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Retzer A, Ciytak B, Khatsuria F, El-Awaisi J, Harris IM, Chapman L, Kelly T, Richards J, Lam E, Newsome PN, Calvert M. A toolkit for capturing a representative and equitable sample in health research. Nat Med 2023; 29:3259-3267. [PMID: 38066209 PMCID: PMC10719102 DOI: 10.1038/s41591-023-02665-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/24/2023] [Indexed: 12/17/2023]
Abstract
Research participants often do not represent the general population. Systematic exclusion of particular groups from research limits the generalizability of research findings and perpetuates health inequalities. Groups considered underserved by research include those whose inclusion is lower than expected based on population estimates, those with a high healthcare burden but limited research participation opportunities and those whose healthcare engagement is less than others. The REP-EQUITY toolkit guides representative and equitable inclusion in research. The toolkit was developed through a methodological systematic review and synthesis and finalized in a consensus workshop with 24 participants. The REP-EQUITY toolkit describes seven steps for investigators to consider in facilitating representative and equitable sample selection. This includes clearly defining (1) the relevant underserved groups, (2) the aims relating to equity and representativeness, (3) the sample proportion of individuals with characteristics associated with being underserved by research, (4) the recruitment goals, (5) the strategies by which external factors will be managed, (6) the methods by which representation in the final sample will be evaluated and (7) the legacy of having used the toolkit. Using the REP-EQUITY toolkit could promote trust between communities and research institutions, increase diverse participation in research and improve the generalizability of health research. National Institute for Health and Care Research PROSPERO identifier: CRD42022355391.
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Affiliation(s)
- Ameeta Retzer
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK.
- NIHR Birmingham Biomedical Research Centre (BRC), University of Birmingham, Birmingham, UK.
| | - Bircan Ciytak
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre (BRC), University of Birmingham, Birmingham, UK
| | - Foram Khatsuria
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre (BRC), University of Birmingham, Birmingham, UK
| | - Juma El-Awaisi
- NIHR Birmingham Biomedical Research Centre (BRC), University of Birmingham, Birmingham, UK
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Isobel M Harris
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Laura Chapman
- NIHR Birmingham Biomedical Research Centre (BRC), University of Birmingham, Birmingham, UK
| | - Tony Kelly
- NIHR Birmingham Biomedical Research Centre (BRC), University of Birmingham, Birmingham, UK
| | - Jenny Richards
- NIHR Birmingham Biomedical Research Centre (BRC), University of Birmingham, Birmingham, UK
| | - Emily Lam
- NIHR Birmingham Biomedical Research Centre (BRC), University of Birmingham, Birmingham, UK
| | - Philip N Newsome
- NIHR Birmingham Biomedical Research Centre (BRC), University of Birmingham, Birmingham, UK
- Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre (BRC), University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- Midlands Health Data Research UK, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
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Velez MA, Glenn BA, Garcia-Jimenez M, Cummings AL, Lisberg A, Nañez A, Radwan Y, Lind-Lebuffe JP, Brodrick PM, Li DY, Fernandez-Turizo MJ, Gower A, Lindenbaum M, Hegde M, Brook J, Grogan T, Elashoff D, Teitell MA, Garon EB. Consent document translation expense hinders inclusive clinical trial enrolment. Nature 2023; 620:855-862. [PMID: 37532930 PMCID: PMC11046417 DOI: 10.1038/s41586-023-06382-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/28/2023] [Indexed: 08/04/2023]
Abstract
Patients from historically under-represented racial and ethnic groups are enrolled in cancer clinical trials at disproportionately low rates in the USA1-3. As these patients often have limited English proficiency4-7, we hypothesized that one barrier to their inclusion is the cost to investigators of translating consent documents. To test this hypothesis, we evaluated more than 12,000 consent events at a large cancer centre and assessed whether patients requiring translated consent documents would sign consent documents less frequently in studies lacking industry sponsorship (for which the principal investigator pays the translation costs) than for industry-sponsored studies (for which the translation costs are covered by the sponsor). Here we show that the proportion of consent events for patients with limited English proficiency in studies not sponsored by industry was approximately half of that seen in industry-sponsored studies. We also show that among those signing consent documents, the proportion of consent documents translated into the patient's primary language in studies without industry sponsorship was approximately half of that seen in industry-sponsored studies. The results suggest that the cost of consent document translation in trials not sponsored by industry could be a potentially modifiable barrier to the inclusion of patients with limited English proficiency.
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Affiliation(s)
- Maria A Velez
- Department of Medicine, Division of Hematology/Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Beth A Glenn
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Health Policy and Management, University of California, Los Angeles, Los Angeles, CA, USA
- UCLA Center for Cancer Prevention and Control Research, University of California, Los Angeles, Los Angeles, CA, USA
- UCLA Kaiser Permanente Center for Health Equity, University of Califonia, Los Angeles, Los Angeles, CA, USA
| | - Maria Garcia-Jimenez
- Department of Medicine, Division of Hematology/Oncology, University of California, Los Angeles, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
- Division of Hematology/Oncology, UCLA-Olive View Medical Center, Los Angeles, CA, USA
| | - Amy L Cummings
- Department of Medicine, Division of Hematology/Oncology, University of California, Los Angeles, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Aaron Lisberg
- Department of Medicine, Division of Hematology/Oncology, University of California, Los Angeles, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Andrea Nañez
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Yazeed Radwan
- Department of Medicine, Division of Hematology/Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jackson P Lind-Lebuffe
- Department of Medicine, Division of Hematology/Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Paige M Brodrick
- Department of Medicine, Division of Hematology/Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Debory Y Li
- Department of Medicine, Division of Hematology/Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Arjan Gower
- Department of Medicine, Division of Hematology/Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Maggie Lindenbaum
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Manavi Hegde
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jenny Brook
- Department of Medicine Statistics Core, University of California, Los Angeles, Los Angeles, CA, USA
| | - Tristan Grogan
- Department of Medicine Statistics Core, University of California, Los Angeles, Los Angeles, CA, USA
| | - David Elashoff
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Medicine Statistics Core, University of California, Los Angeles, Los Angeles, CA, USA
| | - Michael A Teitell
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Edward B Garon
- Department of Medicine, Division of Hematology/Oncology, University of California, Los Angeles, Los Angeles, CA, USA.
