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Vanderpool RC, Ng D, Huang G, Dwyer LA, Kueppers G. Disparities in cancer clinical trials information-seeking: Findings from the National Cancer Institute's Cancer Information Service. PATIENT EDUCATION AND COUNSELING 2024; 127:108358. [PMID: 38936161 PMCID: PMC11323059 DOI: 10.1016/j.pec.2024.108358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/03/2024] [Accepted: 06/15/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE To better understand cancer clinical trials (CCT) information-seeking, a necessary precursor to patient and provider engagement with CCT. METHODS Data from the National Cancer Institute's Cancer Information Service (CIS) were used to examine CCT information-seeking patterns over a 5-year period. Descriptive and logistic regression analyses were conducted to examine characteristics of CIS inquiries and their associations with having a CCT discussion. RESULTS Between September 2018 - August 2023, 117,016 CIS inquiries originated from cancer survivors, caregivers, health professionals, and the general public; 27.5 % of these inquiries included a CCT discussion (n = 32,160). Among CCT discussions, 35.5 % originated from survivors, 53.5 % from caregivers, 6.1 % from the public, and 4.9 % from health professionals. Inquiries in Spanish had lower odds of a CCT discussion (OR=.26, [.25-.28]), whereas inquiries emanating from the CIS instant messaging (OR=2.29, [2.22-2.37]) and email (OR=1.24, [1.18-1.30]) platforms were associated with higher odds of discussing CCT compared to the telephone. Individuals who were male, younger, insured, and had higher income and education had significantly higher odds of a CCT discussion while those who were non-Hispanic Black and living in rural locales had significantly lower odds. CONCLUSIONS Disparities in CCT information-seeking may contribute to downstream CCT participation. PRACTICE IMPLICATIONS Quality, language-concordant health information is needed to enable equitable awareness of - and ultimately engagement in - CCT.
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Affiliation(s)
- Robin C Vanderpool
- National Cancer Institute, Behavioral Research Program, Division of Cancer Control and Population Sciences, 9609 Medical Center Dr, Rockville, MD, USA.
| | - Diane Ng
- Westat, 1600 Research Blvd, Rockville, MD, USA
| | - Grace Huang
- Westat, 1600 Research Blvd, Rockville, MD, USA
| | - Laura A Dwyer
- Cape Cox Facilities Services, 7050 Infantry Ridge Rd, Manassas, VA, USA
| | - George Kueppers
- National Cancer Institute, Behavioral Research Program, Division of Cancer Control and Population Sciences, 9609 Medical Center Dr, Rockville, MD, USA
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Shapiro GK, Santiago AT, Pittman T, Iwano K, Rodin G, Cole H, Zeman K, Sellmann S, Oza AM, Jones J, Rosenthal M, Conti RM, Rodin D. Disparities in clinical trial enrollment at a Canadian comprehensive cancer center: A 15-year retrospective study. Cancer 2024; 130:2782-2794. [PMID: 38662430 DOI: 10.1002/cncr.35331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/26/2024] [Accepted: 03/22/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Disparities in clinical trials (CTs) enrollment perpetuate inequities in treatment access and outcomes, but there is a paucity of Canadian data. The objective of this study was to examine disparities in cancer CT enrollment at a large Canadian comprehensive cancer center. METHODS Retrospective study of CT enrollment among new patient consultations from 2006 to 2019, with follow-up to 2021 (N = 154,880), with the primary outcome of enrollment as a binary variable. Factors associated with CT enrollment were evaluated using multivariable Bayesian hierarchical logistic regression with random effects for most responsible physician (MRP) and geography, adjusted for patient characteristics (sex, age, language, geography, and primary care provider [PCP]), area-level marginalization (residential instability, material deprivation, dependency, and ethnic concentration), disease (cancer site and stage), and MRP (department, sex, language, and training). A sensitivity analysis of the cumulative incidence of enrollment was conducted to account for differences in disease type and follow-up length. RESULTS CT enrollment was 11.2% overall, with a 15-year cumulative incidence of 18%. Lower odds of enrollment were observed in patients who were female (adjusted odds ratio [AOR], 0.82; 95% confidence interval [CI], 0.78-0.86), ≥65 years (AOR vs. <40, 0.61; 95% CI, 0.56-0.66), non-English speakers (0.72; 95% CI, 0.67-0.77), living ≥250 km away (AOR vs. <15 km, 0.71; 95% CI, 0.62-0.80), and without a PCP. Disease characteristics accounted for the largest proportion of observed variation (20.8%), with significantly greater odds of enrollment in patients with genitourinary cancers and late-stage disease. CONCLUSION Significant sociodemographic disparities were observed, suggesting the need for targeted strategies to increase diversity in access to cancer CTs in Canada.
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Affiliation(s)
- Gilla K Shapiro
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Anna T Santiago
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Tyler Pittman
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kai Iwano
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Heather Cole
- Cancer Clinical Research Unit, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Katherine Zeman
- Cancer Clinical Research Unit, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Susanna Sellmann
- Cancer Clinical Research Unit, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Amit M Oza
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Jones
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Meredith Rosenthal
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rena M Conti
- Department of Markets, Public Policy, and Law, Boston University Questrom School of Business, Boston, Massachusetts, USA
| | - Danielle Rodin
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
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Sinha A, Barwell L, Jeffery H, Peterson Z, Shifa B, Attia M, Badawy K, Purushotham A. Inclusivity of patients in early phase breast cancer clinical trials. J Cancer Policy 2024; 41:100494. [PMID: 39038736 DOI: 10.1016/j.jcpo.2024.100494] [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: 02/01/2024] [Revised: 05/14/2024] [Accepted: 07/03/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION Studies have shown that certain groups of patients are underrepresented in clinical trials including non-Caucasian ethnicity, poor fluency in English, low socioeconomic status, older age, neurodivergence, and large Body Mass Index (BMI). There is a need to ensure adequate representation of these groups so that the results of any trial accurately reflect the population. The aim of this study was to review the pathway of patients recruited into two early phase breast cancer clinical and determine the inclusivity of patients from the aforementioned sub-groups. METHODS The Breast Cancer Research Database was reviewed, and the characteristics of all patients who were screened for eligibility in two early phase clinical trials was examined. The English Indices of Deprivation was used to populate the Index of Multiple Deprivation (IMD) for each patient using their postcode. RESULTS In total, 392 patients were eligible to participate, between September 2020 to May 2023. Of these, 144 (36.7%) were recruited to these two trials. In all, 100% of patients eligible for these trials were approached and screened for participation. Eligible patients had a mean age of 53.5 years. Recruited patients were younger on average than those not recruited (49.1 years vs 56.0 years, p<0.0001). Only one recruited patient required an interpreter, compared with 24 (9.7%%) of those who were not recruited (p<0.001). There was no difference in the IMD (p=0.38), BMI (p=0.34) and neurodiversity (p=0.10) between patients recruited into clinical trials and those who were not. CONCLUSION Older age and poor fluency in the English language remain barriers to participation in early-phase clinical trials despite implementing a clear pathway to trial recruitment. There is a pressing need to address these barriers by raising awareness, improve appropriate training and providing comprehensive trial information to patients in the language of their choice.
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Affiliation(s)
- A Sinha
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - L Barwell
- King's College London, London, United Kingdom
| | - H Jeffery
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - Z Peterson
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - B Shifa
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, United Kingdom
| | - M Attia
- Guy's and St Thomas' NHS Foundation Trust, United Kingdom; Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - K Badawy
- King's College London, London, United Kingdom
| | - A Purushotham
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, United Kingdom.
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Brijnath B, Muoio R, Feldman P, Ghersi D, Chan AW, Welch V, Treweek S, Green H, Orkin AM, Owusu-Addo E. "We are not invited": Australian focus group results on how to improve ethnic diversity in trials. J Clin Epidemiol 2024; 170:111366. [PMID: 38631530 DOI: 10.1016/j.jclinepi.2024.111366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 03/26/2024] [Accepted: 04/09/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES Lack of ethnic diversity in trials may contribute to health disparities and to inequity in health outcomes. The primary objective was to investigate the experiences and perspectives of ethnically diverse populations about how to improve ethnic diversity in trials. STUDY DESIGN AND SETTING Qualitative data were collected via 16 focus groups with participants from 21 ethnically diverse communities in Australia. Data collection took place between August and September 2022 in community-based settings in six capital cities: Sydney, Melbourne, Perth, Adelaide, Brisbane, and Darwin, and one rural town: Bordertown (South Australia). RESULTS One hundred and fifty-eight purposively sampled adults (aged 18-85, 49% women) participated in groups speaking Tamil, Greek, Punjabi, Italian, Mandarin, Cantonese, Karin, Vietnamese, Nepalese, and Arabic; or English-language groups (comprising Fijian, Filipino, African, and two multicultural groups). Only 10 participants had previously taken part in medical research including three in trials. There was support for medical research, including trials; however, most participants had never been invited to participate. To increase ethnic diversity in trial populations, participants recommended recruitment via partnering with communities, translating trial materials and making them culturally accessible using audiovisual ways, promoting retention by minimizing participant burden, establishing trust and rapport between participants and researchers, and sharing individual results. Participants were reluctant to join studies on taboo topics in their communities (eg, sexual health) or in which physical specimens (eg, blood) were needed. Participants said these barriers could be mitigated by communicating about the topic in more culturally cognizant and safe ways, explaining how data would be securely stored, and reinforcing the benefit of medical research to humanity. CONCLUSION Participants recognized the principal benefits of trials and other medical research, were prepared to take part, and offered suggestions on recruitment, consent, data collection mechanisms, and retention to enable this to occur. Researchers should consider these community insights when designing and conducting trials; and government, regulators, funders, and publishers should allow for greater innovation and flexibility in their processes to enable ethnic diversity in trials to improve.
