participate (WTP) in health/medical research and attitudes and beliefs that may influence WTP among Black patients with HCV. Two hundred participants who had current or prior HCV diagnosis and self-identified as Black or African American were recruited from a national HCV cohort study and an outpatient hepatology clinic. WTP responses ranged from 1 (not at all willing) to 5 (very willing). Multivariable models were used to identify factors associated with the overall mean WTP score. In addition, an open-ended question solicited strategies to help increase research participation from the Black community. Overall, participants reported moderate WTP in research (Mean [95% Confidence Interval (CI)] = 3.78 [3.68, 3.88]). Of 13 types of research presented, participants reported lowest WTP for randomized controlled trials of medications (Mean [95% CI] = 2.31 [2.11, 2.50]). The initial multivariable model identified higher subjective knowledge of research as positively associated with WTP (Parameter estimate [95% CI] = 0.15 [0.02, 0.27]). Sensitivity analyses also identified higher perceived benefits of research as an additional factor associated with WTP. Qualitative findings indicate that greater community-based outreach efforts would increase accessibility of research opportunities. When given the opportunity to participate, Black participants with HCV reported moderate WTP in health/medical research. Research sponsors and investigators should employ community-based outreach to expand access and awareness of research opportunities.
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Affiliation(s)
- F Hunter McGuire
- Department of Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA.,Center for Gastrointestinal Biology and Disease, UNC School of Medicine, Chapel Hill, NC, USA
| | - Kat André
- Center for Gastrointestinal Biology and Disease, UNC School of Medicine, Chapel Hill, NC, USA.,College of Psychology, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Minyone L Bradsher
- Center for Gastrointestinal Biology and Disease, UNC School of Medicine, Chapel Hill, NC, USA
| | - Dawn Harrison
- Division of Gastroenterology and Hepatology, UNC School of Medicine, Chapel Hill, NC, USA
| | - Richard K Sterling
- Division of Gastroenterology, Hepatology & Nutrition, Virginia Commonwealth University, Richmond, VA, USA
| | - K Rajender Reddy
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Marina Serper
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Carol E Golin
- Department of Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA.,Division of General Medicine and Epidemiology, UNC School of Medicine, Chapel Hill, NC, USA
| | - Nancy Reau
- Department of Internal Medicine, Section of Hepatology, Rush University Medical Center, Chicago, IL, USA
| | - Joseph K Lim
- Digestive Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - David R Nelson
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Florida, Jacksonville, FL, USA
| | - Souvik Sarkar
- Division of Gastroenterology and Hepatology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Donna M Evon
- Center for Gastrointestinal Biology and Disease, UNC School of Medicine, Chapel Hill, NC, USA.,Division of Gastroenterology and Hepatology, UNC School of Medicine, Chapel Hill, NC, USA
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17
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Habr D, Ferdinand R. Addressing racial/ethnic disparities in cancer clinical trials: Everyone has a role to play. Cancer 2021; 127:3282-3289. [PMID: 33904590 DOI: 10.1002/cncr.33600] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/25/2021] [Accepted: 03/27/2021] [Indexed: 12/12/2022]
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18
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Martin-Willett R, Bidwell LC. Call to Action for Enhanced Equity and Inclusion in Cannabis Research. Cannabis Cannabinoid Res 2021; 6:77-81. [PMID: 33907711 PMCID: PMC8064966 DOI: 10.1089/can.2020.0149] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Introduction: Policies regarding cannabis use are rapidly evolving in the United States as exemplified by the legalization of recreational use in 11 states and the District of Columbia. Previous cannabis-related laws, however, disproportionately targeted communities of color before legalization, and many argue new policies are not being developed with the input of minority stakeholders postlegalization. Given that biomedical research has also historically underrepresented communities of color, there is an obligation on the part of researchers now to actively work toward improving equity in cannabis research at a time when the field is rapidly expanding. This is particularly important for research concerning therapeutic uses of cannabis and risk liabilities. Objective: This article is a call to action to improve equity and inclusion in cannabis research design and practice. Specifically, it includes three recommendations focusing on (1) inclusiveness of recruitment, (2) improve demographic reporting in articles, and (3) strengthening publication requirements. Conclusion: These efforts will enhance the shared values and ethics of our field and improve the quality and validity of our research findings moving forward.