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA.
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3
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Recommendations for Diversifying Racial and Ethnic Representation in Autism Intervention Research: A Crossover Review of Recruitment and Retention Practices in Pediatric Mental Health. J Clin Med 2022; 11:jcm11216468. [PMID: 36362698 PMCID: PMC9654487 DOI: 10.3390/jcm11216468] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
Disparities in diagnosis and access to healthcare and therapeutic services are well-documented for children with autism spectrum disorder (ASD) from minoritized races and ethnicities, but there is little empirical research to guide the selection and implementation of interventions and practices that will effectively support racially/ethnically diverse children with ASD and their families. This cross-over systematic review summarizes parent-mediated intervention research of children with or at risk for mental health disorders to identify potentially effective recruitment and retention strategies for diverse participants in parent-mediated intervention research for children with autism. Electronic database keyword, lead author name searches in PyschNet, MEDLINE, and ancestral searches were conducted to identify 68 relevant articles that used experimental designs to evaluate the effects of parent-mediated interventions on children with or at risk for mental health disorders. Articles were coded for participant demographics; intervention setting and type, recruitment and retention strategies, cultural adaptation of intervention, and reported attrition. Findings are discussed and applied to practices in autism parent-mediated intervention research. Suggestions for future research and limitations are discussed.
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Graham L, Ngwa J, Ntekim O, Ogunlana O, Johnson S, Nadarajah S, Fungwe TV, Turner J, Ruiz MR, Khan J, Obisesan TO. The Role of Transportation in the Enrollment of Elderly African Americans into Exercise and Memory Study: GEMS Study. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01367-7. [PMID: 35931916 DOI: 10.1007/s40615-022-01367-7] [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: 02/24/2022] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Understanding the factors driving recruitment and enrollment of African Americans (AA)s in clinical translational research will assure that underrepresented populations benefit from scientific progress and new developments in the diagnosis and treatment of Alzheimer's disease and related disorders. While transportation is pivotal to volunteers' ability to participate in research, its contribution to enrollment in exercise studies on AD is yet to be elucidated. Thus, this research focuses on identifying factors that influence the recruitment and enrollment of African Americans in biomedical studies and determining whether the availability of transportation motivates participation in time-demanding exercise studies on AD. METHODS We analyzed recruitment data collected from 567 volunteers ages 55 and older screened through various recruitment sources and considered for enrollment in our exercise and memory study. To determine whether transportation influenced the enrollment of African Americans (AA)s in biomedical studies, multiple logistic regression analysis was performed to identify significant factors that drive enrollment. Furthermore, the association of race and demographic factors on the availability of transportation was assessed. RESULTS Demographic factors, age at screening, education, gender, and cognitive scores were not significantly different among those enrolled compared to control (not-enrolled). In the relationship of enrollment to transportation, enrolled participants were more likely to have access to transportation (79.12%) than not-enrolled participants who had less access to transportation (71.6%); however, the association was not statistically significant. However, race differentially influenced the likelihood of enrollment, with elderly AAs being significantly less likely to have transportation (p = 0.020) than the Whites but more likely than "others" to have transportation. CONCLUSION Our findings suggest that access to transportation may be a key factor motivating enrollment in an exercise and memory study in a predominantly AA sample. Notably, AAs in our sample were less likely to have transportation than Whites. Other demographic factors and cognitive scores did not significantly influence enrollment in our sample. A larger sample and more detailed assessment of transportation are needed to further discern the role of transportation in clinical trials.
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Affiliation(s)
- Lennox Graham
- Department of Health Management, College of Nursing and Allied Health Sciences, Howard University, Washington, DC, 20059, USA
| | - Julius Ngwa
- Division of Cardiovascular Medicine, College of Medicine, Howard University, Washington, DC, 20059, USA
| | - Oyonumo Ntekim
- Department of Nutritional Sciences, College of Nursing and Allied Health Sciences, Howard University, Washington, DC, 20059, USA
| | - Oludolapo Ogunlana
- Department of Medicine and Clinical Translational Science Program, Division of Geriatrics, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA
| | - Steven Johnson
- Department of Nutritional Sciences, College of Nursing and Allied Health Sciences, Howard University, Washington, DC, 20059, USA
| | - Sheeba Nadarajah
- Department of Nursing, College of Nursing and Allied Health Sciences, Howard University, Washington, DC, 20059, USA
| | - Thomas V Fungwe
- Department of Nutritional Sciences, College of Nursing and Allied Health Sciences, Howard University, Washington, DC, 20059, USA
| | - Jillian Turner
- Department of Medicine and Clinical Translational Science Program, Division of Geriatrics, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA
| | - Mara Ramirez Ruiz
- Department of Medicine and Clinical Translational Science Program, Division of Geriatrics, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA
| | - Javed Khan
- Department of Medicine and Clinical Translational Science Program, Division of Geriatrics, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA
| | - Thomas O Obisesan
- Department of Medicine and Clinical Translational Science Program, Division of Geriatrics, Howard University Hospital, 2041 Georgia Ave NW, Washington, DC, 20060, USA.