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Affiliation(s)
- Bianca Brijnath
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia; Social Gerontology, National Ageing Research Institute, Melbourne, Australia; School of Social Sciences, University of Western Australia, Perth, Australia.
| | - Rachel Muoio
- Social Gerontology, National Ageing Research Institute, Melbourne, Australia
| | - Peter Feldman
- Social Gerontology, National Ageing Research Institute, Melbourne, Australia
| | - Davina Ghersi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - An-Wen Chan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Vivian Welch
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Shaun Treweek
- Health Services Research Unit, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland
| | - Heidi Green
- Health Services Research Unit, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland; Research and Insights Team, COUCH Health, Manchester, UK
| | - Aaron M Orkin
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Li Ka Shing Knowledge Institute of Unity Health, Toronto, Canada
| | - Ebenezer Owusu-Addo
- Social Gerontology, National Ageing Research Institute, Melbourne, Australia; Bureau of Integrated Rural Development, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
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Robertson EG, Komesaroff R, Eisenstat DD, Robertson A, Ludlow LE. A Pilot Evaluation of an Educational Video to Support Consent to a Pediatric Malignancy Biobank. Biopreserv Biobank 2024. [PMID: 38800954 DOI: 10.1089/bio.2024.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
Introduction: The collection of biological specimens is necessary to support basic and translational research. However, the complexity of biobanking introduces numerous ethical issues, particularly regarding informed consent. Objective: To evaluate the acceptability and perceived benefits of an educational video facilitating the consent process for the Children's Cancer Centre Biobank. Methods: We invited individuals who had previously consented to be (or their child to be) part of the Biobank, and health professionals who were involved in obtaining consent. Participants watched the video and completed a purpose-designed online survey. Results: A total of 16 health professionals (invited = 30) and 15 patients/caregivers (invited = 127) participated. Most patients/caregivers felt informed about the Biobank at consent, however, noted how overwhelmed they were at the time and that they did not engage with the written information. Overall, both patients/caregivers and health professionals rated the video favorably regarding the information provided and format. Participants valued that it was simple and clear, with several health professionals noting the need for linguistic translations to better support the families they work with. Most patients/caregivers agreed that the video provided enough information to begin considering participation. This aligned with the health professionals' feedback that the video was most effective when used as a conversation starter to help formalize the written consent. Conclusion: Our findings suggest that our video is an acceptable and beneficial tool to assist in the Biobank consenting process, from both the perspective of decision-makers and health professionals obtaining consent. It appears particularly valuable as a precursor to an interactive, formal consent discussion. Further work is required to determine whether our video has a significant impact on outcomes such as decision-making satisfaction and knowledge, and to determine the value to adolescents.
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Affiliation(s)
- Eden G Robertson
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, Australia
- School of Clinical Medicine, UNSW Medicine & Health, Sydney, Australia
| | - Rebecca Komesaroff
- The Royal Children's Hospital Melbourne, Parkville, Australia
- Victorian Comprehensive Cancer Centre (VCCC) Alliance, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - David D Eisenstat
- The Royal Children's Hospital Melbourne, Parkville, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Alexandra Robertson
- The Royal Children's Hospital Melbourne, Parkville, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Louise E Ludlow
- The Royal Children's Hospital Melbourne, Parkville, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
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Marks J, Sridhar A, Ai A, Kiel L, Kaufman R, Abioye O, Mantz C, Florez N. Precision Immuno-Oncology in NSCLC through Gender Equity Lenses. Cancers (Basel) 2024; 16:1413. [PMID: 38611091 PMCID: PMC11010825 DOI: 10.3390/cancers16071413] [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: 03/07/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
Precision immuno-oncology involves the development of personalized cancer treatments that are influenced by the unique nature of an individual's DNA, immune cells, and their tumor's molecular characterization. Biological sex influences immunity; females typically mount stronger innate and adaptive immune responses than males. Though more research is warranted, we continue to observe an enhanced benefit for females with lung cancer when treated with combination chemoimmunotherapy in contrast to the preferred approach of utilizing immunotherapy alone in men. Despite the observed sex differences in response to treatments, women remain underrepresented in oncology clinical trials, largely as a result of gender-biased misconceptions. Such exclusion has resulted in the development of less efficacious treatment guidelines and clinical recommendations and has created a knowledge gap in regard to immunotherapy-related survivorship issues such as fertility. To develop a more precise approach to care and overcome the exclusion of women from clinical trials, flexible trial schedules, multilingual communication strategies, financial, and transportation assistance for participants should be adopted. The impact of intersectionality and other determinants of health that affect the diagnosis, treatment, and outcomes in women must also be considered in order to develop a comprehensive understanding of the unique impact of immunotherapy in all women with lung cancer.
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Affiliation(s)
- Jennifer Marks
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057, USA;
| | | | - Angela Ai
- Olive View-UCLA Medical Center, University of California Los Angeles, Los Angeles, CA 90095, USA;
| | - Lauren Kiel
- Dana-Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (R.K.); (O.A.); (C.M.)
| | - Rebekah Kaufman
- Dana-Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (R.K.); (O.A.); (C.M.)
| | - Oyepeju Abioye
- Dana-Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (R.K.); (O.A.); (C.M.)
| | - Courtney Mantz
- Dana-Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (R.K.); (O.A.); (C.M.)
| | - Narjust Florez
- Dana-Farber Cancer Institute, Boston, MA 02215, USA; (L.K.); (R.K.); (O.A.); (C.M.)
- Harvard Medical School, Boston, MA 02115, USA
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Roydhouse J, Connolly A, Daveson B, de Graaff B, Blanchard M, Currow DC. Palliative care symptoms and problems in a culturally and linguistically diverse population: large retrospective cohort study. BMJ Support Palliat Care 2024; 13:e1228-e1237. [PMID: 36720586 DOI: 10.1136/spcare-2022-004111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/09/2023] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Migrant Australians with cancer have higher unmet needs and poorer health-related quality of life. Less is known about their palliative care experience. We aimed to assess comparative symptom distress and problem severity for culturally and linguistically diverse Australians with cancer in palliative care. METHODS This was a retrospective, consecutive cohort study using data from the Palliative Care Outcomes Collaboration, which routinely collects standardised symptom assessments nationally at point-of-care. Adults with a cancer diagnosis who died 01/01/2016-31/12/2019 were included. The presence/absence of patient-reported symptom distress and clinician-rated problem severity were compared between people who preferred English and people who preferred another language using logistic regression models. We also compared people who preferred English and the four most common non-English languages in the dataset: Chinese, Greek, Italian and Slavic. RESULTS A total of 53 964 people with cancer died within the study period, allowing analysis of 104 064 assessments. People preferring non-English languages were less likely to report symptoms (pain: OR=0.89 (0.84 to 0.94); all other symptoms except fatigue OR<1 and CIs did not contain 1). Except for family/carer problems (OR=1.24 (1.12 to 1.31)), linguistically diverse people were less likely to report problems. Variation was seen between non-English language groups. CONCLUSIONS We did not find evidence of comparatively worse symptom distress or problem severity for nearly all scores for culturally and linguistically diverse Australians. Better symptom management or differential reporting may explain this. It is important to examine this further, including assessing differences within cultural and linguistic groups to ensure the delivery of high-quality palliative care.
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Affiliation(s)
- Jessica Roydhouse
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Alanna Connolly
- Palliative Care Outcomes Collaboration, Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Barbara Daveson
- Palliative Care Outcomes Collaboration, Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Barbara de Graaff
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Megan Blanchard
- Palliative Care Outcomes Collaboration, Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - David C Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
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Guo XM, Neuman MK, Vallejo A, Matsuo K, Roman LD. An absence of translated consent forms limits oncologic clinical trial enrollment for limited English proficiency participants. Gynecol Oncol 2024; 180:86-90. [PMID: 38061275 DOI: 10.1016/j.ygyno.2023.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/21/2023] [Accepted: 11/23/2023] [Indexed: 02/18/2024]
Abstract
OBJECTIVES A lack of diversity amongst participants in cancer clinical trials has raised scrutiny over the past decade. Patients with limited English proficiency (LEP) are further excluded. One modifiable reason for low LEP participation is a lack of non-English consent forms. METHODS We queried the clinical trials registry database at an academic hospital serving a predominantly Spanish-speaking patient population. Clinical trials related to gynecology oncology were evaluated for the availability of fully translated Spanish consent forms, the racial and ethnic identification of enrolled patients, and the number of signed Spanish consents. Enrolment data was compared before and after 2019, when institutional financial support for document translation was withdrawn. RESULTS Sixteen gynecologic oncology clinical trials were opened between 2014 and 2022, with 10 trials enrolling 128 patients. Eight trials opened prior to 2019, all with fully translated consent forms. Seven of these trials enrolled 99 participants, 70% of whom identified as Hispanic and 60% who signed a Spanish consent. Eight trials opened after 2019 and one had a fully translated consent form. Three of the trials enrolled 29 participants, with 10% of subjects identifying as Hispanic and none signing a Spanish consent form. CONCLUSIONS There was a decrease in fully translated clinical trial consent forms for gynecologic oncology studies following the loss of subsidized translation services in our single institution with a predominantly LEP population. This correlated with a decrease in enrollment of Hispanic subjects. To increase enrollment of diverse participants, including those with LEP, simple actions such as fully translating consent forms would help maintain equity in research conduct and improve clinical outcomes through trial involvement.