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Affiliation(s)
- Renée Martin-Willett
- Department of Psychology and Neuroscience, and University of Colorado Boulder, Boulder, Colorado, USA
| | - L Cinnamon Bidwell
- Department of Psychology and Neuroscience, and University of Colorado Boulder, Boulder, Colorado, USA.,Institute of Cognitive Science, University of Colorado Boulder, Boulder, Colorado, USA
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19
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Spielman DB, Liebowitz A, Kelebeyev S, Smith TL, McKinney K, Woodard T, Safi C, Overdevest JB, Gudis DA. Race in Rhinology Clinical Trials: A Decade of Disparity. Laryngoscope 2021; 131:1722-1728. [PMID: 33493376 DOI: 10.1002/lary.29371] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/16/2020] [Accepted: 12/28/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE/HYPOTHESIS The aim of this study is to assess the ethnic and racial demographics of patients enrolled in prospective chronic rhinosinusitis (CRS) studies relative to the corresponding geographic demographics of the United States (U.S.) census data. STUDY DESIGN Systematic Review and Population analysis. METHODS A systematic review was performed to identify CRS clinical trials, conducted in the U.S. and published between 2010 and 2020 in which patients were prospectively enrolled. Pooled racial and ethnicity data were compared to national and corresponding regional census data. RESULTS Eighty-three studies were included, comprising 12,027 patients. 50.4% were male and the average age was 49.2 years. 8,810 patients underwent a surgical procedure. Of the 12,027 patients, 81.67% were identified as White, 5.35% as Black, 1.27% as Asian, 0.02% as Pacific Islander, 0.12% as American Indian, and 11.57% were classified as Other. The racial and ethnic composition of the pooled study population differs significantly from the national U.S. census data with the underrepresentation of each minority population (P ≤ .0002). Regional sub-analyses yield variable results. In the Northeast and West, there was an underrepresentation of all minority populations. In the South and Midwest, Black enrollment was similar to the U.S. census data, while all other minorities were underrepresented. CONCLUSIONS The racial and ethnic composition of patients enrolled in prospective CRS clinical trials differs significantly from the demographics of the U.S. POPULATION The generalizability and external validity of findings derived from studies comprised of demographically mismatched populations has not been established. Future efforts to enroll more representative populations should be emphasized by the research community, funding bodies, and editorial boards. LEVEL OF EVIDENCE NA Laryngoscope, 131:1722-1728, 2021.
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Affiliation(s)
- Daniel B Spielman
- Department of Otolaryngology Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A
| | - Andi Liebowitz
- Department of Otolaryngology Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A
| | - Saveliy Kelebeyev
- Department of Otolaryngology Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A
| | - Timothy L Smith
- Department of Otolaryngology Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, U.S.A
| | - Kibwei McKinney
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, U.S.A
| | - Troy Woodard
- Department of Otolaryngology Head and Neck Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A
| | - Chetan Safi
- Department of Otolaryngology Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A
| | - Jonathan B Overdevest
- Department of Otolaryngology Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A
| | - David A Gudis
- Department of Otolaryngology Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, U.S.A
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20
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Kircher SM, Mulcahy M, Kalyan A, Weldon CB, Trosman JR, Benson AB. Telemedicine in Oncology and Reimbursement Policy During COVID-19 and Beyond. J Natl Compr Canc Netw 2020; 19:1-7. [PMID: 32998106 DOI: 10.6004/jnccn.2020.7639] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/13/2020] [Indexed: 11/17/2022]
Abstract
The first confirmed case of coronavirus disease 2019 (COVID-19) in the United States was reported on January 20, 2020. As of September 17, 2020, there were more than 6.6 million confirmed cases and 196,277 deaths. Limited data are available on outcomes of immunocompromised patients, but early published reports from China indicate that those with cancer have a 3.5 times higher risk of ICU admission, mechanical ventilation, or death than those without cancer. Because of the uncertain behavior of COVID-19, it has become imperative for practices to limit exposure to vulnerable patients. Telemedicine has been one of the cornerstones of caring for patients with cancer during the COVID-19 pandemic. This review provides an overview of reimbursement policy by public and private payers before and during the COVID-19 pandemic, describes implications in cancer care, and offers considerations for future reimbursement policy.