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Abstract
Since the completion of the Human Genome Project, considerable progress has been made in translating knowledge about the genetic basis of disease risk and treatment response into clinical services and public health interventions that have greater precision. It is anticipated that more precision approaches to early detection, prevention, and treatment will be developed and will enhance equity in healthcare and outcomes among disparity populations. Reduced access to genomic medicine research, clinical services, and public health interventions has the potential to exacerbate disparities in genomic medicine. The purpose of this article is to describe these challenges to equity in genomic medicine and identify opportunities and future directions for addressing these issues. Efforts are needed to enhance access to genomic medicine research, clinical services, and public health interventions, and additional research that examines the clinical utility of precision medicine among disparity populations should be prioritized to ensure equity in genomic medicine. Expected final online publication date for the Annual Review of Genomics and Human Genetics, Volume 23 is October 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Chanita Hughes Halbert
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA; .,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
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Nkimbeng M, Rosebush CE, Akosah KO, Yam H, Russell WN, Bustamante G, Albers EA, Shippee TP, Sasikumar AP, Gaugler JE. The Immigrant Memory Collaborative: A Community-University Partnership to Assess African Immigrant Families' Experiences with Dementia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074075. [PMID: 35409758 PMCID: PMC8997896 DOI: 10.3390/ijerph19074075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/07/2022] [Accepted: 03/22/2022] [Indexed: 12/04/2022]
Abstract
Research suggests a disparity in the prevalence of dementia, with Black older adults having double the risk compared to their White counterparts. African immigrants are a fast-growing segment of the U.S. Black population, but the dementia care needs and resources of this population are not fully understood. In this paper, we describe the process of working collaboratively with a community partner and project advisory board to conduct a culturally informed project. Specifically, we describe the process of developing culturally informed instruments to collect data on dementia care needs and resources among African immigrants. Working together with a diverse project advisory board, a guide was developed and used to conduct community conversations about experiences with dementia/memory loss. Transcripts from six conversations with 24 total participants were transcribed and analyzed thematically by two independent coders in Nvivo. These qualitative findings were used to inform the development of a survey for quantitative data collection that is currently ongoing. Themes (e.g., cultural attitudes, challenges, and current resources) from the community conversations that informed the survey are described briefly. Despite the challenges of conducting research during a global pandemic, having trusting relationships with a partnering community organization and project advisory board facilitated the successful development of instruments to conduct preliminary dementia care research in an underserved population. We anticipate that survey results will inform interventions that increase education, outreach, and access to dementia care and caregiving resources for this population. It may serve as a model for community–university partnerships for similar public health efforts in dementia as well as other chronic disease contexts.
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Affiliation(s)
- Manka Nkimbeng
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN 55455, USA; (C.E.R.); (K.O.A.); (H.Y.); (E.A.A.); (T.P.S.); (J.E.G.)
- Correspondence:
| | - Christina E. Rosebush
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN 55455, USA; (C.E.R.); (K.O.A.); (H.Y.); (E.A.A.); (T.P.S.); (J.E.G.)
| | - Kwame O. Akosah
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN 55455, USA; (C.E.R.); (K.O.A.); (H.Y.); (E.A.A.); (T.P.S.); (J.E.G.)
| | - Hawking Yam
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN 55455, USA; (C.E.R.); (K.O.A.); (H.Y.); (E.A.A.); (T.P.S.); (J.E.G.)
| | - Wynfred N. Russell
- African Career Education and Resources Inc., Brooklyn Park, MN 55445, USA; (W.N.R.); (A.P.S.)
| | - Gabriela Bustamante
- Program in Health Disparities Research, Department of Family Medicine & Community Health, University of Minnesota Medical School, Minneapolis, MN 55455, USA;
- School of Public Health, Universidad San Francisco de Quito, Quito 170901, Ecuador
| | - Elizabeth A. Albers
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN 55455, USA; (C.E.R.); (K.O.A.); (H.Y.); (E.A.A.); (T.P.S.); (J.E.G.)
| | - Tetyana P. Shippee
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN 55455, USA; (C.E.R.); (K.O.A.); (H.Y.); (E.A.A.); (T.P.S.); (J.E.G.)
| | - Arundhathi P. Sasikumar
- African Career Education and Resources Inc., Brooklyn Park, MN 55445, USA; (W.N.R.); (A.P.S.)
| | - Joseph E. Gaugler
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN 55455, USA; (C.E.R.); (K.O.A.); (H.Y.); (E.A.A.); (T.P.S.); (J.E.G.)
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Bulkley JE, O'Keeffe-Rosetti M, Wendel CS, Davis JV, Danforth KN, Harrison TN, Kwan ML, Munneke J, Brooks N, Grant M, Leo MC, Banegas M, Weinmann S, McMullen CK. The effect of multiple recruitment contacts on response rates and patterns of missing data in a survey of bladder cancer survivors 6 months after cystectomy. Qual Life Res 2019; 29:879-889. [PMID: 31811594 DOI: 10.1007/s11136-019-02379-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The Bladder Cancer Quality of Life Study collected detailed and sensitive patient-reported outcomes from bladder cancer survivors in the period after bladder removal surgery, when participation in survey research may present a burden. This paper describes the study recruitment methods and examines the response rates and patterns of missing data. METHODS Detailed surveys focusing on quality of life, healthcare decision-making, and healthcare expenses were mailed to patients 5-7 months after cystectomy. We conducted up to 10 follow-up recruitment calls. We analyzed survey completion rates following each contact in relation to demographic and clinical characteristics, and patterns of missing data across survey content areas. RESULTS The overall response rate was 71% (n = 269/379). This was consistent across patient clinical characteristics; response rates were significantly higher among patients over age 70 and significantly lower among racial and ethnic minority patients compared to non-Hispanic white patients. Each follow-up contact resulted in marginal survey completion rates of at least 10%. Rates of missing data were low across most content areas, even for potentially sensitive questions. Rates of missing data differed significantly by sex, age, and race/ethnicity. CONCLUSIONS Despite the effort required to participate in research, this population of cancer survivors showed willingness to share detailed information about quality of life, health care decision-making, and expenses, soon after major cancer surgery. Additional contacts were effective at increasing participation. Response patterns differed by race/ethnicity and other demographic factors. Our data collection methods show that it is feasible to gather detailed patient-reported outcomes during this challenging period.
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Affiliation(s)
- Joanna E Bulkley
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA.
