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Cardenas-Rojas A, Castelo-Branco L, Pacheco-Barrios K, Shaikh ES, Uygur-Kucukseymen E, Giannoni-Luza S, Vasconcelos Felippe L, Gonzalez-Mego P, Luna-Cuadros MA, Gianlorenco ACL, Teixeira PE, Caumo W, Fregni F. Recruitment characteristics and non-adherence associated factors of fibromyalgia patients in a randomized clinical trial: A retrospective survival analysis. Contemp Clin Trials Commun 2021; 24:100860. [PMID: 34849424 PMCID: PMC8609141 DOI: 10.1016/j.conctc.2021.100860] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 10/08/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Fibromyalgia is a complex pain condition that affects mostly women. Given the disease's lack of understanding, patients report poor adherence to medication and mistrust of medical services. This study aims to describe the recruitment characteristics and non-adherence associated factors of fibromyalgia patients to an RCT. METHODS We performed a retrospective longitudinal analysis with data from our ongoing RCT. We investigated characteristics of subjects recruited, consented, and randomized. Adherence was studied using survival analysis techniques, and its associated factors were identified using Cox proportional hazards regression model. RESULTS 524 subjects were contacted, 269 were eligible, 61 consented and 40 subjects were randomized. Thirty-eight percent were non-adherent to the protocol with a median of visits of five. The recruitment survey reported that 90% would likely participate in RCTs, 52% had previous participation, and 19% were aware of RCTs by their physicians. Some barriers were investigator-related (staff's friendliness and receiving the results of their trial participation) and center-related (privacy-confidentiality issues and the institution's reputation), without difference between adherent and non-adherent participants. We report significant factors for non-adherence as VAS anxiety score of 5 or more (5.3 HR, p = 0.01), Body Mass Index (BMI) (0.91 HR, p = 0.041) and Quality of Life (QoL) - Personal development subdomain (0.89 HR, p = 0.046). CONCLUSION Recruitment and adherence of fibromyalgia patients is a challenge; however, they seem eager to participate in RCTs. We recommend creating a comfortable, friendly and trusting environment to increase the recruitment rate. Higher anxiety, lower BMI and lower quality of life were associated with a higher attrition rate.
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Affiliation(s)
- Alejandra Cardenas-Rojas
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Luis Castelo-Branco
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - Emad Salman Shaikh
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Elif Uygur-Kucukseymen
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Stefano Giannoni-Luza
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Luna Vasconcelos Felippe
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Paola Gonzalez-Mego
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Maria Alejandra Luna-Cuadros
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anna Carolyna Lepesteur Gianlorenco
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Physical Therapy, Federal University of Sao Carlos, Brazil
| | - Paulo E.P. Teixeira
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- MGH Institute of Health Professions, USA
| | - Wolnei Caumo
- Pain and Palliative Care Service at Clinical Hospital of Porto Alegre (HCPA), Federal University of Rio Grande do Sul, Brazil
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Rouan J, Velazquez G, Freischlag J, Kibbe MR. Publication bias is the consequence of a lack of diversity, equity, and inclusion. J Vasc Surg 2021; 74:111S-117S. [PMID: 34303450 DOI: 10.1016/j.jvs.2021.03.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/13/2021] [Indexed: 01/09/2023]
Abstract
Publication bias has been shown to exist in research across medical and surgical specialties. Bias can occur at any stage of the publication process and can be related to race, ethnicity, age, religion, sex, gender, or sexual orientation. Although some improvements have been made toward addressing this issue, bias still spans the publication process from authors and peer reviewers, to editorial board members and editors, with poor inclusion of women and underrepresented minorities throughout. The result of bias remaining unchecked is the publication of research that leaves out certain groups, is not applicable to all people, and can result in harm to some populations. We have highlighted the current landscape of publication bias and strived to demonstrate the importance of addressing it. We have also provided solutions for reducing bias at multiple stages throughout the publication process. Increasing diversity, equity, and inclusion throughout all aspects of the publication process, requiring diversity, equity, and inclusion statements in reports, and providing specific education and guidelines will ensure the identification and eradication of publication bias. By following these measures, we hope that publication bias will be eliminated, which will reduce further harm to certain populations and promote better, more effective research pertinent to all people.
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Affiliation(s)
- Jessica Rouan
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Gabriela Velazquez
- Department of Vascular and Endovascular Surgery, Wake Forest School of Medicine, Wake Forest, NC
| | - Julie Freischlag
- Department of Vascular and Endovascular Surgery, Wake Forest School of Medicine, Wake Forest, NC
| | - Melina R Kibbe
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC; Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC.
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Lee S, Zhang S, Ma C, Ou FS, Wolfe EG, Ogino S, Niedzwiecki D, Saltz LB, Mayer RJ, Mowat RB, Whittom R, Hantel A, Benson A, Atienza D, Messino M, Kindler H, Venook A, Gross CP, Irwin ML, Meyerhardt JA, Fuchs CS. Race, Income, and Survival in Stage III Colon Cancer: CALGB 89803 (Alliance). JNCI Cancer Spectr 2021; 5:pkab034. [PMID: 34104867 PMCID: PMC8178799 DOI: 10.1093/jncics/pkab034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 12/10/2020] [Accepted: 02/19/2021] [Indexed: 01/01/2023] Open
Abstract
Background Disparities in colon cancer outcomes have been reported across race and socioeconomic status, which may reflect, in part, access to care. We sought to assess the influences of race and median household income (MHI) on outcomes among colon cancer patients with similar access to care. Methods We conducted a prospective, observational study of 1206 stage III colon cancer patients enrolled in the CALGB 89803 randomized adjuvant chemotherapy trial. Race was self-reported by 1116 White and 90 Black patients at study enrollment; MHI was determined by matching 973 patients’ home zip codes with publicly available US Census 2000 data. Multivariate analyses were adjusted for baseline sociodemographic, clinical, dietary, and lifestyle factors. All statistical tests were 2-sided. Results Over a median follow-up of 7.7 years, the adjusted hazard ratios for Blacks (compared with Whites) were 0.94 (95% confidence interval [CI] = 0.66 to 1.35, P = .75) for disease-free survival, 0.91 (95% CI = 0.62 to 1.35, P = .65) for recurrence-free survival, and 1.07 (95% CI = 0.73 to 1.57, P = .73) for overall survival. Relative to patients in the highest MHI quartile, the adjusted hazard ratios for patients in the lowest quartile were 0.90 (95% CI = 0.67 to 1.19, Ptrend = .18) for disease-free survival, 0.89 (95% CI = 0.66 to 1.22, Ptrend = .14) for recurrence-free survival, and 0.87 (95% CI = 0.63 to 1.19, Ptrend = .23) for overall survival. Conclusions In this study of patients with similar health-care access, no statistically significant differences in outcomes were found by race or MHI. The substantial gaps in outcomes previously observed by race and MHI may not be rooted in differences in tumor biology but rather in access to quality care.