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Affiliation(s)
- X Mona Guo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.
| | - Monica K Neuman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Andrew Vallejo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
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9
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Pal A, Smith B, Allan C, Karikios D, Boyle F. Improving Access to Cancer Clinical Trials for Patients From Culturally and Linguistically Diverse Backgrounds in Australia: A Survey of Clinical and Research Professionals. JCO Oncol Pract 2023; 19:1039-1047. [PMID: 37677123 DOI: 10.1200/op.23.00291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/05/2023] [Accepted: 08/01/2023] [Indexed: 09/09/2023] Open
Abstract
PURPOSE Patients with cancer from racial and ethnic minorities, referred to as culturally and linguistically diverse (CALD) in Australia, are significantly under-represented in cancer clinical trials. We performed a national survey of the Australian cancer clinical trials workforce to determine barriers and preferred solutions to address this inequity. METHODS A 15-item online survey containing both closed- and open-ended purpose-designed questions was created using REDCap. The survey was emailed to members of the Clinical Oncology Society of Australia, Medical Oncology Group of Australia, and Australian cancer cooperative trial groups, and promoted via Twitter. Descriptive analyses summarized quantitative data, and free-text entries underwent thematic analysis with NVivo Version 12. RESULTS Ninety one respondents completed the survey-with representation across Australia. Eighty-seven percent were directly involved in clinical trial recruitment. Sixty-eight percent were clinicians. Seventy-four percent of respondents did not collect routine data on CALD patient enrollment to cancer clinical trials. Communication (eg, lack of translated materials) and opportunity-related barriers (eg, exclusionary trial protocols) were the most frequently perceived barriers to recruitment. Additionally, qualitative analysis indicated that insufficient consultation time and difficulties accessing interpreters for patients with non-English language preference were significant barriers. Trial navigators and a generic cancer trial pamphlet available in multiple languages were judged the most likely solutions to improve recruitment. CONCLUSION This study articulates the Australian clinical trials workforce's perspective on current barriers and potential solutions to the under-representation of patients from CALD backgrounds on cancer clinical trials. The insights and solutions from this survey provide steps toward achieving equity in Australian cancer clinical trials.
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Affiliation(s)
- Abhijit Pal
- Liverpool Hospital, Sydney, NSW, Australia
- Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- University of Sydney, Sydney, NSW, Australia
| | - Ben Smith
- Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- South West Sydney Clinical Campuses, University of New South Wales, Sydney, NSW, Australia
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Murphy SL, Jay GM, Samuels EM, Eakin BL, Harper AE, Piatt GA, Trujillo VI, Weeks-Norton KL, Striley CW, O’Leary C, Hahn J, Watkins DC, Cottler LB, Aguilar Gaxiola S. Evaluation of an online research best practices training for community health workers and promotoras. J Clin Transl Sci 2023; 7:e195. [PMID: 37771414 PMCID: PMC10523289 DOI: 10.1017/cts.2023.624] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/30/2023] Open
Abstract
Introduction Community health workers and promotoras (CHW/Ps) have a fundamental role in facilitating research with communities. However, no national standard training exists as part of the CHW/P job role. We developed and evaluated a culturally- and linguistically tailored online research best practices course for CHW/Ps to meet this gap. Methods After the research best practices course was developed, we advertised the opportunity to CHW/Ps nationwide to complete the training online in English or Spanish. Following course completion, CHW/Ps received an online survey to rate their skills in community-engaged research and their perceptions of the course using Likert scales of agreement. A qualitative content analysis was conducted on open-ended response data. Results 104 CHW/Ps completed the English or Spanish course (n = 52 for each language; mean age 42 years SD ± 12); 88% of individuals identified as female and 56% identified as Hispanic, Latino, or Spaniard. 96%-100% of respondents reported improvement in various skills. Nearly all CHW/Ps (97%) agreed the course was relevant to their work, and 96% felt the training was useful. Qualitative themes related to working more effectively as a result of training included enhanced skills, increased resources, and building bridges between communities and researchers. Discussion The CHW/P research best practices course was rated as useful and relevant by CHW/Ps, particularly for communicating about research with community members. This course can be a professional development resource for CHW/Ps and could serve as the foundation for a national standardized training on their role related to research best practices.
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Affiliation(s)
- Susan L. Murphy
- Michigan Institute of Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Gina M. Jay
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Elias M. Samuels
- Michigan Institute of Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA
| | - Brenda L. Eakin
- Michigan Institute of Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA
| | - Alexandra E. Harper
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Gretchen A. Piatt
- Department of Learning Health Sciences, Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Vanessa I. Trujillo
- Clinical and Translational Science Center, University of California, Davis, CA, USA
- Center for Reducing Health Disparities, University of California, Davis, CA, USA
| | - Kristen L. Weeks-Norton
- Clinical and Translational Science Center, University of California, Davis, CA, USA
- Center for Reducing Health Disparities, University of California, Davis, CA, USA
| | - Catherine W. Striley
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainseville, FL, USA
| | | | - Jordan Hahn
- Michigan Institute of Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA
| | - Daphne C. Watkins
- School of Social Work, Vivian A. and James L. Curtis Center for Health Equity Research and Training, University of Michigan, Ann Arbor, MI, USA
| | - Linda B. Cottler
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainseville, FL, USA
| | - Sergio Aguilar Gaxiola
- Clinical and Translational Science Center, University of California, Davis, CA, USA
- Center for Reducing Health Disparities, University of California, Davis, CA, USA
- Department of Internal Medicine, University of California, Davis, CA, USA
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11
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Werner‐Seidler A, Maston K, Calear AL, Batterham PJ, Larsen ME, Torok M, O’Dea B, Huckvale K, Beames JR, Brown L, Fujimoto H, Bartholomew A, Bal D, Schweizer S, Skinner SR, Steinbeck K, Ratcliffe J, Oei J, Venkatesh S, Lingam R, Perry Y, Hudson JL, Boydell KM, Mackinnon A, Christensen H. The Future Proofing Study: Design, methods and baseline characteristics of a prospective cohort study of the mental health of Australian adolescents. Int J Methods Psychiatr Res 2023; 32:e1954. [PMID: 36444163 PMCID: PMC10485316 DOI: 10.1002/mpr.1954] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/17/2022] [Accepted: 10/25/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES The Future Proofing Study (FPS) was established to examine factors associated with the onset and course of mental health conditions during adolescence. This paper describes the design, methods, and baseline characteristics of the FPS cohort. METHODS The FPS is an Australian school-based prospective cohort study with an embedded cluster-randomized controlled trial examining the effects of digital prevention programs on mental health. Data sources include self-report questionnaires, cognitive functioning, linkage to health and education records, and smartphone sensor data. Participants are assessed annually for 5 years. RESULTS The baseline cohort (N = 6388, M = 13.9 years) is broadly representative of the Australian adolescent population. The clinical profile of participants is comparable to other population estimates. Overall, 15.1% of the cohort met the clinical threshold for depression, 18.6% for anxiety, 31.6% for psychological distress, and 4.9% for suicidal ideation. These rates were significantly higher in adolescents who identified as female, gender diverse, sexuality diverse, or Aboriginal and/or Torres Strait Islander (all ps < 0.05). CONCLUSIONS This paper provides current and comprehensive data about the status of adolescent mental health in Australia. The FPS cohort is expected to provide significant insights into the risk, protective, and mediating factors associated with development of mental health conditions during adolescence.