| | - Maureen O'Keeffe-Rosetti
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
| | | | - James V Davis
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
| | - Kim N Danforth
- Kaiser Permanente Department of Research and Evaluation, Pasadena, CA, USA
| | - Teresa N Harrison
- Kaiser Permanente Department of Research and Evaluation, Pasadena, CA, USA
| | - Marilyn L Kwan
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Julie Munneke
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Neon Brooks
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
| | - Marcia Grant
- City of Hope/Beckman Research Institute, Duarte, CA, USA
| | - Michael C Leo
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
| | - Matthew Banegas
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
| | - Sheila Weinmann
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
| | - Carmit K McMullen
- Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97227-1110, USA
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Staples JN, Lester J, Li A, Walsh C, Cass I, Karlan BY, Bresee C, Rimel BJ. Language as a barrier to cancer clinical trial accrual: assessing consenting team knowledge and practices for cancer clinical trial consent among low English fluency patients. ACTA ACUST UNITED AC 2018. [DOI: 10.1186/s41241-018-0065-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Burnett C, Bullock L, Collins CA, Hauser L. Evaluation of a Clinical Cancer Trial Research Training Workshop: Helping Nurses Build Capacity in Southwest Virginia. Public Health Nurs 2016; 33:565-572. [PMID: 27686780 DOI: 10.1111/phn.12295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Residents of Southwest Virginia (SWVA) face significant barriers in accessing the most advanced forms of cancer care, cancer risk reduction, and clinical trials involvement. A collaboration between the University of Virginia (UVA) Cancer Center and UVA School of Nursing was forged with oncology caregivers in this region to build community capacity to support Cancer Clinical trials (CCT) by strengthening the workforce, and thus improving health outcomes for this underserved region of Appalachia. The UVA School of Nursing designed an educational workshop focusing on the basics of CCT to facilitate the development of a skilled nursing workforce in the SWVA region that could provide care to patients on protocol and/or to encourage residents to participate in trials. The goal of the workshop was to offer a CCT training session for oncology nurses that fostered the knowledge and skills necessary to facilitate and support CCT infrastructure across this high-risk region. This evaluation reports the learning outcomes of the CCT training on 32 nurse participants from SWVA. Evaluations of the training program showed high rates of satisfaction, increased comfort level with CCTs, and increased knowledge and attitude toward CCTs. These findings provide information about a curriculum that could be useful in educating other oncology nurses and student nurses how to care for patients who may be enrolled in a clinical trial. Nurses can also be advocates for participation in clinical trials once they have the knowledge and are comfortable in their own understanding of a trial's usefulness. Educating the nursing workforce is an essential component of building capacity and infrastructure to support clinical trials research.
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Affiliation(s)
- Camille Burnett
- Center for Health Policy, University of Virginia School of Nursing, Charlottesville, Virginia
| | - Linda Bullock
- School of Nursing, University of Virginia, Charlottesville, Virginia
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11
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Fouad MN, Acemgil A, Bae S, Forero A, Lisovicz N, Martin MY, Oates GR, Partridge EE, Vickers SM. Patient Navigation As a Model to Increase Participation of African Americans in Cancer Clinical Trials. J Oncol Pract 2016; 12:556-63. [PMID: 27189356 PMCID: PMC4957258 DOI: 10.1200/jop.2015.008946] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Less than 10% of patients enrolled in clinical trials are minorities. The patient navigation model has been used to improve access to medical care but has not been evaluated as a tool to increase the participation of minorities in clinical trials. The Increasing Minority Participation in Clinical Trials project used patient navigators (PNs) to enhance the recruitment of African Americans for and their retention in therapeutic cancer clinical trials in a National Cancer Institute-designated comprehensive cancer center. METHODS Lay individuals were hired and trained to serve as PNs for clinical trials. African American patients potentially eligible for clinical trials were identified through chart review or referrals by clinic nurses, physicians, and social workers. PNs provided two levels of services: education about clinical trials and tailored support for patients who enrolled in clinical trials. RESULTS Between 2007 and 2014, 424 African American patients with cancer were referred to the Increasing Minority Participation in Clinical Trials project. Of those eligible for a clinical trial (N = 378), 304 (80.4%) enrolled in a trial and 272 (72%) consented to receive patient navigation support. Of those receiving patient navigation support, 74.5% completed the trial, compared with 37.5% of those not receiving patient navigation support. The difference in retention rates between the two groups was statistically significant (P < .001). Participation of African Americans in therapeutic cancer clinical trials increased from 9% to 16%. CONCLUSION Patient navigation for clinical trials successfully retained African Americans in therapeutic trials compared with non-patient navigation trial participation. The model holds promise as a strategy to reduce disparities in cancer clinical trial participation. Future studies should evaluate it with racial/ethnic minorities across cancer centers.
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Affiliation(s)
- Mona N Fouad
- University of Alabama at Birmingham, Birmingham, AL
| | - Aras Acemgil
- University of Alabama at Birmingham, Birmingham, AL
| | - Sejong Bae
- University of Alabama at Birmingham, Birmingham, AL
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12
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Greiner KA, Friedman DB, Adams SA, Gwede CK, Cupertino P, Engelman KK, Meade CD, Hébert JR. Effective recruitment strategies and community-based participatory research: community networks program centers' recruitment in cancer prevention studies. Cancer Epidemiol Biomarkers Prev 2015; 23:416-23. [PMID: 24609851 DOI: 10.1158/1055-9965.epi-13-0760] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Community-based participatory research (CBPR) approaches that involve community and academic partners in activities ranging from protocol design through dissemination of study findings can increase recruitment of medically underserved and underrepresented racial/ethnic minority populations into biomedical research. METHODS Five cancer screening and prevention trials in three National Cancer Institute (Bethesda, MD)-funded Community Networks Program Centers (CNPC), in Florida, Kansas, and South Carolina, were conducted across diverse populations. Data were collected on total time period of recruitment, ratios of participants enrolled over potential participants approached, selected CBPR strategies, capacity-building development, and systematic procedures for community stakeholder involvement. RESULTS Community-engaged approaches used included establishing colearning opportunities, participatory procedures for community-academic involvement, and community and clinical capacity building. A relatively large proportion of individuals identified for recruitment was actually approached (between 50% and 100%). The proportion of subjects who were eligible among all those approached ranged from 25% to more than 70% (in the community setting). Recruitment rates were very high (78%-100% of eligible individuals approached) and the proportion who refused or who were not interested among those approached was very low (5%-11%). CONCLUSIONS Recruitment strategies used by the CNPCs were associated with low refusal and high enrollment ratios of potential subjects. Adherence to CBPR principles in the spectrum of research activities, from strategic planning to project implementation, has significant potential to increase involvement in biomedical research and improve our ability to make appropriate recommendations for cancer prevention and control programming in underrepresented diverse populations. IMPACT CBPR strategies should be more widely implemented to enhance study recruitment.