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Affiliation(s)
| | - Sui Zhang
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA, USA
| | - Chao Ma
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA, USA
| | - Fang-Shu Ou
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Eric G Wolfe
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Shuji Ogino
- Department of Oncologic Pathology, Dana-Farber/Partners CancerCare and Harvard Medical School, Boston, MA, USA.,Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Donna Niedzwiecki
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | | | - Robert J Mayer
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA, USA
| | - Rex B Mowat
- Toledo Community Hospital Oncology Program, Toledo, OH, USA
| | | | - Alexander Hantel
- Loyola University Stritch School of Medicine, Naperville, IL, USA
| | - Al Benson
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | | | - Michael Messino
- Southeast Clinical Oncology Research Consortium, Mission Hospitals, Asheville, NC, USA
| | - Hedy Kindler
- University of Chicago Comprehensive Cancer Center, Chicago, IL, USA
| | - Alan Venook
- University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA, USA
| | - Cary P Gross
- Yale School of Medicine, Department of Internal Medicine, New Haven, CT, USA
| | | | - Jeffrey A Meyerhardt
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA, USA
| | - Charles S Fuchs
- Yale School of Medicine, New Haven, CT, USA.,Yale Cancer Center, Smilow Cancer Hospital and Yale School of Medicine, New Haven, CT, USA.,Genentech, South San Francisco, CA, USA
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Patel K, Inman W, Gishe J, Johnson O, Brown E, Kanu M, Theriot R, Sanderson M, Hull P, Hargreaves M. A Community-Driven Intervention for Improving Biospecimen Donation in African American Communities. J Racial Ethn Health Disparities 2018; 5:15-23. [PMID: 28181200 PMCID: PMC5548654 DOI: 10.1007/s40615-017-0336-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 01/02/2017] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Human biospecimens are an invaluable resource for addressing cancers and other chronic diseases. The purpose of this study was to assess the impact of an educational intervention on biospecimen knowledge and attitudes. METHODS The participants consisted of 112 African Americans, 18 years and older, and who had not provided biospecimens for any health-related research in the past. A total of 55 participants received the educational brochure, and 57 received the educational video. The main outcomes of the study were knowledge and attitudes for biospecimen donation. This information was collected pre- and post-intervention. RESULTS The average knowledge scores increased (p < 0.0001) and the average attitude scores for biospecimen donation improved (p < 0.0001) post-intervention for both the video and brochure conditions. There was an interaction between the intervention condition and knowledge where the participants who received the educational video showed a greater increase in knowledge pre-to-post compared to those who received the educational brochure (p = 0.0061). There were no significant interactions between the two intervention conditions for attitudes toward biospecimen donation. DISCUSSION The results of this study demonstrated the feasibility and efficacy of an academic institution collaborating with the African American community in developing educational tools for biospecimen donation.
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Affiliation(s)
- Kushal Patel
- Department of Public Health, Health Adminstration and Health Sciences, College of Health Sciences, Tennessee State University, 330 10th Avenue North, Suite D-411, Nashville, TN, 37203, USA.
| | - Wendelyn Inman
- Department of Public Health, Health Adminstration and Health Sciences, College of Health Sciences, Tennessee State University, 330 10th Avenue North, Suite D-411, Nashville, TN, 37203, USA
| | - Jemal Gishe
- Department of Public Health, Health Adminstration and Health Sciences, College of Health Sciences, Tennessee State University, 330 10th Avenue North, Suite D-411, Nashville, TN, 37203, USA
| | - Owen Johnson
- Department of Public Health, Health Adminstration and Health Sciences, College of Health Sciences, Tennessee State University, 330 10th Avenue North, Suite D-411, Nashville, TN, 37203, USA
| | - Elizabeth Brown
- Department of Public Health, Health Adminstration and Health Sciences, College of Health Sciences, Tennessee State University, 330 10th Avenue North, Suite D-411, Nashville, TN, 37203, USA
| | - Mohamed Kanu
- Department of Public Health, Health Adminstration and Health Sciences, College of Health Sciences, Tennessee State University, 330 10th Avenue North, Suite D-411, Nashville, TN, 37203, USA
| | - Rosemary Theriot
- Department of Public Health, Health Adminstration and Health Sciences, College of Health Sciences, Tennessee State University, 330 10th Avenue North, Suite D-411, Nashville, TN, 37203, USA
| | - Maureen Sanderson
- Meharry Medical College, 1005 Dr. D.B. Todd Jr, Nashville, TN, 37208, USA
| | - Pamela Hull
- Vanderbilt University, 2525 West End, Nashville, TN, 37203, USA
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Lim JW, Paek MS. Recruiting Chinese- and Korean-Americans in Cancer Survivorship Research: Challenges and Lessons Learned. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2016; 31:108-114. [PMID: 25619194 PMCID: PMC4516703 DOI: 10.1007/s13187-015-0790-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This paper describes Asian-American recruitment experiences using data from the cancer survivorship study involving Chinese- and Korean-American breast cancer survivors specifically. The article discusses challenges to the successful recruitment of Asian-American populations for cancer survivorship research and provides recommendations for future recruitment efforts. The study investigated the role of family communication in coping and quality of life for survivors from Chinese- and Korean-American groups diagnosed with breast cancer. Participants were primarily recruited through cancer registries and community outreach. A total of 157 breast cancer survivors (86 Chinese-Americans and 71 Korean-Americans) completed the final survey, yielding a final response rate of 62.8 % of the accessible samples. Chinese-Americans were more likely to agree to participate but less frequently completed the survey, and Korean-Americans were more likely to refuse to participate. Common reasons for refusal were "too busy or too painful to recall," followed by "not interested," "too old," "distrust of the research," or "health issue." Participants were more likely to be young and Korean-American compared to non-participants. Cultural and linguistic barriers, distrust, and lack of awareness about cancer research should be considered to recruit more Asian-American cancer survivors. Community participatory research is required to ensure participation by sufficient numbers of ethnic minorities in cancer survivorship research.