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Affiliation(s)
| | - Kate Maston
- Black Dog InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Alison L. Calear
- Centre for Mental Health ResearchThe Australian National UniversityCanberraAustralian Capital TerritoryAustralia
| | - Philip J. Batterham
- Centre for Mental Health ResearchThe Australian National UniversityCanberraAustralian Capital TerritoryAustralia
| | - Mark E. Larsen
- Black Dog InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Michelle Torok
- Black Dog InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Bridianne O’Dea
- Black Dog InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Kit Huckvale
- Centre for Digital Transformation of HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Joanne R. Beames
- Black Dog InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Lyndsay Brown
- Black Dog InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Hiroko Fujimoto
- Black Dog InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | | | - Debopriyo Bal
- Black Dog InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Susanne Schweizer
- School of PsychologyUniversity of New South WalesSydneyNew South WalesAustralia
- Institute of Cognitive NeuroscienceUniversity College LondonLondonUK
| | - S. Rachel Skinner
- Discipline of Child and Adolescent HealthFaculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Katharine Steinbeck
- Discipline of Child and Adolescent HealthFaculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Julie Ratcliffe
- College of Nursing and Health SciencesFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Ju‐Lee Oei
- School of Women's and Children's HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Svetha Venkatesh
- Applied Artificial Intelligence InstituteDeakin UniversityBurwoodVictoriaAustralia
| | - Raghu Lingam
- School of Women's and Children's HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Yael Perry
- Telethon Kids InstituteUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Jennifer L. Hudson
- Black Dog InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Katherine M. Boydell
- Black Dog InstituteUniversity of New South WalesSydneyNew South WalesAustralia
- Discipline of Psychiatry and Mental HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Andrew Mackinnon
- Black Dog InstituteUniversity of New South WalesSydneyNew South WalesAustralia
| | - Helen Christensen
- Black Dog InstituteUniversity of New South WalesSydneyNew South WalesAustralia
- Discipline of Psychiatry and Mental HealthUniversity of New South WalesSydneyNew South WalesAustralia
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12
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Scanlon B, Durham J, Wyld D, Roberts N, Toloo GS. Exploring equity in cancer treatment, survivorship, and service utilisation for culturally and linguistically diverse migrant populations living in Queensland, Australia: a retrospective cohort study. Int J Equity Health 2023; 22:175. [PMID: 37658395 PMCID: PMC10474708 DOI: 10.1186/s12939-023-01957-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/10/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND There is strong international evidence documenting inequities in cancer care for migrant populations. In Australia, there is limited information regarding cancer equity for Culturally and Linguistically Diverse (CALD) migrant populations, defined in this study as migrants born in a country or region where English is not the primary language. This study sought to quantify and compare cancer treatment, survivorship, and service utilisation measures between CALD migrant and Australian born cancer populations. METHODS A retrospective cohort study was conducted utilising electronic medical records at a major, tertiary hospital. Inpatient and outpatient encounters were assessed for all individuals diagnosed with a solid tumour malignancy in the year 2016 and followed for a total of five years. Individuals were screened for inclusion in the CALD migrant or Australian born cohort. Bivariate analysis and multivariate logistic regression were used to compare treatment, survivorship, and service utilisation measures. Sociodemographic measures included age, sex, post code, employment, region of birth and marital status. RESULTS A total of 523 individuals were included, with 117 (22%) in the CALD migrant cohort and 406 (78%) in the Australian-born cohort. CALD migrants displayed a statistically significant difference in time from diagnosis to commencement of first treatment for radiation (P = 0.03) and surgery (P = 0.02) and had 16.6 times higher odds of declining recommended chemotherapy than those born in Australia (P = 0.00). Survivorship indicators favoured CALD migrants in mean time from diagnosis to death, however their odds of experiencing disease progression during the study period were 1.6 times higher than those born in Australia (P = 0.04). Service utilisation measures displayed that CALD migrants exhibited higher numbers of unplanned admissions (P = < 0.00), longer cumulative length of those admissions (P = < 0.00) and higher failure to attend scheduled appointments (P = < 0.00). CONCLUSION This novel study has produced valuable findings in the areas of treatment, survivorship, and service utilisation for a neglected population in cancer research. The differences identified suggest potential issues of institutional inaccessibility. Future research is needed to examine the clinical impacts of these health differences in the field of cancer care, including the social and institutional determinants of influence.
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Affiliation(s)
- Brighid Scanlon
- Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, 4029, Australia.
- Queensland University of Technology, 149 Victoria Park Road, Kelvin Grove, Brisbane, QLD, 4059, Australia.
| | - Jo Durham
- Queensland University of Technology, 149 Victoria Park Road, Kelvin Grove, Brisbane, QLD, 4059, Australia
| | - David Wyld
- Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, 4029, Australia
- Queensland University of Technology, 149 Victoria Park Road, Kelvin Grove, Brisbane, QLD, 4059, Australia
- University of Queensland, St Lucia, QLD, 4072, Australia
| | - Natasha Roberts
- University of Queensland, St Lucia, QLD, 4072, Australia
- Surgical, Treatment and Rehabilitation Service, STARS Education and Research Alliance, Herston, QLD, 4006, Australia
| | - Ghasem Sam Toloo
- Queensland University of Technology, 149 Victoria Park Road, Kelvin Grove, Brisbane, QLD, 4059, Australia
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13
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Hodgson R, Albatat B, Tacey M, Zucchi E, Strugnell N, Lee B. An integrated interpreting service normalizes access to care for culturally and linguistically diverse (CALD) patients with colorectal cancer. Asia Pac J Clin Oncol 2023; 19:559-565. [PMID: 36507563 DOI: 10.1111/ajco.13907] [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: 02/02/2022] [Accepted: 11/24/2022] [Indexed: 07/20/2023]
Abstract
AIM To compare access to the initial management and overall survival with colorectal cancer for limited English proficient (LEP) patients compared with patients from an English background. METHODS All newly diagnosed patients from 2017 with colorectal cancer from a single health service with a highly multicultural catchment area and a well-developed and integrated translation and language support (TALS) department were recruited. Time from referral to: biopsy, date seen by a surgeon, oncologist, discussion at a multidisciplinary meeting (MDM), and day of commencement of the first treatment modality, and overall survival were analyzed. RESULTS One hundred sixty-two patients were analyzed, including 57 LEP patients from 22 countries of birth. Interpreters were present at 687/782 appointments with LEP patients. There were no differences in demographics or cancer staging. There were no differences between English background and LEP patients with regard to times from referral to biopsy (1 vs. 0 days), specialist review (surgical: 4 vs. 6 days, oncological: 45 vs. 57 days), MDM discussion (23 vs. 15 days), or commencement of treatment (32 vs. 28.5 days). There were no differences in treatment for colorectal cancer, although a higher rate of stomas was noted in LEP patients. There was no difference in overall survival between groups. CONCLUSION Time to critical initial checkpoints and overall survival were similar in LEP and English background patients with colorectal cancer. An integrated TALS department may abrogate the language and cultural barriers that are known to disadvantage LEP patients and may contribute to normalizing care for the culturally and linguistically diverse community.
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Affiliation(s)
- Russell Hodgson
- Division of Surgery, Northern Health, Epping, Victoria, Australia
- Department of Surgery, University of Melbourne, Epping, Victoria, Australia
| | - Batool Albatat
- Division of Surgery, Northern Health, Epping, Victoria, Australia
| | - Mark Tacey
- Department of Research, Northern Health, Epping, Victoria, Australia
- Department of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Emiliano Zucchi
- Transcultural and Language Services, Northern Health, Epping, Victoria, Australia
- School of Languages, Literature, Cultures and Linguistics, Monash University, Clayton, Victoria, Australia
| | - Neil Strugnell
- Division of Surgery, Northern Health, Epping, Victoria, Australia
- Department of Surgery, University of Melbourne, Epping, Victoria, Australia
| | - Belinda Lee
- Department of Oncology, Northern Health, Epping, Victoria, Australia
- Department of Oncology, Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
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14
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Mahoney ME, Sridhar SS. Clinical trial reform in the post-COVID era. Ther Adv Med Oncol 2023; 15:17588359231183676. [PMID: 37431430 PMCID: PMC10331111 DOI: 10.1177/17588359231183676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/31/2023] [Indexed: 07/12/2023] Open
Abstract
The COVID-19 pandemic precipitated the acute and efficient rollout of telehealth and virtual health care around the world. This review article focuses on the adoption of virtual care in the management of oncology patients, and discusses how virtual care offers the potential for large-scale, positive impacts on access to clinical trials. Virtual care during and following the peak of the pandemic has been found to be both safe and efficacious for oncology patients. Features, such as wearable health technologies, remote monitoring, home visits, and investigations being done closer to home, represent just some of the strengths of the virtual assessment rollout that were successfully utilized. One of the primary criticisms of oncological clinical trials is that clinical trial participants are not always representative of the patient populations treated in routine practice. This is in part due to stringent inclusion criteria and more broadly pertains to a lack of access to clinical trials, many of which are geographic as most trials are conducted in an urban, academic, or 'centralized' center. This paper seeks to discuss the barriers to clinical trial participation and to propose that the virtual care transformation that occurred during the pandemic has equipped oncological clinicians and researchers with the tools to better address these obstacles. A review of the literature on the impact of the virtual care rollout during and after the peak of the COVID-19 pandemic both locally and abroad was conducted. It is proposed that improving patient access through the decentralization of clinical trials has the potential to enhance evidence-based, real-world data, and to produce generalizable trial results that ultimately improve patient outcomes.
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Affiliation(s)
- Meghan E. Mahoney
- Department of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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15
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Jorge S, Masshoor S, Gray HJ, Swisher EM, Doll KM. Participation of Patients With Limited English Proficiency in Gynecologic Oncology Clinical Trials. J Natl Compr Canc Netw 2023; 21:27-32.e2. [PMID: 36634612 DOI: 10.6004/jnccn.2022.7068] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/15/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Significant disparities exist in recruitment of minorities to clinical trials, with much of the prior literature focused on race/ethnicity only. Limited English proficiency (LEP) is a known barrier in healthcare that may also drive disparities in trial enrollment. We sought to determine participation rates in gynecologic oncology trials among patients with LEP and to explore barriers to their participation. METHODS In a retrospective cohort study, electronic health record data from >2,700 patients treated over 2 years at one academic gynecologic oncology practice were abstracted and the primary exposure of having LEP was identified. The primary outcome was enrollment in a clinical trial. Demographic, financial, clinical, and healthcare access-related covariates were also abstracted and considered as potential confounders in a multivariable logistic regression model. Age, race, ethnicity, and insurance status were further examined for evidence of effect modification. In addition, a survey was administered to all gynecologic oncology research staff and gynecologic oncology providers (n=25) to assess barriers to research participation among patients with LEP. RESULTS Clinical trial enrollment was 7.5% among fluent English speakers and 2.2% among patients with LEP (risk ratio, 0.29; 95% CI, 0.11-0.78; P=.007), and remained significantly lower in patients with LEP after adjusting for the identified confounders of Hispanic ethnicity and insurance payer (odds ratio, 0.34; 95% CI, 0.12-0.97; P=.043). There was a trend toward race and LEP interaction: Asian patients were equally likely to participate in research regardless of language fluency, whereas White and Black patients with LEP were less likely to participate than non-LEP patients in both groups (P=.07). Providers reported that the most significant barriers to enrollment of patients with LEP in research were unavailability of translated consent forms and increased time needed to enroll patients. CONCLUSIONS Patients with LEP were 3.4 times less likely to participate in gynecologic oncology trials than fluent English speakers. De-aggregation of race, ethnicity, and language proficiency yielded important information about enrollment disparities. These findings offer avenues for future interventions to correct disparities.