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Affiliation(s)
- K Allen Greiner
- Authors' Affiliations: Departments of Family Medicine and Preventive Medicine, University of Kansas Medical Center; University of Kansas Cancer Center, Kansas City, Kansas; South Carolina Statewide Cancer Prevention and Control Program; Arnold School of Public Health; College of Nursing, University of South Carolina, Columbia, South Carolina; and Moffitt Cancer Center and the University of South Florida, Tampa, Florida
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Chen MS, Lara PN, Dang JHT, Paterniti DA, Kelly K. Twenty years post-NIH Revitalization Act: enhancing minority participation in clinical trials (EMPaCT): laying the groundwork for improving minority clinical trial accrual: renewing the case for enhancing minority participation in cancer clinical trials. Cancer 2014; 120 Suppl 7:1091-6. [PMID: 24643646 DOI: 10.1002/cncr.28575] [Citation(s) in RCA: 312] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 08/06/2013] [Accepted: 08/26/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND The National Institutes of Health (NIH) Revitalization Act of 1993 mandated the appropriate inclusion of minorities in all NIH-funded research. Twenty years after this act, the proportion of minority patients enrolled in cancer clinical trials remains persistently low. Clinical trials are vehicles for the development and evaluation of therapeutic and preventive agents under scientifically rigorous conditions. Without representation in trials, it is projected that disparities in the cancer burden for minorities will increase. METHODS For this review article, the authors counted the frequency with which minorities were the primary focus of National Cancer Institute-sponsored clinical trials, examined citations from the PubMed database focusing on the search terms "NIH Revitalization Act of 1993" and "enhancing minority accrual to cancer clinical trials," and supplemented the review with their expertise in NIH-funded research related to minority accrual in cancer clinical trials. RESULTS The reporting and analyses of data based on minorities in clinical trials remain inadequate. Less than 2% of the National Cancer Institute's clinical trials focus on any racial/minority population as their primary emphasis. The current review of the literature indicated that the percentage of authors who reported their study sample by race/ethnicity ranged from 1.5% to 58%, and only 20% of the randomized controlled studies published in a high-impact oncology journal reported analyzing results by race/ethnicity. Proportionately greater population increases in minorities, accompanied by their persistent and disproportionate cancer burden, reinforce the need for their greater representation in clinical trials. CONCLUSIONS Renewing the emphasis for minority participation in clinical trials is warranted. Policy changes are recommended.
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Affiliation(s)
- Moon S Chen
- Division of Hematology and Oncology, Department of Internal Medicine, School of Medicine, University of California, Davis, Sacramento, California; Cancer Control, University of California, Davis Comprehensive Cancer Center, Sacramento, California
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Chen MS, Lara PN, Dang JHT, Paterniti DA, Kelly K. Twenty years post-NIH Revitalization Act: enhancing minority participation in clinical trials (EMPaCT): laying the groundwork for improving minority clinical trial accrual: renewing the case for enhancing minority participation in cancer clinical trials. Cancer 2014. [PMID: 24643646 DOI: 10.1002/cncr.28575.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The National Institutes of Health (NIH) Revitalization Act of 1993 mandated the appropriate inclusion of minorities in all NIH-funded research. Twenty years after this act, the proportion of minority patients enrolled in cancer clinical trials remains persistently low. Clinical trials are vehicles for the development and evaluation of therapeutic and preventive agents under scientifically rigorous conditions. Without representation in trials, it is projected that disparities in the cancer burden for minorities will increase. METHODS For this review article, the authors counted the frequency with which minorities were the primary focus of National Cancer Institute-sponsored clinical trials, examined citations from the PubMed database focusing on the search terms "NIH Revitalization Act of 1993" and "enhancing minority accrual to cancer clinical trials," and supplemented the review with their expertise in NIH-funded research related to minority accrual in cancer clinical trials. RESULTS The reporting and analyses of data based on minorities in clinical trials remain inadequate. Less than 2% of the National Cancer Institute's clinical trials focus on any racial/minority population as their primary emphasis. The current review of the literature indicated that the percentage of authors who reported their study sample by race/ethnicity ranged from 1.5% to 58%, and only 20% of the randomized controlled studies published in a high-impact oncology journal reported analyzing results by race/ethnicity. Proportionately greater population increases in minorities, accompanied by their persistent and disproportionate cancer burden, reinforce the need for their greater representation in clinical trials. CONCLUSIONS Renewing the emphasis for minority participation in clinical trials is warranted. Policy changes are recommended.
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Affiliation(s)
- Moon S Chen
- Division of Hematology and Oncology, Department of Internal Medicine, School of Medicine, University of California, Davis, Sacramento, California; Cancer Control, University of California, Davis Comprehensive Cancer Center, Sacramento, California
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Uniting postcolonial, discourse, and linguistic theory to explore participation of African Americans in cancer research as an effect of social and historical race relationships. ANS Adv Nurs Sci 2014; 37:32-47. [PMID: 24469087 DOI: 10.1097/ans.0000000000000015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article uses a historical framework of postcolonialism; discourse analytic concepts (significance, identity, and relationships); and 5 social and cultural linguistic principles of emergence, positionality, indexicality, relationality, and partialness as a theoretical and methodological triangulation approach to data analysis of focus group discussion. Exemplars of focus group data from a study exploring African American participation in research demonstrate the application of this combined framework as a useful tool for analysis. This approach allows for examination of identity and interaction and generates a more rigorous and complete understanding of how individuals use language to construct identity as participants or nonparticipants in research.
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Frew PM, Williams VA, Shapiro ET, Sanchez T, Rosenberg ES, Fenimore VL, Sullivan PS. From (Un)Willingness to InvolveMENt: Development of a Successful Study Brand for Recruitment of Diverse MSM to a Longitudinal HIV Research. INTERNATIONAL JOURNAL OF POPULATION RESEARCH 2013; 2013:624245. [PMID: 24639900 PMCID: PMC3955100 DOI: 10.1155/2013/624245] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND HIV continues to be a major concern among MSM, yet Black MSM have not been enrolled in HIV research studies in proportionate numbers to White MSM. We developed an HIV prevention research brand strategy for MSM. METHODS Questionnaires and focus groups were conducted with 54 participants. Descriptive statistics and chi-square analyses were performed and qualitative data were transcribed and content analyzed to identify common themes. RESULTS Formative research results indicated that younger Black MSM (18-29 years) were less likely to think about joining prevention studies compared to older (≥30 years) Black MSM (x2 = 5.92, P = 0.015). Qualitative and quantitative results indicate four prominent themes related to brand development: (1) communication sources (message deliverer), (2) message (impact of public health messaging on perceptions of HIV research), (3) intended audience (underlying issues that influence personal relevance of HIV research), and (4) communication channels (reaching intended audiences). CONCLUSION The findings highlight the importance of behavioral communication translational research to effectively engage hard-to-reach populations. Despite reservations, MSM in our formative study expressed a need for active involvement and greater education to facilitate their engagement in HIV prevention research. Thus, the brand concept of "InvolveMENt" emerged.