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Affiliation(s)
- Jung-Won Lim
- College of Social Welfare, Kangnam University, 40 Gangnam-ro, Giheung-gu, Yongin-si, 446-702, Gyeonggi-do, South Korea.
| | - Min-So Paek
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, School of Medicine, Wake Forest University, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
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6
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Phillips F, Jones BL. Understanding the lived experience of Latino adolescent and young adult survivors of childhood cancer. J Cancer Surviv 2013; 8:39-48. [DOI: 10.1007/s11764-013-0310-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 09/13/2013] [Indexed: 10/26/2022]
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7
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King DW, Duello TM, Miranda PY, Hodges KP, Shelton AJ, Chukelu P, Jones LA. Strategies for Recruitment of Healthy Premenopausal Women into the African American Nutrition for Life (A NULIFE) Study. J Womens Health (Larchmt) 2012; 19:855-62. [PMID: 20392156 DOI: 10.1089/jwh.2009.1682] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although African American women have an overall lower incidence of breast cancer, African American women <40 years of age are more likely than Caucasian women of all ages and postmenopausal African American women to be diagnosed with breast cancer and exhibit tumor characteristics associated with poorer survival. To begin to address this disparity, studies must be conducted to examine breast cancer preventive factors in this subpopulation of women. However, the strategies needed to recruit younger African American women have not been well defined. METHODS In this study, we assessed methods used for recruiting and retaining healthy premenopausal African American women into the African American Nutrition for Life (A NULIFE) Study. The number of women contacted, enrolled, and retained by each recruitment strategy and the efficiency of individual strategies were calculated. RESULTS Overall, recruitment through social networking was most effective in contacting large numbers of healthy premenopausal African American women. The worksite recruitment method was the most efficient recruitment strategy employed, with a ratio of 40%. The study participants (n = 164) were more likely to be >or=35 years of age and have completed some college. Additionally, the interpersonal relationships recruitment approach proved most efficient (33%) in retaining participants who completed the yearlong study. CONCLUSIONS The findings from this study add to the evolving research literature on minority recruitment strategies for research studies but specifically address effective recruitment of healthy young premenopausal African American women. The results demonstrate the need to use multiple recruitment strategies when recruiting this subgroup of African American women.
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Affiliation(s)
- Denae W King
- The University of Texas, MD Anderson Cancer Center, Center for Research on Minority Health, Houston, Texas 77230, USA.
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8
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Heiney SP, Millon Underwood S, Tavakoli A, Arp Adams S, Wells LM, Bryant LH. Randomized trial of therapeutic group by teleconference: African American women with breast cancer. Cancer 2011; 118:3822-32. [PMID: 22180125 DOI: 10.1002/cncr.26676] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 10/11/2011] [Accepted: 10/13/2011] [Indexed: 11/12/2022]
Abstract
BACKGROUND The effects of a therapeutic group by teleconference for African American women with breast cancer have not been documented, although the benefits of therapeutic groups for European women are well established. African American women with breast cancer may experience social disconnection, a sense of being cut off from partners, family, and friends because of side effects of treatment and fatalistic beliefs about cancer. A therapeutic group by teleconference may counteract these problems and improve social connection. METHODS A randomized trial design stratified by treatment type was used. Data were collected at baseline, at the end of the intervention, and 16 weeks from baseline. Repeated-measures, fixed-factor analyses of covariance were used for each outcome. The between-subject factors were group and replicate set, and the within-subject factor was time. Physical well being and educational level differed significantly between the 2 groups at baseline and were used as covariates. RESULTS The mixed-model analysis of the outcome variables revealed significant changes over time for knowledge (P ≤ .001), with higher scores on knowledge observed for the control group. Group-by-time interactions were observed for fatalism (P = .0276), fear (P = .0163), and social connection (P = .0174) as measured by the Social Well Being subscale from the Functional Assessment of Cancer Treatment-Breast Cancer Version. No group-by-time interaction was observed for social connection as measured by the Social Support Questionnaire. Social connection measured with the Social Well Being subscale improved significantly in the intervention group, whereas fatalism and fear significantly decreased. CONCLUSIONS In this study, the authors documented the benefits of a therapeutic group by teleconference, a novel way to provide support for African American women with breast cancer. Further research should include a behavioral outcome, such as treatment adherence.
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Affiliation(s)
- Sue P Heiney
- College of Nursing, University of South Carolina, Columbia, SC 29208, USA.
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Scharff DP, Mathews KJ, Jackson P, Hoffsuemmer J, Martin E, Edwards D. More than Tuskegee: understanding mistrust about research participation. J Health Care Poor Underserved 2010; 21:879-97. [PMID: 20693733 DOI: 10.1353/hpu.0.0323] [Citation(s) in RCA: 566] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This paper describes results of a qualitative study that explored barriers to research participation among African American adults. A purposive sampling strategy was used to identify African American adults with and without previous research experience. A total of 11 focus groups were conducted. Groups ranged in size from 4-10 participants (N=70). Mistrust of the health care system emerged as a primary barrier to participation in medical research among participants in our study. Mistrust stems from historical events including the Tuskegee syphilis study and is reinforced by health system issues and discriminatory events that continue to this day. Mistrust was an important barrier expressed across all groups regardless of prior research participation or socioeconomic status. This study illustrates the multifaceted nature of mistrust, and suggests that mistrust remains an important barrier to research participation. Researchers should incorporate strategies to reduce mistrust and thereby increase participation among African Americans.
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Affiliation(s)
- Darcell P Scharff
- Department of Community Health and Associate Dean, Saint Louis University School of Public Health, 3545 Lafayette Ave, St Louis, MO 63104, USA.