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Affiliation(s)
- Sheetal M Kircher
- 1Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago
- 2Northwestern University, Feinberg School of Medicine, Chicago; and
| | - Mary Mulcahy
- 1Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago
- 2Northwestern University, Feinberg School of Medicine, Chicago; and
| | - Aparna Kalyan
- 1Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago
- 2Northwestern University, Feinberg School of Medicine, Chicago; and
| | - Christine B Weldon
- 2Northwestern University, Feinberg School of Medicine, Chicago; and
- 3Center for Business Models in Healthcare, Glencoe, Illinois
| | - Julia R Trosman
- 2Northwestern University, Feinberg School of Medicine, Chicago; and
- 3Center for Business Models in Healthcare, Glencoe, Illinois
| | - Al B Benson
- 1Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago
- 2Northwestern University, Feinberg School of Medicine, Chicago; and
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21
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Olson NL, Albensi BC. Race- and Sex-Based Disparities in Alzheimer's Disease Clinical Trial Enrollment in the United States and Canada: An Indigenous Perspective. J Alzheimers Dis Rep 2020; 4:325-344. [PMID: 33024940 PMCID: PMC7504979 DOI: 10.3233/adr-200214] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Randomized clinical trials (RCT) involve labor-intensive, highly regulated, and controlled processes intended to transform scientific concepts into clinical outcomes. To be effective and targeted, it is imperative they include those populations who would most benefit from those outcomes. Alzheimer's disease (AD) is most detrimental to the aging population, and its clinical manifestation is influenced by socio-economic factors such as poverty, poor education, stress, and chronic co-morbidities. Indigenous populations in the United States and Canada are among the minority populations most influenced by poor socio-economic conditions and are prone to the ravages of AD, with Indigenous women carrying the added burden of exposure to violence, caregiving stresses, and increased risk by virtue of their sex. Race- and sex-based disparities in RCT enrollment has occurred for decades, with Indigenous men and women very poorly represented. In this review, we examined literature from the last twenty years that reinforce these disparities and provide some concrete suggestions and guidelines to increase the enrollment numbers in AD RCT among this vulnerable and poorly represented population.
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Affiliation(s)
- Nancy L Olson
- Division of Neurodegenerative Disorders, St Boniface Hospital Albrechtsen Research Centre, Winnipeg, MB, Canada
| | - Benedict C Albensi
- Division of Neurodegenerative Disorders, St Boniface Hospital Albrechtsen Research Centre, Winnipeg, MB, Canada
- Department of Pharmacology & Therapeutics, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
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22
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Stewart CL, De Andrade JP, Duma N, Ralph OK, Choong K, Gonzalez L, McClintock NC, Sandoval E, Melstrom LG, Warner SG. Unconscious Bias in Speaker Introductions at a Surgical Oncology Meeting: Hierarchy Reigns Over Gender. Ann Surg Oncol 2020; 27:3754-3761. [PMID: 32712891 DOI: 10.1245/s10434-020-08906-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/08/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Recent reviews of medical conferences have shown that women were less likely to receive a formal introduction compared with men. We examined speaker introductions at the Society of Surgical Oncology (SSO) annual meeting to determine whether similar biases exist within our organization. METHODS An observational study of video-archived speaker introductions at the 2018 and 2019 SSO annual meetings was conducted. Professional address was defined as professional title followed by full name or last name. Multivariable logistic regression was used to identify factors associated with form of address. RESULTS There were 499 speaker introductions reviewed. Speakers included 290 (58%) men and 238 (49%) post-graduate trainees (residents and fellows). A non-professional form of address was used to introduce 148 (30%) speakers and was most often used for post-graduate trainees (33%). Full professors were more likely than junior faculty to introduce speakers with a non-professional form of address (37% of full professors vs 18% of assistant professors, p < 0.001). In multivariable regression analysis these findings persisted. Trainees were 2.8 times more likely to receive a non-professional form of address (p = 0.003). Use of a non-professional introduction did not significantly vary by the speaker's nor the introducer's gender. CONCLUSIONS Residents and fellows were more likely to receive a non-professional form of address, and the likelihood of this increased with rising seniority of the introducer. The manner of speaker introduction did not vary by gender in our organization. More research is needed to explore the influence of these disparities on academic advancement for the next generation of surgical oncologists.