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Affiliation(s)
- Paula M. Frew
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
- Emory Center for AIDS Research, Atlanta, GA 30322, USA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
- The Hope Clinic of the Emory Vaccine Center, Decatur, GA 30030, USA
| | - Victoria A. Williams
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Eve T. Shapiro
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Travis Sanchez
- Emory Center for AIDS Research, Atlanta, GA 30322, USA
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Eli S. Rosenberg
- Emory Center for AIDS Research, Atlanta, GA 30322, USA
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | | | - Patrick S. Sullivan
- Emory Center for AIDS Research, Atlanta, GA 30322, USA
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
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Walter JK, Burke JF, Davis MM. Research participation by low-income and racial/ethnic minority groups: how payment may change the balance. Clin Transl Sci 2013; 6:363-71. [PMID: 24127923 DOI: 10.1111/cts.12084] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Minorities are underenrolled in clinical research trials, and one-third of trials are underenrolled overall. The role of payment has not been studied at the national level as an explanation for enrollment patterns. Our objective was to examine the distribution of self-reported previous research participation across different sociodemographic groups; to assess the public's perception of fair payment for a low-risk medicine trial and the association between requested payment and sociodemographic characteristics; to estimate the amount of payment for a medication trial to achieve proportional representation of minorities and different socioeconomic groups. This was a cross-sectional study with nationally representative data collected in 2011 by the C.S. Mott Children's Hospital National Poll on Children's Health. To determine the relationship between perceived fair payment and individual-level characteristics, we used multivariable linear regression. With 60% participation rate, in a sample of 2,150 respondents 11% (n = 221) of the sample had previously participated in medical research. Requested payment differed significantly by racial/ethnic group with Hispanics requesting more payment than non-Hispanic whites (0.37 [95%CI 0.02, 0.72]) In contrast to payment at $49, $149, and $249, payment at $349 yielded proportional representation of racial/ethnic minority groups. Hispanics requested higher payment for research participation, suggesting a possible explanation for their underenrollment.
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Affiliation(s)
- Jennifer K Walter
- Department of Pediatrics, Children's Hospital of Philadelphia associated with the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Hurlimann T, Stenne R, Menuz V, Godard B. Inclusion and exclusion in nutrigenetics clinical research: ethical and scientific challenges. JOURNAL OF NUTRIGENETICS AND NUTRIGENOMICS 2012; 4:322-43. [PMID: 22301706 DOI: 10.1159/000334853] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 11/03/2011] [Indexed: 12/15/2022]
Abstract
BACKGROUND/AIMS There are compelling reasons to ensure the participation of ethnic minorities and populations of all ages worldwide in nutrigenetics clinical research. If findings in such research are valid for some individuals, groups, or communities, and not for others, then ethical questions of justice--and not only issues of methodology and external validity--arise. This paper aims to examine inclusion in nutrigenetics clinical research and its scientific and ethical challenges. METHODS In total, 173 publications were identified through a systematic review of clinical studies in nutrigenetics published between 1998 and 2007. Data such as participants' demographics as well as eligibility criteria were extracted. RESULTS There is no consistency in the way participants' origins (ancestry, ethnicity, or race) and ages are described in publications. A vast majority of the studies identified was conducted in North America and Europe and focused on 'white' participants. Our results show that pregnant women (and fetuses), minors, and the elderly (≥ 75 years old) remain underrepresented. CONCLUSION Representativeness in nutrigenetics research is a challenging ethical and scientific issue. Yet, if nutrigenetics is to benefit whole populations and be used in public and global health agendas, fair representation as well as clear descriptions of participants in publications are crucial.
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Affiliation(s)
- T Hurlimann
- Department of Social and Preventive Medicine, Bioethics Programmes, Faculty of Medicine, University of Montreal, Montreal, Que., Canada
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Variability in frontotemporal brain structure: the importance of recruitment of African Americans in neuroscience research. PLoS One 2010; 5:e13642. [PMID: 21049028 PMCID: PMC2964318 DOI: 10.1371/journal.pone.0013642] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 10/04/2010] [Indexed: 11/19/2022] Open
Abstract
Background Variation in brain structure is both genetically and environmentally influenced. The question about potential differences in brain anatomy across populations of differing race and ethnicity remains a controversial issue. There are few studies specifically examining racial or ethnic differences and also few studies that test for race-related differences in context of other neuropsychiatric research, possibly due to the underrepresentation of ethnic minorities in clinical research. It is within this context that we conducted a secondary data analysis examining volumetric MRI data from healthy participants and compared the volumes of the amygdala, hippocampus, lateral ventricles, caudate nucleus, orbitofrontal cortex (OFC) and total cerebral volume between Caucasian and African-American participants. We discuss the importance of this finding in context of neuroimaging methodology, but also the need for improved recruitment of African Americans in clinical research and its broader implications for a better understanding of the neural basis of neuropsychiatric disorders. Methodology/Principal Findings This was a case control study in the setting of an academic medical center outpatient service. Participants consisted of 44 Caucasians and 33 ethnic minorities. The following volumetric data were obtained: amygdala, hippocampus, lateral ventricles, caudate nucleus, orbitofrontal cortex (OFC) and total cerebrum. Each participant completed a 1.5 T magnetic resonance imaging (MRI). Our primary finding in analyses of brain subregions was that when compared to Caucasians, African Americans exhibited larger left OFC volumes (F 1,68 = 7.50, p = 0.008). Conclusions The biological implications of our findings are unclear as we do not know what factors may be contributing to these observed differences. However, this study raises several questions that have important implications for the future of neuropsychiatric research.