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Affiliation(s)
- Soledad Jorge
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington
| | | | - Heidi J Gray
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington
| | - Elizabeth M Swisher
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington
| | - Kemi M Doll
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington
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Jorge S. Health Equity in Gynecologic Oncology: Focus on Limited English Proficiency. Gynecol Oncol 2022; 167:414-416. [PMID: 36273924 DOI: 10.1016/j.ygyno.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Soledad Jorge
- University of Washington, Seattle, WA, United States of America.
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17
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Carter-Bawa L, Schofield E, Atkinson TM, Ostroff JS. Development and psychometric evaluation of the Spanish version of the lung cancer screening health belief scale. Eur J Cancer Care (Engl) 2022; 31:e13707. [PMID: 36109851 PMCID: PMC10074415 DOI: 10.1111/ecc.13707] [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: 05/10/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to describe the translation and psychometric testing of the Lung Cancer Screening Health Belief Scale (LCSHBS) into Spanish. METHODS The English version of the LCSHBS was professionally translated in accordance with best practices in the translation of patient-reported outcome tools. The independent certified professional translator completed a forward translation of the LCSHBS from English to Spanish, followed by a review of the translated questionnaire by a certified Memorial Sloan Kettering Cancer Center Spanish-English bicultural expert, who reviewed the scale for accuracy. RESULTS Initial testing of the scales is valid and reliable, and supports the Spanish version of the LCSHBS (LCSHBS-S). Internal consistency reliability of the scales was supported with Cronbach's ranging from 0.81 to 0.96. Construct validity was established with confirmatory factor analysis and testing for differences between individuals who have and have not screened in theoretically proposed directions. These newly translated scales can help investigators expand this research into the large Spanish-speaking lung screening-eligible population as they develop and test critical behavioural interventions to increase lung cancer screening in the at-risk population. CONCLUSIONS Development of effective interventions to enhance shared decision-making about lung cancer screening between patients and providers must first identify factors influencing the individual's screening participation. Future efforts facilitating patient-provider conversations are better informed by understanding the perspective of the individual making the decision.
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Affiliation(s)
- Lisa Carter-Bawa
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Elizabeth Schofield
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Thomas M Atkinson
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jamie S Ostroff
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Bu S, Smith A‘B, Janssen A, Donnelly C, Dadich A, Mackenzie LJ, Smith AL, Young AL, Wu VS, Smith SJ, Sansom-Daly UM. Optimising implementation of telehealth in oncology: A systematic review examining barriers and enablers using the RE-AIM planning and evaluation framework. Crit Rev Oncol Hematol 2022; 180:103869. [DOI: 10.1016/j.critrevonc.2022.103869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
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Bregio C, Finik J, Baird M, Ortega P, Roter D, Karliner L, Diamond LC. Exploring the Impact of Language Concordance on Cancer Communication. JCO Oncol Pract 2022; 18:e1885-e1898. [PMID: 36112970 PMCID: PMC9653203 DOI: 10.1200/op.22.00040] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 04/13/2022] [Accepted: 07/24/2022] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Patients with cancer who have limited English proficiency are more likely to experience inequities in cancer knowledge, timely care, and access to clinical trials. Matching patients with language-concordant clinicians and working with professional interpreters can effectively reduce language-related disparities, but little data are available regarding the impact of language-concordant interactions in oncology care. This study aimed to assess the use of the Roter Interaction Analysis System (RIAS) in language-concordant and -discordant interactions for patients with non-English language preference presenting for an initial oncology visit at four New York City hospitals. METHODS We used the RIAS, a validated tool for qualitative coding and quantitative analysis, to evaluate interactions between 34 patients and 16 clinicians. The pairings were stratified into dyads: English language-concordant (n = 12); professionally interpreted (n = 11); partially language-concordant (n = 4, partially bilingual clinicians who communicated in Spanish and/or used ad hoc interpreters); and Spanish language-concordant (n = 7). A trained Spanish-speaking coder analyzed the recordings using established RIAS codes. RESULTS Spanish language-concordant clinicians had almost two-fold greater number of statements about biomedical information than English language-concordant clinicians. Spanish language-concordant patients had a higher tendency to engage in positive talk such as expressing agreement. The number of partnership/facilitation-related statements was equivalent for English and Spanish language-concordant groups but lower in professionally interpreted and partially language-concordant dyads. CONCLUSION Language concordance may facilitate more effective biomedical counseling and therapeutic relationships between oncology clinicians and patients. Future research should further explore the impact of language concordance on cancer-specific health outcomes.
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Affiliation(s)
- Celyn Bregio
- Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Jackie Finik
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Morgan Baird
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Pilar Ortega
- Department of Medical Education, University of Illinois College of Medicine, Chicago, IL
- Department of Emergency Medicine, University of Illinois College of Medicine, Chicago, IL
| | - Debra Roter
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Leah Karliner
- Center for Aging in Diverse Communities, University of California, San Francisco, CA
- Multiethnic Health Equity Research Center, University of California, San Francisco, CA
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA
| | - Lisa C. Diamond
- Hospital Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY
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Salomon RE, Dobbins S, Harris C, Haeusslein L, Lin CX, Reeves K, Richoux S, Roussett G, Shin J, Dawson-Rose C. Antiracist symptom science: A call to action and path forward. Nurs Outlook 2022; 70:794-806. [PMID: 36400578 PMCID: PMC10916506 DOI: 10.1016/j.outlook.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/29/2022] [Accepted: 07/31/2022] [Indexed: 11/17/2022]
Abstract
Nurse scientists recognize the experience of racism as a driving force behind health. However, symptom science, a pillar of nursing, has rarely considered contributions of racism. Our objective is to describe findings within symptom science research related to racial disparities and/or experiences of racism and to promote antiracist symptom science within nursing research. In this manuscript, we use an antiracist lens to review a predominant symptom science theory and literature in three areas of symptom science research-oncology, mental health, and perinatal health. Finally, we make recommendations for increasing antiracist research in symptom science by altering (a) research questions, (b) recruitment methods, (c) study design, (d) data analysis, and (e) dissemination of findings. Traditionally, symptom science focuses on individual level factors rather than broader contexts driving symptom experience and management. We urge symptom science researchers to embrace antiracism by designing research with the specific intent of dismantling racism at multiple levels.
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Affiliation(s)
- Rebecca E Salomon
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Sarah Dobbins
- San Francisco Department of Public Health, San Francisco, California
| | | | | | - Chen-Xi Lin
- University of California, San Francisco, San Francisco, California
| | - Katie Reeves
- University of California, San Francisco, San Francisco, California
| | - Sarah Richoux
- University of California, San Francisco, San Francisco, California
| | - Greg Roussett
- University of California, San Francisco, San Francisco, California
| | - Joosun Shin
- University of California, San Francisco, San Francisco, California
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The association between non-English primary language and COVID-19 clinical trial eligibility and enrollment: A retrospective cohort study. Contemp Clin Trials 2022; 122:106932. [PMID: 36152792 PMCID: PMC9492384 DOI: 10.1016/j.cct.2022.106932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/16/2022] [Accepted: 09/17/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Establishing equitable access to COVID-19 clinical trials is an important step in mitigating outcomes disparities. Historically, language has served as a barrier to equitable clinical trial participation. METHODS A centralized research infrastructure was established at our institution to screen potential trial participants and to promote efficient and equitable access to COVID-19 clinical trials. Rates of eligibility and enrollment in COVID-19 clinical trials by primary language between April 9 and July 31, 2020 (during the first regional COVID-19 surge) were evaluated using logistic regression. Estimates were adjusted for potential confounders including age, sex, and time. RESULTS A total of 1245 patients were admitted to the hospital with COVID-19 during the study period and screened for clinical trial eligibility. Among all screened patients, 487 (39%) had a non-English primary language. After adjustment, patients with a non-English primary language had 1.98 times higher odds (CI 1.51 to 2.59) of being eligible for 1 or more COVID-19 clinical trials. Among eligible patients, those with a non-English primary language had 1.83 times higher odds (CI 1.36 to 2.47) of enrolling in COVID-19 clinical trials than patients with English as the primary language. CONCULSION These findings suggest that there are modifiable barriers that can be addressed to lessen the impact of language discordance on access to clinical trials and provide an opportunity to further investigate factors associated with clinical trial participation for patients whose primary language is not English.