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10
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Scharff DP, Mathews KJ, Jackson P, Hoffsuemmer J, Martin E, Edwards D. More than Tuskegee: understanding mistrust about research participation. J Health Care Poor Underserved 2010. [PMID: 20693733 DOI: 10.1353/hpu.0.0323.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This paper describes results of a qualitative study that explored barriers to research participation among African American adults. A purposive sampling strategy was used to identify African American adults with and without previous research experience. A total of 11 focus groups were conducted. Groups ranged in size from 4-10 participants (N=70). Mistrust of the health care system emerged as a primary barrier to participation in medical research among participants in our study. Mistrust stems from historical events including the Tuskegee syphilis study and is reinforced by health system issues and discriminatory events that continue to this day. Mistrust was an important barrier expressed across all groups regardless of prior research participation or socioeconomic status. This study illustrates the multifaceted nature of mistrust, and suggests that mistrust remains an important barrier to research participation. Researchers should incorporate strategies to reduce mistrust and thereby increase participation among African Americans.
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Affiliation(s)
- Darcell P Scharff
- Department of Community Health and Associate Dean, Saint Louis University School of Public Health, 3545 Lafayette Ave, St Louis, MO 63104, USA.
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Bristol-Gould S, Desjardins M, Woodruff TK. The Illinois Women's Health Registry: advancing women's health research and education in Illinois, USA. ACTA ACUST UNITED AC 2010; 6:183-96. [PMID: 20187725 DOI: 10.2217/whe.10.10] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
To achieve the goal of personalized medicine, we must first improve our understanding of the differences in health and illness between men and women. The purpose of the Illinois Women's Health Registry (USA) is to provide a research and education tool that advances scientific knowledge of sex- and gender-based differences in health and disease. Specifically, the Registry is a confidential 30-min health and lifestyle survey for female residents of Illinois over the age of 18 years. The survey includes questions regarding health, environment, health-related behaviors, symptoms and illnesses or conditions that a participant may have now or has had in the past. By enrolling in the Registry, women throughout the state are provided with information and access to clinical research studies that they may be eligible for, based on their self-reported health information. The Registry not only serves as a platform for recruitment into pivotal research studies, but also represents the beginning of a state-wide database that enables researchers to examine the collective de-identified health information provided by women living in Illinois. Ultimately, a cross-sectional and longitudinal analysis of these data will help to clarify the issues that women themselves identify as their main health concerns. In response to these concerns, specific research studies can be designed and launched, allowing us to eventually deliver tailored treatment and prevention options to women. Finally, by creating a reliable state-focused research tool, developed by staff that are trained in women's health research, we can compare health issues across the state and apply strategies for improvement where it is needed most. This article will provide examples of sex differences in disease, the lack of federal enforcement for inclusion of women in studies, researcher-perceived burdens and sex-based reasons as to why recruitment of women is considered to be more challenging. In addition, this article will discuss what a women's health registry is and why we need one in Illinois, how we have recruited women and our successes and challenges. Our goal is to inform the reader about the utility of a state-based tool and to provide a discussion regarding the lessons learned in order to aid other states in implementing this kind of program.
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Affiliation(s)
- Sarah Bristol-Gould
- Institute for Women's Health Research, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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Paskett ED, Reeves KW, McLaughlin JM, Katz ML, McAlearney AS, Ruffin MT, Halbert CH, Merete C, Davis F, Gehlert S. Recruitment of minority and underserved populations in the United States: the Centers for Population Health and Health Disparities experience. Contemp Clin Trials 2008; 29:847-61. [PMID: 18721901 PMCID: PMC2642621 DOI: 10.1016/j.cct.2008.07.006] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Revised: 07/22/2008] [Accepted: 07/28/2008] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The recruitment of minority and underserved individuals to research studies is often problematic. The purpose of this study was to describe the recruitment experiences of projects that actively recruited minority and underserved populations as part of The Centers for Population Health and Health Disparities (CPHHD) initiative. METHODS Principal investigators and research staff from 17 research projects at eight institutions across the United States were surveyed about their recruitment experiences. Investigators reported the study purpose and design, recruitment methods employed, recruitment progress, problems or challenges to recruitment, strategies used to address these problems, and difficulties resulting from Institutional Review Board (IRB) or Health Insurance Portability and Accountability Act of 1996 (HIPAA) requirements. Additionally, information was collected about participant burden and compensation. Burden was classified on a three-level scale. Recruitment results were reported as of March 31, 2007. RESULTS Recruitment attainment ranged from 52% to 184% of the participant recruitment goals. Commonly reported recruitment problems included administrative issues, and difficulties with establishing community partnerships and contacting potential participants. Long study questionnaires, extended follow-up, and narrow eligibility criteria were also problematic. The majority of projects reported difficulties with IRB approvals, though few reported issues related to HIPAA requirements. Attempted solutions to recruitment problems varied across Centers and included using multiple recruitment sites and sources and culturally appropriate invitations to participate. Participant burden and compensation varied widely across the projects, however, accrual appeared to be inversely associated with the amount of participant burden for each project. CONCLUSION Recruitment of minority and underserved populations to clinical trials is necessary to increase study generalizbility and reduce health disparities. Our results demonstrate the importance of flexible study designs which allow adaptation to recruitment challenges. These experiences also highlight the importance of involving community members and reducing participant burden to achieve success in recruiting individuals from minority and underserved populations.
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Affiliation(s)
- Electra D Paskett
- College of Public Health, The Ohio State University, Columbus, OH 43210, USA.
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Larkey LK, Gonzalez JA, Mar LE, Glantz N. Latina recruitment for cancer prevention education via Community Based Participatory Research strategies. Contemp Clin Trials 2008; 30:47-54. [PMID: 18775798 DOI: 10.1016/j.cct.2008.08.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Revised: 08/12/2008] [Accepted: 08/16/2008] [Indexed: 11/15/2022]
Abstract
Increasing minority participation in cancer research is an ethical and statistical necessity for gaining population-specific knowledge of cancer prevention, screening, and treatment. Locating and recruiting eligible and willing minority participants presents unique structural and cultural/linguistic challenges. Community Based Participatory Research provides a viable set of principles for facilitating recruitment in hard-to-recruit communities. We focus on the specific challenge of recruiting and engaging low-income and underinsured Latina women in cancer prevention education research, and present community-based strategies used to recruit women into a recently completed study in Arizona, Juntos en la Salud (Together in Health). Community representatives and promotoras' (Latino community health educators) involvement in site identification, individual recruitment, and development of strategies and materials for the interventions built engagement and trust. These strategies resulted in enrollment of an especially low-income, underinsured population. To emphasize the degree to which a particularly underserved population was recruited, we present data comparing demographic and screening profiles of enrollees to the general population of Latinos in Arizona.