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Affiliation(s)
- Camille L Stewart
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA.
| | - James P De Andrade
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Narjust Duma
- Department of Medicine, Division of Hematology, Medical Oncology and Palliative Care, University of Wisconsin, Madison, WI, USA
| | - Oliver K Ralph
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Kevin Choong
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Lorena Gonzalez
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | | | - Ethan Sandoval
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Laleh G Melstrom
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Susanne G Warner
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
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23
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Levenberg K, Proctor DN, Maman SR, Luck JC, Miller AJ, Aziz F, Radtka JF, Muller MD. A prospective community engagement initiative to improve clinical research participation in patients with peripheral artery disease. SAGE Open Med 2020; 8:2050312120930915. [PMID: 32587692 PMCID: PMC7294489 DOI: 10.1177/2050312120930915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 05/11/2020] [Indexed: 01/04/2023] Open
Abstract
Objective: Patients diagnosed with peripheral artery disease are difficult to recruit into clinical trials. However, there is currently no high-quality, patient-centered information explaining why peripheral artery disease patients choose to participate or not participate in clinical research studies. Methods: The current study was a prospective community engagement initiative that specifically asked patients with and without peripheral artery disease: (1) what motivates them to participate in clinical research studies, (2) their willingness to participate in different research procedures, (3) the barriers to participation, (4) preferences about study design, and (5) demographic and disease-related factors influencing participation. Data were gathered through focus groups (n = 19, participants aged 55–79 years) and mailed questionnaires (n = 438, respondents aged 18–85 years). Results: More than half of the respondents stated that they would be willing to participate in a study during evening or weekend time slots. Peripheral artery disease patients (n = 45) were more willing than those without peripheral artery disease (n = 360) to participate in drug infusion studies (48% versus 18%, p < 0.001) and trials of investigational drugs (44% versus 21%, p < 0.001). Motivating factors and barriers to participation were largely consistent with previous studies. Conclusion: Adults in our geographic region are interested in participating in clinical research studies related to their health; they would like their doctor to tell them what studies they qualify for and they prefer to receive a one-page advertisement that has color pictures of the research procedures. Peripheral artery disease patients are more willing than those without peripheral artery disease to participate in drug infusion studies, trials of investigational drugs, microneurography, and spinal/epidural infusions.
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Affiliation(s)
- Kate Levenberg
- Heart and Vascular Institute, College of Medicine, Penn State University, Hershey, PA, USA.,Noll Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, PA, USA
| | - David N Proctor
- Heart and Vascular Institute, College of Medicine, Penn State University, Hershey, PA, USA.,Noll Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, PA, USA
| | - Stephan R Maman
- Heart and Vascular Institute, College of Medicine, Penn State University, Hershey, PA, USA
| | - J Carter Luck
- Heart and Vascular Institute, College of Medicine, Penn State University, Hershey, PA, USA
| | - Amanda J Miller
- Heart and Vascular Institute, College of Medicine, Penn State University, Hershey, PA, USA
| | - Faisal Aziz
- Heart and Vascular Institute, College of Medicine, Penn State University, Hershey, PA, USA
| | - John F Radtka
- Heart and Vascular Institute, College of Medicine, Penn State University, Hershey, PA, USA
| | - Matthew D Muller
- Heart and Vascular Institute, College of Medicine, Penn State University, Hershey, PA, USA.,Department of Anesthesiology and Perioperative Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Master of Science in Anesthesia Program, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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24
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Begic D, Janda-Martinac C, Vrdoljak M, Puljak L. Reporting and analyses of sex/gender and race/ethnicity in randomized controlled trials of interventions published in the highest-ranking anesthesiology journals. J Comp Eff Res 2019; 8:1417-1423. [PMID: 31789050 DOI: 10.2217/cer-2019-0071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Aim: We assessed reporting of data on sex/gender and race/ethnicity in randomized controlled trials of interventions published in the highest-ranking anesthesiology journals from 2014 to 2017. Methods: We extracted data regarding terminology for sex/gender, proportion of participants according to the race/gender and race/ethnicity, and results shown for the race/gender and race/ethnicity. Results: Among the analyzed 732 trials, few stratified allocation of participants on the basis of sex/gender and race/ethnicity, few reported results for sex/gender or race/ethnicity and the outcomes reported may be influenced by one or both. Conclusion: In conclusion, outcomes of anesthesiology trials could be vulnerable to an important and avoidable source of bias; trialists need to pay more attention to sex and race/ethnicity when designing and reporting their studies.