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22
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Atkinson TM, Lynch KA, Vera J, Olivares NM, Webb A, Diamond LC, González J, Lubetkin EI, Bucher G, Rosa-Cunha I, Berry-Lawhorn JM, Levine R, Aboulafia D, Schouten J, Holland SM, Cella D, Palefsky JM. Linguistic validation of the Spanish version of the Anal Cancer High-Grade squamous intraepithelial lesions outcomes Research Health-Related Symptom Index (A-HRSI): AMC-A04. J Patient Rep Outcomes 2022; 6:108. [PMID: 36219358 PMCID: PMC9552152 DOI: 10.1186/s41687-022-00515-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/21/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The Anal Cancer High-grade squamous intraepithelial lesions (HSIL) Outcomes Research (ANCHOR) Health-Related Symptom Index (A-HRSI) is a 25-item measure that assesses physical symptoms and impacts, and psychological symptoms. To promote generalizability and equity in the capture of these concepts in Spanish-speaking participants, we linguistically validated a Spanish version of A-HRSI. METHODS Following independent forward translation and reconciliation of A-HRSI from English to Spanish, two rounds of cognitive interviews were completed with ANCHOR participants who had been diagnosed with anal HSIL in the prior nine months and preferred delivery of their healthcare in Spanish. Interviews were coded to highlight any items and concepts that were reported as being difficult for any reason by ≥ 3 participants, with such items revised during a research team panel discussion and tested in a second round of interviews if applicable. RESULTS Seventeen participants representing 8 nationalities were enrolled (Round 1 n=10, Round 2 n=7); 7 participants reported not completing high school (41.2%). No difficulties were reported with respect to the theoretical concepts measured by A-HRSI. We made modifications to the Spanish translation of eight items and two response option terms in cases where participants had difficulty understanding a term, experienced problems in discriminating between terms, or preferred the use of an alternative term to represent the concept(s). CONCLUSION The Spanish version of A-HRSI is a linguistically valid tool that can be used to assess physical symptoms, impacts, and psychological symptoms related to anal HSIL. Language is a tremendous barrier to enrolling patients to clinical trials. The anal cancer high-grade squamous intraepithelial lesions (HSIL) outcomes research [ANCHOR] trial is a randomized clinical trial that recently established that the treatment of anal HSIL, versus active monitoring, is effective in reducing incidence of anal cancer in persons living with HIV (PLWH). The ANCHOR Health-Related Symptom Index (A-HRSI) is a 25-item patient-reported outcomes measure that was developed to assess physical symptoms, physical impacts, and psychological symptoms related to anal HSIL. As approximately 10% of ANCHOR participants preferred the delivery of their healthcare in Spanish, the purpose of the present study was to linguistically validate a Spanish version of A-HRSI. Based on feedback from interviews with 17 participants from the ANCHOR trial who had been diagnosed with anal HSIL in the prior nine months and preferred delivery of their healthcare in Spanish, we made modifications to the Spanish translation of eight items and two response option terms in cases where participants had difficulty understanding a term, experienced problems in discriminating between terms, or preferred the use of an alternative term to represent the concept(s). The Spanish version of A-HRSI is a linguistically valid tool that can be used to assess physical symptoms, impacts, and psychological symptoms related to anal HSIL as part of clinical trials or routine care.
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Affiliation(s)
- Thomas M. Atkinson
- grid.51462.340000 0001 2171 9952Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, 10022 New York, NY USA
| | - Kathleen A. Lynch
- grid.51462.340000 0001 2171 9952Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, 10022 New York, NY USA ,grid.137628.90000 0004 1936 8753New York University, New York, NY USA
| | - Jacqueline Vera
- grid.51462.340000 0001 2171 9952Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, 10022 New York, NY USA
| | - Nuria Mendoza Olivares
- grid.51462.340000 0001 2171 9952Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, 10022 New York, NY USA ,grid.137628.90000 0004 1936 8753New York University, New York, NY USA
| | - Andrew Webb
- grid.51462.340000 0001 2171 9952Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, 10022 New York, NY USA
| | - Lisa C. Diamond
- grid.51462.340000 0001 2171 9952Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, 10022 New York, NY USA
| | - Javier González
- grid.51462.340000 0001 2171 9952Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, 10022 New York, NY USA
| | - Erica I. Lubetkin
- grid.254250.40000 0001 2264 7145CUNY School of Medicine, New York, NY USA
| | - Gary Bucher
- Anal Dysplasia Clinic MidWest, Chicago, IL USA
| | | | | | - Rebecca Levine
- grid.240283.f0000 0001 2152 0791Montefiore Medical Center, New York, NY USA
| | - David Aboulafia
- grid.416879.50000 0001 2219 0587Virginia Mason Medical Center, Seattle, WA USA
| | - Jeffrey Schouten
- grid.416879.50000 0001 2219 0587Virginia Mason Medical Center, Seattle, WA USA
| | - Susan M. Holland
- grid.51462.340000 0001 2171 9952Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, 10022 New York, NY USA
| | - David Cella
- grid.16753.360000 0001 2299 3507Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Joel M. Palefsky
- grid.266102.10000 0001 2297 6811University of California-San Francisco, San Francisco, CA USA
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23
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Kim SK. Beyond language: Motivators and barriers to breast cancer screening among Korean-speaking women in Sydney Metropolitan, Australia. Health Promot J Austr 2022; 33:412-425. [PMID: 34080752 DOI: 10.1002/hpja.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/30/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There are persistent disparities in breast screening participation rates between Australian-born women and women from culturally and linguistically diverse (CALD) backgrounds. Cancer Institute NSW statistics from 2015 show Korean speaking women had the second lowest breast screening participation rates when compared across all language groups. OBJECTIVE The study aimed to gain a better understanding of the motivators and barriers associated with participation in breast cancer screening among women from a Korean background living in the Sydney metropolitan area. METHODS Semi-structured individual interviews (n = 32) and small focus groups (n = 28) were conducted. Data from interviews and focus group discussions were analysed using thematic analysis. RESULTS The findings highlight the barriers to access breast screening services extend beyond language to include perception, a lack of knowledge and understanding of the services offered, unfamiliarity with the Australian healthcare system and distrust in breast screening services. CONCLUSION Supporting Korean women to understand and navigate the Australian healthcare system plays an important role in increasing breast screening participation rates. Key strategies to provide this support include the delivery of culturally sensitive health promotion and community engagement as well as the provision of translated health information.
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Affiliation(s)
- Su Kyung Kim
- Population Health, Sydney Local Health District, Forest Lodge, NSW, Australia
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24
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Roy M, Purington N, Liu M, Blayney DW, Kurian AW, Schapira L. Limited English Proficiency and Disparities in Health Care Engagement Among Patients With Breast Cancer. JCO Oncol Pract 2021; 17:e1837-e1845. [PMID: 33844591 PMCID: PMC9810131 DOI: 10.1200/op.20.01093] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Race and ethnicity have been shown to affect quality of cancer care, and patients with low English proficiency (LEP) have increased risk for serious adverse events. We sought to assess the impact of primary language on health care engagement as indicated by clinical trial screening and engagement, use of genetic counseling, and communication via an electronic patient portal. METHODS Clinical and demographic data on patients with breast cancer diagnosed and treated from 2013 to 2018 within the Stanford University Health Care system were compiled via linkage of electronic health records, an internal clinical trial database, and the California Cancer Registry. Logistic and linear regression models were used to evaluate for association of clinical trial engagement and patient portal message rates with primary language group. RESULTS Patients with LEP had significantly lower rates of clinical trial engagement compared with their English-speaking counterparts (adjusted odds ratio [OR], 0.29; 95% CI, 0.16 to 0.51). Use of genetic counseling was similar between language groups. Rates of patient portal messaging did not differ between English-speaking and LEP groups on multivariable analysis; however, patients with LEP were less likely to have a portal account (adjusted OR, 0.89; 95% CI, 0.83 to 0.96). Among LEP subgroups, Spanish speakers were significantly less likely to engage with the patient portal compared with English speakers (estimated difference in monthly rate: OR, 0.43; 95% CI, 0.24 to 0.77). CONCLUSION We found that patients with LEP had lower rates of clinical trial engagement and odds of electronic patient portal enrollment. Interventions designed to overcome language and cultural barriers are essential to optimize the experience of patients with LEP.
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Affiliation(s)
- Mohana Roy
- Stanford University School of Medicine and Stanford Cancer Institute, Stanford, CA,Mohana Roy, MD, Division of Hematology and Oncology, Stanford University School of Medicine, 875 Blake Wilbur Rd, Stanford, CA 94305; e-mail:
| | - Natasha Purington
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA
| | - Mina Liu
- Research Informatics Center, Stanford University School of Medicine, Stanford, CA
| | - Douglas W. Blayney
- Stanford University School of Medicine and Stanford Cancer Institute, Stanford, CA
| | - Allison W. Kurian
- Stanford University School of Medicine and Stanford Cancer Institute, Stanford, CA,Departments of Medicine and of Epidemiology and Population Health, Stanford University, Stanford, CA
| | - Lidia Schapira
- Stanford University School of Medicine and Stanford Cancer Institute, Stanford, CA
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25
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Palmer NR, Borno HT, Gregorich SE, Livaudais-Toman J, Kaplan CP. Prostate cancer patients' self-reported participation in research: an examination of racial/ethnic disparities. Cancer Causes Control 2021; 32:1161-1172. [PMID: 34189651 PMCID: PMC8416807 DOI: 10.1007/s10552-021-01463-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/13/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE We examined prostate cancer patients' participation in research and associated factors by race/ethnicity in a multiethnic sample. METHODS Men with a new diagnosis of prostate cancer were identified through the California Cancer Registry. Patients completed a cross-sectional telephone interview in English, Spanish, Cantonese or Mandarin. Multivariable logistic regression models, stratified by race/ethnicity, estimated the associations of patient demographic and health characteristics with participation in (1) any research, (2) behavioral research, and (3) biological/clinical research. RESULTS We included 855 prostate cancer patients: African American (19%), Asian American (15%), Latino (24%), and White (42%). In the overall model of participation in any research, African American men (Odds Ratio (OR) = 2.54, 95% CI 1.63-3.94), and those with two or more comorbidities (OR = 2.20, 95% CI 1.27-3.80) were more likely to report participation. Men 65 years old and older (OR = 0.65, 95% CI 0.47-0.91), those who were married or living with a partner (OR = 0.67, 95% CI 0.45-0.98), and those who completed the interview in Spanish (OR = 0.36, 95% CI 0.15-0.85) were less likely to report participating in any research. Stratified analyses identified racial/ethnic-specific sociodemographic characteristics associated with lower research participation, including Spanish or Chinese language, older age, and lower education. CONCLUSION African American prostate cancer patients reported higher research participation than all other groups. However, recruitment efforts are still needed to overcome barriers to participation for Spanish and Chinese speakers, and barriers among older adults and those with lower education levels.