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Affiliation(s)
- Linda K Larkey
- University of Arizona, College of Medicine, Arizona Cancer Center, Scottsdale, Arizona 85258, United States.
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Lamerato LE, Marcus PM, Jacobsen G, Johnson CC. Recruitment in the prostate, lung, colorectal, and ovarian (PLCO) cancer screening trial: the first phase of recruitment at Henry Ford Health System. Cancer Epidemiol Biomarkers Prev 2008; 17:827-33. [PMID: 18398023 DOI: 10.1158/1055-9965.epi-06-0528] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Recruitment of healthy subjects to long-term randomized controlled trials (RCTs) of cancer prevention or early detection has proven to be a difficult task. To quantify recruitment yield as well as characteristics of successfully recruited participants, we examined recruitment outcomes at 1 of the 10 centers participating in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial, a National Cancer Institute-funded RCT of cancer screening modalities. MATERIALS AND METHODS During the early recruitment phase of PLCO (1993-1997), data on recruitment outcome were collected at the Henry Ford Health System (HFHS) in Detroit, Michigan. In this phase, HFHS identified potential participants using patient databases. Records were used to assess recruitment success by age, sex, race, household income (using area-based U.S. Census data), and preexisting morbidity. Logistic regression was used to assess whether enrollment success differed significantly according to these factors. RESULTS Of 74,139 persons ages 55 to 74 invited by HFHS to participate, 8,250 (11%) ;enrolled. In multivariate analyses, the odds of enrolling were modestly but significantly higher for women, Caucasians, persons in their 60's, and persons living in census blocks with higher median household income. Persons with two or more preexisting morbidities had significantly lower odds of enrolling compared to those with one or no preexisting morbidities. CONCLUSIONS These data suggest that only a small fraction of persons invited to enroll in long-term RCTs of cancer screening modalities actually do so. In this urban, Midwestern setting, certain characteristics including age, race, and income influenced recruitment success, albeit modestly.
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Affiliation(s)
- Lois E Lamerato
- Department of Biostatistics and Research Epidemiology, Henry Ford Health System, One Ford Place-5C, Detroit, MI 48125, USA.
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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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Larkey LK, Ogden SL, Tenorio S, Ewell T. Latino recruitment to cancer prevention/screening trials in the Southwest: setting a research agenda. Appl Nurs Res 2008; 21:30-9. [PMID: 18226761 DOI: 10.1016/j.apnr.2006.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2005] [Accepted: 09/10/2006] [Indexed: 11/24/2022]
Abstract
Examples of cancer prevention and screening trials in the Southwest are reviewed as a platform for highlighting gaps in research on Latino recruitment. Three trials are described, using "message/source/channel" categories as a framework. Each trial engaged community members to facilitate recruitment and developed tailored strategies to meet challenges emerging after recruitment began. Although we affirm that culturally relevant messages, community member referral networks, and adjustment to community realities seem important to Latino recruitment, current anecdotal and research findings do not allow evidence-based recommendations to be made. We suggest a research agenda to further illuminate critical factors for successful Latino recruitment.
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Affiliation(s)
- Linda K Larkey
- Cancer Prevention Office, Arizona Cancer Center, University of Arizona, Scottsdale, AZ 85258, USA.
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17
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Sanson-Fisher RW, Williams N, Outram S. Health inequities: the need for action by schools of medicine. MEDICAL TEACHER 2008; 30:389-394. [PMID: 18569660 DOI: 10.1080/01421590801948042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND It is well recognised that marked inequalities in mortality and morbidity exist between populations particularly those in lower socio-economic groups, including Indigenous and some ethnic minorities. Academic medicine has not yet articulated a clear stance on reducing health inequity within communities. AIM To develop criteria that medical schools can implement to reduce health inequity. These criteria will enable the performance of a medical school's commitment to health equity to be measured. RESULTS AND CONCLUSION We suggest that the contribution to lessening health inequity should be seen as an integral and important role of undergraduate medical education and the academic institutions that provide such programs. Five strategies aimed at increasing the commitment of medical and other undergraduate health students to work with disadvantaged groups to improve their health are described. They include student selection to increase representativeness of students and importantly, support for retention and academic success; undergraduate curriculum, both core and elective, to address inequality and provide skills necessary to implement change in a range of areas that impact on health; academic physicians modelling the above by actively working in and for disadvantaged groups; developing centres of excellence carrying out research in health inequity, particularly intervention rather than solely descriptive research and creating high status academic appointments in key designated positions addressing inequity. Schools of Medicine could be rated on their action on these criteria so that benchmarking across institutions could occur.
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Meeske KA, Patel SK, Palmer SN, Nelson MB, Parow AM. Factors associated with health-related quality of life in pediatric cancer survivors. Pediatr Blood Cancer 2007; 49:298-305. [PMID: 16779805 DOI: 10.1002/pbc.20923] [Citation(s) in RCA: 146] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Childhood cancer survivors are at risk for late effects of disease and treatment that may be attributed to multiple causes. This study describes health-related quality of life (HRQOL) in childhood cancer survivors and identifies factors related to poor quality of life outcomes. PROCEDURE Patients age 8-18 years, who attended the long-term information, follow-up, and evaluation (LIFE) clinic at Childrens Hospital Los Angeles during a 1-year time-period were eligible for the study. Eighty-six survivors (mean time off-treatment=7.8 years) completed the Pediatric Quality of Life Inventory 4.0 Generic Core Scales, a LIFE Clinic Intake Questionnaire and rated their fatigue using a 10-point scale. Oncology nurses independently rated subjects' late effects using a 3-point severity scale. Linear regression procedures were used to evaluate the association between demographic and medical factors and HRQOL. RESULTS Fatigue and more severe late effects were associated with poorer physical functioning (fatigue, P<0.02; late effects, P<0.01). Fatigue, ethnic minority status, and a brain tumor diagnosis were associated with poorer psychosocial functioning (fatigue, P<0.0001; minority status, P<0.04; brain tumor, P<0.01). Fatigue was the only factor related to both poor physical and psychosocial HRQOL. CONCLUSIONS Long-term follow-up clinics for childhood cancer survivors are in a unique position to monitor HRQOL over time. Factors associated with poorer HRQOL include fatigue, ethnic minority status, a brain tumor diagnosis, and more severe late effects. Future studies need to clarify relationships between ethnicity, socioeconomic status (SES), and HRQOL in cancer survivors.