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Affiliation(s)
- Dinka Begic
- Department of Endocrinology, University Clinical Center Tuzla, Tuzla, Bosnia & Hercegovina
| | | | | | - Livia Puljak
- Center for Evidence-Based Medicine & Health Care, Catholic University of Croatia, Zagreb, Croatia
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Withers M, Sayegh P, Rodriguez-Agudelo Y, Ernstrom K, Raman R, Montoya L, Zuno-Reyes A, Mosieri C, Matute E, Ringman JM. A mixed-methods study of cultural beliefs about dementia and genetic testing among Mexicans and Mexican-Americans at-risk for autosomal dominant Alzheimer's disease. J Genet Couns 2019; 28:921-932. [PMID: 31207006 PMCID: PMC7500864 DOI: 10.1002/jgc4.1133] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 04/30/2019] [Accepted: 05/06/2019] [Indexed: 01/04/2023]
Abstract
Trials to prevent autosomal dominantly inherited Alzheimer's disease (ADAD) are critical and timely. However, cultural beliefs about AD and genetic testing may preclude informed consent and participation, especially among racial/ethnic minorities. This mixed-methods study examines cultural beliefs about AD and genetic screening among at-risk populations of Mexican heritage. We surveyed 86 Mexican and 37 Mexican-American family members of patients with ADAD and interviewed 18 respondents in Mexico to explore perceptions and knowledge regarding AD and genetic testing. While most respondents understood that AD is inherited in their families, they also had limited understanding of the genetic mechanisms behind AD. Many believed that AD is a normal part of aging or that it is a mental illness caused by bad habits. However, beliefs that AD is caused by a curse or God's will were uncommon. The interviews demonstrated that very few at-risk respondents understood their own risk for harboring the mutation causing AD in their family. Once informed, most expressed a strong interest in genetic testing, largely motivated by the desire to be better prepared for the development of AD. Health professionals treating and investigators enrolling members from families with ADAD cannot assume that they fully understand the nature of the illness; therefore, providers should provide comprehensive information about ADAD and genetic testing.
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Affiliation(s)
- Mellissa Withers
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Philip Sayegh
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
| | | | - Karin Ernstrom
- Alzheimer’s Therapeutic Research Institute, University of Southern California, Los Angeles, California, USA
| | - Rema Raman
- Alzheimer’s Therapeutic Research Institute, University of Southern California, Los Angeles, California, USA
| | - Lucy Montoya
- Department of Neurology, University of Southern California, Los Angeles, California, USA
| | | | - Chizoba Mosieri
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Esmeralda Matute
- Institute of Neurosciences, University of Guadalajara, Guadalajara, Mexico
| | - John M. Ringman
- Department of Neurology, University of Southern California, Los Angeles, California, USA
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Sturgeon KM, Hackley R, Fornash A, Dean LT, Laudermilk M, Brown JC, Sarwer DB, DeMichele AM, Troxel AB, Schmitz KH. Strategic recruitment of an ethnically diverse cohort of overweight survivors of breast cancer with lymphedema. Cancer 2017; 124:95-104. [PMID: 28881471 DOI: 10.1002/cncr.30935] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 06/16/2017] [Accepted: 07/09/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Black women are more likely to experience adverse effects from cancer treatment such as lymphedema. Thus, black women may particularly benefit from research regarding interventions to improve lymphedema. Herein, the authors report the challenges and strategies related to the recruitment of minority survivors of breast cancer and to the recruitment of survivors of breast cancer with lymphedema into the Women In Steady Exercise Research (WISER) Survivor Clinical Trial. METHODS Subjects for this community-based trial were recruited from the Philadelphia area through active (mailings) and passive (printed materials and Web site) recruitment strategies. In addition, education sessions coordinated through partner hospitals in communities with a predominantly minority population were conducted to increase awareness of lymphedema in survivors of breast cancer. Women who were interested in the study were screened for lymphedema via telephone questionnaire and invited to see a study-related certified lymphedema therapist to confirm the presence of lymphedema. RESULTS Screening was conducted among 2295 women: 628 were eligible, 450 consented, and 351 were randomized. Minority women comprised 38% of the study population. Letters to women on state and hospital registries resulted in a 0.4% randomization rate; education sessions yielded a 10% randomization rate. The authors observed that approximately 23.6% of the study sample had no previous diagnosis of lymphedema. CONCLUSIONS The WISER Survivor Clinical Trial faced multiple recruitment challenges and used unique strategies to successfully enroll minority survivors of breast cancer into a lifestyle intervention. Cancer 2018;124:95-104. © 2017 American Cancer Society.