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Affiliation(s)
- Nynikka R Palmer
- Department of Medicine, Division of General Internal Medicine at Zuckerberg, San Francisco General Hospital, University of California San Francisco, UCSF, 1001 Potrero Avenue, Box 1364, San Francisco, CA, 94143, USA.
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, USA.
| | - Hala T Borno
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, USA
- Department of Medicine, Division of Hematology/Oncology, University of California San Francisco, San Francisco, USA
| | - Steven E Gregorich
- Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, USA
- Multiethnic Research Center, University of California San Francisco, San Francisco, USA
| | - Jennifer Livaudais-Toman
- Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, USA
| | - Celia P Kaplan
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, USA
- Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, USA
- Multiethnic Research Center, University of California San Francisco, San Francisco, USA
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26
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Netfa F, King C, Davies C, Rashid H, Tashani M, Booy R, Skinner SR. Knowledge, Attitudes, and Perceptions of the Arabic-Speaking Community in Sydney, Australia, toward the Human Papillomavirus (HPV) Vaccination Program: A Qualitative Study. Vaccines (Basel) 2021; 9:vaccines9090940. [PMID: 34579177 PMCID: PMC8473026 DOI: 10.3390/vaccines9090940] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Little is known about acceptability of the human papillomavirus (HPV) vaccine among parents of adolescents from culturally and linguistically diverse backgrounds in Australia. This study aimed to explore the knowledge and attitudes of parents from Arabic backgrounds towards HPV vaccination offered to their children in the national school-based vaccination program. Methods: Qualitative interviews were conducted in Western Sydney, with parents of adolescents from Arabic backgrounds. Recruitment was via informal personal contacts and passive snowballing. Face-to-face semi-structured interviews were conducted in Arabic. These were audio-recorded, transcribed, and translated into English. Thematic analysis was used to identify emerging themes. Results: Commonly identified themes across fifteen interviews included: (1) lack of awareness and knowledge of HPV and its vaccination, (2) awareness and understanding of the government vaccination information sheet, (3) parents’ preferences for information provision, (4) the role of parents’ religious beliefs in forming attitudes about HPV vaccination, and (5) lost opportunities to educate parents about HPV vaccination during general practitioner (GP) visits. Conclusion: The findings point to the need to address cultural, language, and communication barriers to improve awareness and acceptability of HPV vaccination in the Arabic community. Educational strategies should be tailored to this community based on their specific information needs and preferences.
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Affiliation(s)
- Faeza Netfa
- Discipline of Child and Adolescent Health, The University of Sydney Children’s Hospital Westmead Clinical School, Westmead, NSW 2145, Australia; (C.K.); (C.D.); (H.R.); (M.T.); (R.B.); (S.R.S.)
- Kids Research, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
- Correspondence: or ; Tel.: +61-2-9351-2222; Fax: +61-29845-1418
| | - Catherine King
- Discipline of Child and Adolescent Health, The University of Sydney Children’s Hospital Westmead Clinical School, Westmead, NSW 2145, Australia; (C.K.); (C.D.); (H.R.); (M.T.); (R.B.); (S.R.S.)
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Cristyn Davies
- Discipline of Child and Adolescent Health, The University of Sydney Children’s Hospital Westmead Clinical School, Westmead, NSW 2145, Australia; (C.K.); (C.D.); (H.R.); (M.T.); (R.B.); (S.R.S.)
- Kids Research, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Harunor Rashid
- Discipline of Child and Adolescent Health, The University of Sydney Children’s Hospital Westmead Clinical School, Westmead, NSW 2145, Australia; (C.K.); (C.D.); (H.R.); (M.T.); (R.B.); (S.R.S.)
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
| | - Mohamed Tashani
- Discipline of Child and Adolescent Health, The University of Sydney Children’s Hospital Westmead Clinical School, Westmead, NSW 2145, Australia; (C.K.); (C.D.); (H.R.); (M.T.); (R.B.); (S.R.S.)
- Faculty of Medicine, University of Tripoli, Tripoli 13275, Libya
| | - Robert Booy
- Discipline of Child and Adolescent Health, The University of Sydney Children’s Hospital Westmead Clinical School, Westmead, NSW 2145, Australia; (C.K.); (C.D.); (H.R.); (M.T.); (R.B.); (S.R.S.)
- National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
| | - S. Rachel Skinner
- Discipline of Child and Adolescent Health, The University of Sydney Children’s Hospital Westmead Clinical School, Westmead, NSW 2145, Australia; (C.K.); (C.D.); (H.R.); (M.T.); (R.B.); (S.R.S.)
- Kids Research, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
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27
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Scanlon B, Brough M, Wyld D, Durham J. Equity across the cancer care continuum for culturally and linguistically diverse migrants living in Australia: a scoping review. Global Health 2021; 17:87. [PMID: 34321015 PMCID: PMC8318324 DOI: 10.1186/s12992-021-00737-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/08/2021] [Indexed: 01/04/2023] Open
Abstract
International evidence suggests migrants experience inequitable access, outcomes and treatment quality across the cancer care continuum. There is currently limited research assessing equity across the cancer care continuum for culturally and linguistically diverse migrants living in Australia. A detailed protocol and search strategy were developed and used to identify all relevant literature, utilising the Joanna Briggs Institute Reviewer’s Manual. Systematic searching was conducted via multiple databases and identified studies were screened against pre-identified inclusion and exclusion criteria. 71 studies met the inclusion criteria for analysis. Most studies examined cancer detection via screening. Very few studies examined cancer prevention, diagnosis, treatment or palliative care. Most studies focused on patient-sided barriers to care and there was a paucity of information regarding institutional barriers to health. Cancer-related outcomes were seldom examined, and most studies were qualitative or behavioral analysis. Results highlighted significant communication issues spanning the cancer care continuum and a context of inadequate support for both patients and clinicians. There is a demonstrable need to examine equity in access and outcomes for culturally and linguistically diverse cancer populations. This requires the identification of cancer-related disparities and an examination of institutional barriers to care. Through addressing this dearth of information, future research and health policy can support the operationalisation of health equity.
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Affiliation(s)
- Brighid Scanlon
- Queensland University of Technology, 149 Victoria Park Road, QLD, 4059, Kelvin Grove, Australia. .,Royal Brisbane and Women's Hospital, Butterfield Street, QLD, 4029, Herston, Australia.
| | - Mark Brough
- Queensland University of Technology, 149 Victoria Park Road, QLD, 4059, Kelvin Grove, Australia
| | - David Wyld
- Queensland University of Technology, 149 Victoria Park Road, QLD, 4059, Kelvin Grove, Australia.,Royal Brisbane and Women's Hospital, Butterfield Street, QLD, 4029, Herston, Australia.,University of Queensland, 20 Weightman Street, QLD, 4006, Herston, Australia
| | - Jo Durham
- Queensland University of Technology, 149 Victoria Park Road, QLD, 4059, Kelvin Grove, Australia
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28
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Ngo P, Goldsbury DE, Karikios D, Yap S, Yap ML, Egger S, O'Connell DL, Ball D, Fong KM, Pavlakis N, Rankin NM, Vinod S, Canfell K, Weber MF. Lung cancer treatment patterns and factors relating to systemic therapy use in Australia. Asia Pac J Clin Oncol 2021; 18:e235-e246. [PMID: 34250751 DOI: 10.1111/ajco.13637] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 06/21/2021] [Indexed: 01/09/2023]
Abstract
AIM Systemic therapies for lung cancer are rapidly evolving. This study aimed to describe lung cancer treatment patterns in New South Wales, Australia, prior to the introduction of immunotherapy and latest-generation targeted therapies. METHODS Systemic therapy utilization and treatment-related factors were examined for participants in the New South Wales 45 and Up Study with incident lung cancer ascertained by record linkage to the New South Wales Cancer Registry (2006-2013). Systemic therapy receipt to June 2016 was determined using medical and pharmaceutical claims data from Services Australia, and in-patient hospital records. Factors related to treatment were identified using competing risks regressions. RESULTS A total of 1,116 lung cancer cases were identified with a mean age at diagnosis of 72 years and median survival of 10.6 months. Systemic therapy was received by 45% of cases. Among 400 cases with metastatic non-small cell lung cancer, 51% and 28% received first- and second-line systemic therapy, respectively. Among 112 diagnosed with small-cell lung cancer, 79% and 29% received first- and second-line systemic therapy. The incidence of systemic therapy was lower for participants with indicators of poor performance status, lower educational attainment, and those who lived in areas of socioeconomic disadvantage; and was higher for participants with small-cell lung cancer histology or higher body mass index. CONCLUSION This population-based Australian study identified patterns of systemic therapy use for lung cancer, particularly small-cell lung cancer. Despite a universal healthcare system, the analysis revealed socioeconomic disparities in health service utilization and relatively low utilization of systemic therapy overall.