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Affiliation(s)
- Kathleen A Meeske
- HOPE Program, Childrens Hospital Los Angeles, Los Angeles, California 90027, USA.
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Giger J, Davidhizar RE, Purnell L, Harden JT, Phillips J, Strickland O. American Academy of Nursing Expert Panel report: developing cultural competence to eliminate health disparities in ethnic minorities and other vulnerable populations. J Transcult Nurs 2007; 18:95-102. [PMID: 17416710 DOI: 10.1177/1043659606298618] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The members of the Expert Panel on Cultural Competence of the American Academy of Nursing (AAN) envisioned this article to serve as a catalyst to action by the Academy to take the lead in ensuring that measurable outcomes be achieved that reduce or eliminate health disparities commonly found among racial, ethnic, uninsured, underserved, and underrepresented populations residing throughout the United States. The purposes of this article are to (a) assess current issues related to closing the gap in health disparities and achieving cultural competence, (b) discuss a beginning plan of action from the Expert Panel on Cultural Competence for future endeavors and continued work in these areas beyond the 2002 annual conference on Closing the Gap in Health Disparities, and (c) provide clearly delineated recommendations to assist the Academy to plan strategies and to step forward in taking the lead in reshaping health care policies to eliminate health care and health disparities.
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Meade CD, Menard J, Martinez D, Calvo A. Impacting health disparities through community outreach: utilizing the CLEAN look (culture, literacy, education, assessment, and networking). Cancer Control 2007; 14:70-7. [PMID: 17242673 DOI: 10.1177/107327480701400110] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Community outreach programs are important vehicles for reducing the discovery-delivery disconnect by bringing cancer education and screening services directly to community members. Such programs are consistent with the priority areas of the Department of Health and Human Services' initiatives for reducing health disparities by 2010, and they support the use of culturally, linguistically, and literacy-specific approaches for eliminating cancer health disparities. METHODS This article reviews the important tenets of culture and literacy when developing community outreach programs for medically underserved populations, examines a health education empowerment model for community program planning, and describes the use of the CLEAN Look Checklist (in which CLEAN is an easy-to-remember mnemonic of culture, literacy, education, assessment, and networking) for identifying cues and strategies to achieve relevant outreach. RESULTS This article illustrates the application of this approach with an example of outreach strategies for reaching at-risk Haitian American women in our community. CONCLUSIONS Meeting the challenge of a strong health disparities agenda requires integration of cultural and literacy considerations in outreach program, message, and intervention development. The use of a checklist may help clinicians, educators, and researchers create a sustainable model of community outreach guided by a paradigm that incorporates a multilevel approach to address cancer outcomes for disenfranchised populations.
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Affiliation(s)
- Cathy D Meade
- Division of Cancer Prevention & Control, Health Outcomes & Behavior Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA.
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DeMarco TA, Loffredo CA, Sampilo ML, Tercyak KP. On using a cancer center cancer registry to identify newly affected women eligible for hereditary breast cancer syndrome testing: practical considerations. J Genet Couns 2006; 15:129-36. [PMID: 16761104 DOI: 10.1007/s10897-005-9006-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The goals of this research were to describe the process of identifying and recruiting individuals registered with a cancer center's cancer registry who were eligible to participate in cancer genetic research. This study specifically focused on younger women with personal and family cancer histories strongly suggestive of hereditary breast cancer syndromes, as determined by genetic counselor review. Of special interest was to determine the proportion of women from minority backgrounds who were (a) identifiable in this manner and (b) interested in genetic testing for hereditary breast cancer through a family cancer clinical research program. An initial query of the 292 cases of women newly affected with breast cancer and contained within the registry indicated that 124 met demographic eligibility criteria. The personal and family cancer histories of each of these women were then reviewed by a genetic counselor and the remaining, eligible patients (n = 31) were subsequently contacted by mail and telephone: approximately three-fifths (18/31) of these patients were White and two-fifths (13/31) were Black or of another racial background. Of the women who were sent one or more study-related mailings, 10% (3/31) were unreachable by telephone due to incorrect contact information, 32% (10/31) were reachable by telephone but unresponsive to messages left, 26% (8/31) had already participated in the family cancer program (i.e., were positive controls), 6% (2/31) were interested in participating in the program, 23% (7/31) were uninterested in participating in the program, and 3% (1/31) were later determined to be ineligible. Comparing the racial backgrounds of women who were either positive controls or interested in participating (i.e., "tester" category) to women who were either unreachable, nonresponsive, uninterested, or ineligible (i.e., "nontester" category), there was a nonsignificant trend for more non-White women to fall into the nontester than tester category, Fisher's Exact Test = .09. This work underscores practical steps in planning and carrying-out cancer genetic testing research among women newly affected with breast cancer and members of special populations. It also underscores the role that genetic counseling professionals play in this process.
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Affiliation(s)
- Tiffani A DeMarco
- Cancer Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia 20007-2401, USA
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22
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Hudson SV, Momperousse D, Leventhal H. Physician perspectives on cancer clinical trials and barriers to minority recruitment. Cancer Control 2006; 12 Suppl 2:93-6. [PMID: 16327757 DOI: 10.1177/1073274805012004s14] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Shawna V Hudson
- Department of Family Medicine, University of Medicine and Dentistry of New Jersey (UMDNJ), The Cancer Institute of New Jersey, New Brunswick, NJ 08903-2681, USA.