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Affiliation(s)
- Kathleen M Sturgeon
- Department of Public Health Sciences, Pennsylvania State University, Hershey, Pennsylvania
| | - Renata Hackley
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anna Fornash
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Justin C Brown
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - David B Sarwer
- College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Angela M DeMichele
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrea B Troxel
- Department of Population Health, New York University, New York City, New York
| | - Kathryn H Schmitz
- Department of Public Health Sciences, Pennsylvania State University, Hershey, Pennsylvania
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Abstract
African-Americans, as historically disadvantaged minorities, have more advanced stages of cancer when diagnosed, lower survival rates, and lower rates of accessing timely care than do Caucasians. Lung cancer incidence and mortality, in particular, are high among African-Americans. The U.S. Preventive Services Task Force recently released an evidence-based lung cancer screening technology called low-dose computerized tomography. High-risk African-Americans might benefit greatly from such screening but not many are aware of this technology. Public health nurses can play a key role in increasing awareness of the technology among African-American communities and encouraging qualified African-Americans to obtain screening. This study discusses issues with lung cancer and smoking among African-Americans, a recently released evidence-based lung cancer screening technology, and implications for public health nurses to enhance uptake of the new screening technology among high-risk African-Americans.
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Affiliation(s)
- Mo-Kyung Sin
- Seattle University College of Nursing, Seattle, WA, USA
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28
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Underrepresentation of Hispanics and Other Minorities in Clinical Trials: Recruiters' Perspectives. J Racial Ethn Health Disparities 2017; 5:322-332. [PMID: 28452008 DOI: 10.1007/s40615-017-0373-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/08/2017] [Accepted: 04/11/2017] [Indexed: 12/21/2022]
Abstract
Clinical trials and research studies often fail to recruit participants from the minorities, hampering the generalizability of results. In order to mitigate this problem, the present study investigated how race/ethnicity affects the process of recruiting people from racial and ethnic minority groups, by conducting 11 focus groups with professional recruiters. Several themes emerged, such as how to adapt to potential participants' language competency and literacy levels, the importance to engage in culturally appropriate verbal and non-verbal communication, and to establish a sense of homophily between recruiters and patients. In addition, recruiters pointed out possible solutions to accommodate socioeconomic concerns, to adapt to contextual factors-including immigration status-and ultimately to respond to potential participants' mistrust of medical research. These findings are discussed, and future recommendations are provided.
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Zullig LL, Carpenter WR, Williams CD. Next steps to improve disparities in lung cancer treatment clinical trial enrollment. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:118. [PMID: 28361083 DOI: 10.21037/atm.2017.01.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Leah L Zullig
- Center for Health Services Research in Primary Care, Durham VA Health Care System, Durham, NC, USA;; Division of General Internal Medicine, Duke University, Durham, NC, USA
| | - William R Carpenter
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC, USA
| | - Christina D Williams
- Cooperative Studies Program Epidemiology Center, Durham VA Health Care System, Durham, NC, USA;; Division of Medical Oncology, Duke University, Durham, NC, USA
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