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DuBois JM, O’Leary CC, Cottler LB. The attitudes of females in drug court toward additional safeguards in HIV prevention research. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2009; 10:345-52. [PMID: 19452277 PMCID: PMC2838183 DOI: 10.1007/s11121-009-0136-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This article examines the attitudes of 97 women from the St. Louis City Drug Court who previously participated in an HIV prevention study. Data from the previous study indicated that the women met multiple criteria for vulnerability in research. Federal regulations require that such participants be provided with "additional safeguards." The survey explored the following questions: (1) What are participants' attitudes toward commonly proposed additional safeguards for vulnerable participants in research, and (2) Are attitudes toward safeguards related to participants' previous compliance with an HIV prevention protocol? Preferences regarding safeguards in research were not significantly related to participants' compliance in the previous study. Most participants wanted researchers to take extra measures not only to provide consent information, but to ensure that they are not high on drugs, that they understand relevant information, and that they retain consent information at each visit. Most participants wanted researchers themselves, and not a third party, to assume this responsibility.
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Affiliation(s)
- James M. DuBois
- Department of Health Care Ethics, Saint Louis University, 221 North Grand Blvd, St. Louis, MO 63103, USA
| | - Catina Callahan O’Leary
- Epidemiology and Prevention Research Group, School of Medicine, Washington University, 40 N. Kingshighway, Suite 4, St. Louis, MO 63108, USA
| | - Linda B. Cottler
- Epidemiology and Prevention Research Group, School of Medicine, Washington University, 40 N. Kingshighway, Suite 4, St. Louis, MO 63108, USA
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Bozeman B, Slade C, Hirsch P. Understanding bureaucracy in health science ethics: toward a better institutional review board. Am J Public Health 2009; 99:1549-56. [PMID: 19608947 PMCID: PMC2724460 DOI: 10.2105/ajph.2008.152389] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2008] [Indexed: 11/04/2022]
Abstract
Research involving human participants continues to grow dramatically, fueled by advances in medical technology, globalization of research, and financial and professional incentives. This creates increasing opportunities for ethical errors with devastating effects. The typical professional and policy response to calamities involving human participants in research is to layer on more ethical guidelines or strictures. We used a recent case-the Johns Hopkins University/Kennedy Kreiger Institute Lead Paint Study-to examine lessons learned since the Tuskegee Syphilis Study about the role of institutionalized science ethics in the protection of human participants in research. We address the role of the institutional review board as the focal point for policy attention.
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Affiliation(s)
- Barry Bozeman
- Department of Public Administration and Policy at the University of Georgia, Athens
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Taylor HA. Inclusion of women, minorities, and children in clinical trials: opinions of research ethics board administrators. J Empir Res Hum Res Ethics 2009; 4:65-73. [PMID: 19480593 DOI: 10.1525/jer.2009.4.2.65] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
IN AN ATTEMPT TO ENCOURAGE INCLUSION of women, minorities, and children in clinical trials, the U.S. National Institutes of Health (NIH) requires investigators conducting NIH-sponsored research to adequately address NIH inclusion guidelines concerning recruitment of women, minorities, and children. A survey of U.S. Research Ethics Board (REB) administrators at institutions receiving NIH funding indicated awareness and implementation of the inclusion guidelines. According to the administrators, investigators and REBs address inclusion in more than half of the relevant protocols. About half of the REB administrators consider the guidelines partly responsible for increased attention to inclusion, but only about a quarter believe that there is greater inclusion as a result.
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Affiliation(s)
- Holly A Taylor
- School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
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Iltis AS, Wall A, Lesandrini J, Rangel EK, Chibnall JT. Federal Interpretation and Enforcement of Protections for Vulnerable Participants in Human Research. J Empir Res Hum Res Ethics 2009; 4:37-41. [DOI: 10.1525/jer.2009.4.1.37] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Regulations and policies governing research, codes of ethics, and the research ethics literature reflect the need to provide special protections to vulnerable research participants. Nevertheless, there is disagreement about who is vulnerable and why, what protections are appropriate, and when to disallow research involving vulnerable persons. The Common Rule (CR) governs much of the human research conducted in the United States and the Office for Human Research Protections (OHRP) oversees much of this research. The CR requires special protections for pregnant women, fetuses, neonates, prisoners, and children. Although it also requires that researchers employ “additional safeguards” to protect other vulnerable persons, it does not define vulnerability or identify appropriate “safeguards.” Very little is known about how OHRP interprets the “additional safeguards” requirement. We examined all letters of determination posted on the OHRP website between July 1, 2000 and December 31, 2006 (n = 636) to study the extent to which OHRP addressed, in its audits and investigations, the requirement to protect vulnerable persons. The letters did not reveal guidance on understanding vulnerability, determining whether a study includes vulnerable persons or protecting vulnerable participants. If institutions and investigators are to fulfill the ethical obligation to provide appropriate safeguards when conducting research on vulnerable persons, they must develop and implement mechanisms to identify and address vulnerability.
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Spiker CA, Weinberg AD. Policies to address disparities in clinical trials: the EDICT Project. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2009; 24:S39-S49. [PMID: 20024825 DOI: 10.1007/bf03182311] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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James RD, Yu JH, Henrikson NB, Bowen DJ, Fullerton SM. Strategies and stakeholders: minority recruitment in cancer genetics research. ACTA ACUST UNITED AC 2008; 11:241-9. [PMID: 18417972 DOI: 10.1159/000116878] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The Cancer Genetics Network (CGN) is one of a growing number of large-scale registries designed to facilitate investigation of genetic and environmental contributions to health and disease. Despite compelling scientific and social justice arguments that recommend diverse participation in biomedical research, members of ethnic minority groups continue to be chronically underrepresented in such projects. The CGN studies reported in this issue used strategies well documented to increase minority participation in research activities, including use of community-targeted materials, addressing community trust concerns, and the adoption of personalized and flexible research protocols. Here, we review the outcome of these efforts to increase minority recruitment to the CGN, and ask what lessons the findings suggest for future minority recruitment initiatives.
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Affiliation(s)
- Rosalina D James
- Department of Medical History and Ethics and Genome Sciences, School of Public Health, Boston University, Boston, Mass., USA.