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Lara PN, Paterniti DA, Chiechi C, Turrell C, Morain C, Horan N, Montell L, Gonzalez J, Davis S, Umutyan A, Martel CL, Gandara DR, Wun T, Beckett LA, Chen MS. Evaluation of factors affecting awareness of and willingness to participate in cancer clinical trials. J Clin Oncol 2006; 23:9282-9. [PMID: 16361626 DOI: 10.1200/jco.2005.02.6245] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Annually, only 3% of patients participate in cancer clinical trials (CCTs). Barriers to accrual include lack of CCT awareness and uncertain third-party payer coverage. In January 2002, a California law (Senate Bill 37 [SB37]) required all third-party payers to reimburse patient care costs related to CCTs. We evaluated the level of awareness of patients and/or their family members/friends regarding CCTs and SB37. METHODS We used both a written survey for patients and/or their family members and friends seen in oncology clinics, and a verbal telephone version for Cancer Information Service callers. We tested for correlations between CCT awareness and SB37 knowledge, and willingness to participate in CCTs. RESULTS Of 1,188 respondents, 59% were aware of CCTs, 19% knew of SB37, and 36% were very likely to consider a CCT. There were significant positive correlations between CCT awareness and willingness to participate (P < .001, Spearman), and between SB37 knowledge and willingness to participate (P = .001, Pearson chi2). Reduced awareness was seen in respondents who were either black or African American (odds ratio [OR], 0.44; P = .004), Hispanic (OR, 0.56; P = .03), had an annual income less than 25,000 dollars (OR, 0.38; P < .001), or had less than a college degree (OR, 0.12 to 0.53; P < .001 to .013). Reduced willingness to participate in CCTs was seen in black or African American participants (OR, 0.38; P < .001), Asians (OR, 0.44; P < .006), or respondents aged 18 to 24 years (OR, 0.35; P = .002). CONCLUSION These results support the hypothesis that improving CCT awareness and SB37 knowledge especially among lower income, less educated, and minority patients, may potentially overcome barriers to participation and subsequently increase accrual in California.
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Affiliation(s)
- Primo N Lara
- University of California Davis Cancer Center, Sacramento, CA 95817, USA.
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Tu SP, Chen H, Chen A, Lim J, May S, Drescher C. Clinical trials: understanding and perceptions of female Chinese-American cancer patients. Cancer 2006; 104:2999-3005. [PMID: 16247796 PMCID: PMC1810650 DOI: 10.1002/cncr.21524] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Under-representation of minority and female participants prompted the U.S. legislature to mandate the inclusion of women and minorities in federally funded research. Recruitment of minorities to participate in clinical trials continues to be challenging. Although Asian Americans constitute one of the major minority groups in the U.S., published literature contains sparse data concerning the participation of Asian Americans in cancer clinical trials. The authors completed qualitative, semistructured interviews with 34 participants: Chinese-American female cancer patients ages 20-85 years or their family members. Interviews were conducted in Cantonese, Mandarin, or English and were audiotaped. Chinese interviews were translated into English, and all interviews were transcribed subsequently into English. A team of five coders individually reviewed then met to discuss the English transcripts. The authors used the constant comparative technique throughout the entire coding process as part of the analysis. Among participants, 62% lacked any knowledge of clinical trials, and many expressed negative attitudes toward clinical trials. Barriers to participation included inadequate resources, language issues, and a lack of financial and social support. Facilitating factors included recommendations by a trusted oncologist or another trusted individual and information in the appropriate language. It is noteworthy that family members played an important role in the cancer experience of these participants. To promote participation, there is a need to increase knowledge of clinical trials among Chinese cancer patients. It also is necessary to examine the applicability of current patient-physician communication and interaction models. In addition, decision-making based on Asian philosophies within the context of Euro-American bioethics requires further study.
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Affiliation(s)
- Shin-Ping Tu
- Department of Medicine, University of Washington, Seattle, WA 98104, USA.
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25
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Paterniti DA, Chen MS, Chiechi C, Beckett LA, Horan N, Turrell C, Smith L, Morain C, Montell L, Luis Gonzalez J, Davis S, Lara PN. Asian Americans and cancer clinical trials: a mixed-methods approach to understanding awareness and experience. Cancer 2006; 104:3015-24. [PMID: 16247795 PMCID: PMC1810970 DOI: 10.1002/cncr.21522] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cancer clinical trials have been based on low accrual rates. Barriers to recruitment of minority populations affect the generalizability and impact of trial findings for those populations. The authors undertook a mixed-methods approach to understanding levels of awareness and experiences with cancer clinical trials. A survey was administered to new cancer patients and their caretakers (family, close friends, or other social support) at outpatient oncology clinics. Field observations of the trial accrual process also were conducted by employing the grounded theory approach in qualitative methods. Comparison of survey results for Asian-American respondents and non-Asian respondents indicated that Asians were less likely to have heard the term "clinical trial" and were more likely to define a clinical trial as "an experiment" or "a test procedure in a clinic" than non-Asians. Asians were more likely to have employer-based insurance and to report understanding issues related to cost reimbursement. Asians were less likely to have been involved in or to know someone in a trial and reported less willingness than white respondents to consider trial participation. Qualitative observations suggested that Asians who presented for a potential trial were interested in the availability of a novel cancer therapy but were not eligible for available trials. Multiple strategies will be necessary to enhance awareness of and experience with accrual to cancer clinical trials for Asians, including richer understanding and increased involvement of Asians in cancer clinical trials and greater attention to the location and diversity of the Asian population in structuring study centers and evaluating trial results.
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Affiliation(s)
- Debora A Paterniti
- Center for Health Services Research in Primary Care, University of California-Davis Cancer Center, Sacramento, CA 95817, USA.
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Ellington L, Wahab S, Sahami Martin S, Field R, Mooney KH. Factors that influence Spanish- and English-speaking participants' decision to enroll in cancer randomized clinical trials. Psychooncology 2006; 15:273-84. [PMID: 15973647 DOI: 10.1002/pon.943] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Cancer randomized clinical trial (RCT) participation is low, particularly among ethnic and racial minorities. Hispanic enrollment is far below their representation in the US population, yet their cancer burden is higher. Little is known from the patient perspective about factors which influence the decision to enroll in RCTs. We asked Spanish- and English-speaking individuals what factors influence decisions about cancer RCT participation. Eight focus groups were conducted with 55 participants (25 Spanish and 30 English-speaking). The groups were taped, transcribed, and analyzed for themes. Six major themes emerged: patient-provider communication, personal relationship with provider, involvement of significant others in decision making, role of faith, need for information, and impact of discrimination on decision making. Both similarities (e.g. need for comprehensive information) and differences (e.g. need for provider acknowledgement of emotional and spiritual concerns) were found between Spanish- and English-speaking participants. Among Spanish-speaking participants, level of education was differentially related to decision-making themes. Implications for providers are discussed.
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Affiliation(s)
- Lee Ellington
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT 84112-5850, USA.
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Trauth JM, Jernigan JC, Siminoff LA, Musa D, Neal-Ferguson D, Weissfeld J. Factors Affecting Older African American Women's Decisions to Join the PLCO Cancer Screening Trial. J Clin Oncol 2005; 23:8730-8. [PMID: 16314633 DOI: 10.1200/jco.2004.00.9571] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The purpose of this study is to describe the factors associated with the decisions of older African American women to join the PLCO (Prostate, Lung, Colorectal and Ovarian) Cancer Screening Trial when recruited. Methods African American women between ages 55 and 74 years who were never diagnosed with a PLCO cancer were eligible for our study. Two methods of recruitment were used. First, mailings were sent to a random sample of women describing the PLCO followed by a telephone call to determine interest in the PLCO. If women were not interested in PLCO but consented to participate in our study, they were interviewed immediately. Second, we followed up with African American women who responded to mass mailings sent out before the start of our study by the Pittsburgh PLCO office. Women completed an interview about their cancer and clinical trial knowledge, attitudes, beliefs, and behaviors. The responses of women who joined the PLCO Trial are contrasted with the responses of women who did not join. Results Numerous factors were associated with the decision of older African American women to join the PLCO, including perceptions of cancer prevention and detection, the experience of having a loved one with cancer, knowledge of and experience with clinical trials, and beliefs regarding the benefits and risks of clinical trial participation. Conclusion Minority recruitment to cancer clinical trials could be increased by designing interventions focused on individual, organizational, and community needs.
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Affiliation(s)
- Jeanette M Trauth
- Graduate School of Public Health, 217 Parran Hall, University of Pittsburgh, Pittsburgh, PA 15261, USA.
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Ellington L, Wahab S, Sahami S, Field R, Mooney K. Decision-making issues for randomized clinical trial participation among Hispanics. Cancer Control 2004; 10:84-6. [PMID: 14581909 DOI: 10.1177/107327480301005s12] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Lee Ellington
- University of Utah College of Nursing, Salt Lake City, 84112-5880, USA.
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Barnholtz-Sloan JS, Schwartz AG, Qureshi F, Jacques S, Malone J, Munkarah AR. Ovarian cancer: changes in patterns at diagnosis and relative survival over the last three decades. Am J Obstet Gynecol 2003; 189:1120-7. [PMID: 14586365 DOI: 10.1067/s0002-9378(03)00579-9] [Citation(s) in RCA: 150] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to examine patterns of diagnosis and relative survival in women who had a diagnosis of primary invasive epithelial ovarian cancer (EOC) from 1973 to 1997, with follow-up through the end of 1999. STUDY DESIGN From the population-based Surveillance, Epidemiology and End Results (SEER) Program, 32,845 women diagnosed between 1973 and 1997 were used for analysis. The study population was divided in three cohorts based on year of diagnosis and the cohorts were compared with respect to variables of interest by using chi(2) tests and relative survival analysis by the life table method. RESULTS There was an increase in the proportions of minorities diagnosed with EOC, of women 60 years or older at diagnosis, and of women undergoing surgery over time. Survival continuously improved over time, although older patients (60 years or older) and African Americans continued to have the poorest survival. CONCLUSION Over time, relative survival of women who had primary invasive EOC diagnosed improved.
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Affiliation(s)
- Jill S Barnholtz-Sloan
- Division of Hematology/Oncology, Department of Internal Medicine, Wayne State University School of Medicine and Barbara Ann Karmanos Cancer Institute, Detroit, Michigan 48201, USA.
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Curry L, Jackson J. The science of including older ethnic and racial group participants in health-related research. THE GERONTOLOGIST 2003; 43:15-7. [PMID: 12604741 DOI: 10.1093/geront/43.1.15] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Leslie Curry
- Braceland Center for Mental Health and Aging, The Institute of Living, Hartford Hospital Mental Health Network, CT 06106, USA.
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Abstract
The successful treatment for children with cancer has greatly increased the survival rates for these young people compared to children diagnosed with cancer 30 years ago. These new medical realities direct attention to the psychosocial consequences of successful treatment and subsequent survival. In this paper, quality of life in 176 childhood cancer survivors (age 16-28) is assessed using a survey instrument designed for cancer survivors. In addition, the instrument is evaluated for its utility with this population. Survivors indicate that symptoms often associated with treatment are at a minimum but that other long-term effects like fatigue, aches, and pain negatively impact quality of life. They rate themselves high on happiness, feeling useful, life satisfaction and their ability to cope as a result of having had cancer but their hopefulness is tempered by uncertainty. Whereas the salience of spiritual and religious activities appears to be low, having a sense of purpose in life and perceiving positive changes as a result of cancer are associated with positive quality of life. A lower valence of physical concerns reflects the vitality and positive life outlook of a young population.
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Affiliation(s)
- Brad J Zebrack
- UCLA School of Medicine, Department of Pediatrics, Los Angeles, CA 90024, USA.
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32
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Patt J, Morrison S. National Cancer Institute resources for patients and their caregivers. CANCER PRACTICE 2001; 9:257-61. [PMID: 11879323 DOI: 10.1046/j.1523-5394.2001.009005257.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- J Patt
- Cancer Information Service Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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Burhansstipanov L, Gilbert A, LaMarca K, Krebs LU. An innovative path to improving cancer care in Indian country. Public Health Rep 2001. [DOI: 10.1016/s0033-3549(04)50071-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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34
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Burhansstipanov L, Gilbert A, LaMarca K, Krebs LU. An innovative path to improving cancer care in Indian country. Public Health Rep 2001; 116:424-33. [PMID: 12042607 PMCID: PMC1497357 DOI: 10.1093/phr/116.5.424] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The Native American Cancer Survivors' Support Network is an innovative public health program designed to improve survival from cancer and the quality of life after a cancer diagnosis for American Indians, Alaska Natives, and Canadian Aboriginal patients and their loved ones. The Network, initiated in 1999, now has more than 300 survivors enrolled as members. This article briefly describes the process that led to its formation and preliminary findings, primarily for breast cancer survivors, of ongoing qualitative and quantitative research. Network data show patterns of cancer care that are partially responsible for poor survivorship outcomes.
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