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Corbie-Smith GM, Durant RW, St George DMM. Investigators' assessment of NIH mandated inclusion of women and minorities in research. Contemp Clin Trials 2006; 27:571-9. [PMID: 16843069 DOI: 10.1016/j.cct.2006.05.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2005] [Revised: 05/01/2006] [Accepted: 05/31/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND While investigators were concerned about the impact of mandated inclusion of minorities and women on the conduct of research, there has been little subsequent assessment of investigator views on the effectiveness of the mandate in achieving gender and racial/ethnic research diversity. We describe investigators' assessment of the impact of the mandate on inclusion of women and minorities in research. METHODS 440 principal investigators (PIs) surveyed between August 2002 and December 2002. RESULTS Most PIs (69%) felt the mandate has been successful in increasing gender diversity, 7% felt that the mandate had failed to increase females and 24% were unsure. Fifty-five percent of PIs felt the mandate had been successful in increasing minorities; 12% felt it had failed and 32% were unsure. Those who felt that failure to include women makes it hard to draw conclusions about treatment/prevention strategies (P=0.05), white PIs (P=0.05), and those who ascribed importance to female inclusion (P=0.03) were more positive about the mandate's success for women. Similarly, those who felt more strongly that diversity in study samples ensures generalizability (P=0.03), white PIs (P=0.01), and those who ascribed importance to minority inclusion (P<0.01) were more positive about the mandate's success for minorities. CONCLUSION While the majority of PIs were positive in their assessment of the mandate on increasing diversity in research, many were ambivalent. Greater clarity on the criteria the scientific community should use in assessing the effectiveness of the mandate would allow us to reach the mandate goals.
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Affiliation(s)
- Giselle M Corbie-Smith
- Department of Social Medicine, University of North Carolina at Chapel Hill, Wing D, CB#7240, Chapel Hill, NC 27599, USA.
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Bolen S, Tilburt J, Baffi C, Gary TL, Powe N, Howerton M, Ford J, Lai G, Wilson R, Bass E. Defining "success" in recruitment of underrepresented populations to cancer clinical trials: moving toward a more consistent approach. Cancer 2006; 106:1197-204. [PMID: 16453333 DOI: 10.1002/cncr.21745] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Although medically underserved groups bear a heavy burden of cancer disease and governmental agencies have required inclusion of minorities and women in cancer clinical trials since 1993, many of these groups are underrepresented in cancer prevention or treatment clinical trials. To assess and enhance recruitment of underrepresented populations into cancer-related clinical trials, investigators and governmental agencies need consistent measurement approaches for recruitment that can be applied to diverse settings where trials are conducted. We conducted a systematic review to evaluate what measurement approaches were used to evaluate the success of recruitment of underrepresented groups into cancer prevention or treatment trials, and whether these recruitment goals were stated a priori. Only two articles reported an a priori recruitment goal. The recruitment measurement approaches varied considerably, with no consistent standard, especially for individual trials. By using the empiric evidence from this review in conjunction with the National Institutes of Health (NIH) guidelines, we constructed a framework for choosing consistent a priori recruitment goals for underrepresented groups based on the research question and study location. Using consistent measurement approaches for underrepresented groups will improve comparability of recruitment strategies across trials, improve equity in distribution of benefits and burdens of cancer-related clinical trials, and may improve applicability of trial results to multiple populations.
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Affiliation(s)
- Shari Bolen
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Nguyen TT, Somkin CP, Ma Y. Participation of Asian-American women in cancer chemoprevention research: physician perspectives. Cancer 2006; 104:3006-14. [PMID: 16247807 PMCID: PMC1704078 DOI: 10.1002/cncr.21519] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
To the authors' knowledge, little is known regarding the participation of Asian Americans in cancer prevention research. In 2002, the authors mailed surveys to primary care physicians in Northern California to assess their knowledge, attitudes, behaviors, and barriers concerning the participation of Asian-American women in breast cancer chemoprevention research. The response rate was 52.3% (n=306 physicians). For physician barriers, most respondents selected lack of study knowledge (73%) and effort required to establish eligibility (75%) and to explain risks and benefits (68%). For patient barriers, most physicians chose the following: physicians did not inform patients about trials (76%), limited English proficiency (78%), researcher-participant language discordance (74%), and complex protocols (69%). Significantly more Asian-American physicians than non-Asian-American physicians (but a majority of each) selected as patient barriers a lack of culturally relevant information on breast cancer, a lack of knowledge about research concepts, and fear of experimentation. A majority of Asian-American physicians also selected the following patient barriers: lack of knowledge of preventive care or breast cancer, work concern, misperception that experimental treatment is inferior, personal modesty, and lack of personal benefit. In multivariate analyses, physicians who were in practice longer, who spent more time with patients, or who knew of tools to estimate breast cancer risk were more likely to discuss such trials with Asian-American women; whereas male physicians and those who believed that Asian-American women's deference to physicians was a barrier were less likely to have discussed such trials with Asian-American women. Efforts to increase research participation among Asian Americans should include physician education and linguistically appropriate recruitment efforts.
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Affiliation(s)
- Tung T Nguyen
- Division of General Internal Medicine, University of California-San Francisco, San Francisco, CA 94143, USA.
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Fong M, Braun KL, Chang RML. Native Hawaiian preferences for informed consent and disclosure of results from genetic research. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2006; 21:S47-52. [PMID: 17020502 DOI: 10.1207/s15430154jce2101s_10] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Informed consent is generally waived when using anonymous stored specimens in research because individual harm is minimal; however, group harm may arise if specimens contain ethnic identifiers. METHODS We assessed preferences for informed consent and disclosure of results from genetic research through a survey (N = 429, 83.2% Native Hawaiian). RESULTS Native Hawaiians were more likely than non-Hawaiians to require informed consent for genetic research using personally identified (81% vs 77.8%), anonymous (40.9% vs 34.7%), and ethnically identified specimens (51.3% vs 33.3%). Most respondents wanted results reported to them (87.6%) and to their physicians (79.0%). CONCLUSIONS Recognizing community preferences for informed consent and disclosure of research results may alleviate concerns about group harms inherent in genetic research.
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Affiliation(s)
- Megan Fong
- Imi Hale-Native Hawaiian Cancer Awareness, Research, and Training Network, Program of Papa Ola Lokahi, Honolulu, HI 96813, USA.
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