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Affiliation(s)
- Preston Ngo
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, NSW, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - David E Goldsbury
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, NSW, Australia
| | - Deme Karikios
- Nepean Cancer Care Centre, Nepean Hospital, Penrith, NSW, Australia.,Nepean Clinical School, the University of Sydney, Sydney, NSW, Australia
| | - Sarsha Yap
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, NSW, Australia
| | - Mei Ling Yap
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, NSW, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute, Sydney, NSW, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia.,Macarthur Cancer Therapy Centre, Campbelltown Hospital, Campbelltown, NSW, Australia.,School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Sam Egger
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, NSW, Australia
| | - Dianne L O'Connell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, NSW, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, NSW, Australia
| | - David Ball
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia.,Department of Radiation Oncology Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Kwun M Fong
- UQ Thoracic Research Centre, The Prince Charles Hospital, University of Queensland, Brisbane, QLD, Australia.,Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, QLD, Australia
| | - Nick Pavlakis
- Northern Clinical School, The University of Sydney, Sydney, NSW, Australia.,Department of Medical Oncology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Nicole M Rankin
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Sydney Health Partners, The University of Sydney, Sydney, NSW, Australia
| | - Shalini Vinod
- Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW, Australia.,South Western Sydney Clinical School, University of NSW, Campbelltown, NSW, Australia
| | - Karen Canfell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, NSW, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
| | - Marianne F Weber
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, NSW, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
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29
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Chan RJ, Agbejule OA, Yates PM, Emery J, Jefford M, Koczwara B, Hart NH, Crichton M, Nekhlyudov L. Outcomes of cancer survivorship education and training for primary care providers: a systematic review. J Cancer Surviv 2021; 16:279-302. [PMID: 33763806 PMCID: PMC7990618 DOI: 10.1007/s11764-021-01018-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/05/2021] [Indexed: 12/30/2022]
Abstract
Purpose To identify published literature regarding cancer survivorship education programs for primary care providers (PCPs) and assess their outcomes. Methods PubMed, Embase, and CINAHL databases were searched between January 2005 and September 2020. The Quality of Cancer Survivorship Care Framework and Kirkpatrick’s 4-level evaluation model were used to summarize program content and outcomes, respectively. Data extraction and critical appraisal were conducted by two authors. Results Twenty-one studies were included, describing self-directed online courses (n=4), presentations (n=2), workshops and training sessions (n=6), placement programs (n=3), a live webinar, a fellowship program, a referral program, a survivorship conference, a dual in-person workshop and webinar, and an in-person seminar and online webinar series. Eight studies described the use of a learner framework or theory to guide program development. All 21 programs were generally beneficial to PCP learners (e.g., increased confidence, knowledge, behavior change); however, methodological bias suggests caution in accepting claims. Three studies reported positive outcomes at the patient level (i.e., satisfaction with care) and organizational level (i.e., increased screening referrals, changes to institution practice standards). Conclusions A range of cancer survivorship PCP education programs exist. Evidence for clinical effectiveness was rarely reported. Future educational programs should be tailored to PCPs, utilize an evidence-based survivorship framework, and evaluate patient- and system-level outcomes. Implications for Cancer Survivors PCPs have an important role in addressing the diverse health care needs of cancer survivors. Improving the content, approach, and evaluation of PCP-focused cancer survivorship education programs could have a positive impact on health outcomes among cancer survivors. Supplementary Information The online version contains supplementary material available at 10.1007/s11764-021-01018-6.
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Affiliation(s)
- Raymond J Chan
- Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, QLD, Australia. .,School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia. .,Division of Cancer Services, Princess Alexandra Hospital, Brisbane, QLD, Australia.
| | - Oluwaseyifunmi Andi Agbejule
- Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, QLD, Australia.,School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Patsy M Yates
- Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, QLD, Australia.,School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia.,Division of Cancer Services, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Jon Emery
- Centre for Cancer Research and Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Michael Jefford
- Centre for Cancer Research and Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.,Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Bogda Koczwara
- Flinders Center for Innovation in Cancer and Flinders Medical Centre, Flinders University, Adelaide, SA, Australia
| | - Nicolas H Hart
- Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, QLD, Australia.,School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia.,School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia.,Institute for Health Research, University of Notre Dame Australia, Perth, WA, Australia
| | - Megan Crichton
- Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, QLD, Australia.,School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Larissa Nekhlyudov
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Woodland L, Blignault I, O'Callaghan C, Harris-Roxas B. A framework for preferred practices in conducting culturally competent health research in a multicultural society. Health Res Policy Syst 2021; 19:24. [PMID: 33602261 PMCID: PMC7893969 DOI: 10.1186/s12961-020-00657-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 11/02/2020] [Indexed: 11/10/2022] Open
Abstract
Background Improving the health and well-being of the whole population requires that health inequities be addressed. In an era of unprecedented international migration, meeting the health care needs of growing multicultural or multiethnic societies presents major challenges for health care systems and for health researchers. Considerable literature exists on the methodological and ethical difficulties of conducting research in a cross-cultural context; however, there is a need for a framework to guide health research in multicultural societies. Methods The framework was informed by “research on research” that we have undertaken in community and primary health care settings in Sydney, Australia. Case studies are presented as illustrative examples. Results We present a framework for preferred practices in conducting health research that is culturally informed, high-quality, safe, and actionable. Conclusions The framework is not intended to be universal, however many of its aspects will have relevance for health research generally. Application of the framework for preferred practices could potentially make health research more culturally competent, thus enabling enhanced policies, programmes and practices to better meet population health needs. The framework needs to be further tested and refined in different contexts.
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Affiliation(s)
- Lisa Woodland
- Priority Populations, Population and Community Health, South Eastern Sydney Local Health District, 301 Forbes St, Darlinghurst, NSW, 2010, Australia. .,South Eastern Sydney Research Collaboration Hub, Centre for Primary Health Care and Equity, University of NSW, Level 3, AGSM Building, UNSW, Sydney, NSW, 2052, Australia.
| | - Ilse Blignault
- Translational Health Research Institute, School of Medicine, Western Sydney University, Translational Health Research Institute, Building 3, David Pilgrim Avenue, Campbelltown, NSW, 2560, Australia
| | - Cathy O'Callaghan
- South Eastern Sydney Research Collaboration Hub, Centre for Primary Health Care and Equity, University of NSW, Level 3, AGSM Building, UNSW, Sydney, NSW, 2052, Australia
| | - Ben Harris-Roxas
- Priority Populations, Population and Community Health, South Eastern Sydney Local Health District, 301 Forbes St, Darlinghurst, NSW, 2010, Australia.,Population and Community Health, South Eastern Sydney Local Health District, 301 Forbes St, Darlinghurst NSW 2010, Sydney, NSW, 2010, Australia
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Smith AB, Niu AY, Descallar J, Delaney GP, Wu VS, Agar MR, Girgis A. Clinical trials knowledge and attitudes of Vietnamese- and Anglo-Australian cancer patients: A cross-sectional study. Asia Pac J Clin Oncol 2020; 16:e242-e251. [PMID: 32779349 DOI: 10.1111/ajco.13388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/13/2020] [Indexed: 11/27/2022]
Abstract
AIM Low participation in cancer clinical trials by culturally and linguistically diverse (CALD) patients limits access to cutting-edge treatments and generalizability of results. This is the first study exploring trials knowledge/attitudes and their association with trial participation in Vietnamese- and Anglo-Australian cancer patients. METHODS Eligible patients diagnosed with cancer in the past 10 years were invited to complete a self-report questionnaire comprising validated measures of: trials knowledge and attitudes, preferred information amount, preferred decision-making involvement, health literacy, and past and future (i.e. hypothetical) trial participation. Multivariable linear regression evaluated correlates of trials knowledge/attitudes. Multinomial logistic regression estimated the relationship between trials knowledge/attitudes and possible future trial participation. RESULTS Vietnamese-Australian participants (n = 50) had more negative attitudes regarding trials than Anglo-Australians (n = 100; B = -9.28; 95% confidence interval [CI], -17.60 to -0.97; P = 0.029), but similar knowledge (B = -0.91; 95% CI, -2.27 to 0.44; P = 0.18). Future trial participation was associated with positive attitudes (odds ratio [OR] = 1.08; 95% CI, 1.04-1.12; P < 0.001) and greater knowledge (OR = 1.30; 95% CI, 1.04-1.62; P = 0.02), but not Vietnamese background (OR = 0.95; 95% CI, 0.27-3.32; P = 0.93). CONCLUSION Despite poorer attitudes regarding trials in Vietnamese-Australians, Vietnamese background was not associated with less likely future trial participation, suggesting low trial participation by CALD patients may be more due to opportunity barriers. Improving knowledge and attitudes may increase trial participation generally.
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Affiliation(s)
- Allan B Smith
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Liverpool, NSW, Australia
| | - Anita Y Niu
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Liverpool, NSW, Australia
| | - Joseph Descallar
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Liverpool, NSW, Australia
| | - Geoff P Delaney
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Liverpool, NSW, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Verena S Wu
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Liverpool, NSW, Australia
| | - Meera R Agar
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Liverpool, NSW, Australia.,Liverpool Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW, Australia.,Clinical Trials Unit, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Afaf Girgis
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, Liverpool, NSW, Australia
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Feijoo-Cid M, Rivero-Santana A, Moriña D, Cesar C, Fink V, Sued O. Decision-making in HIV clinical trials: a study with patients enrolled in antiretroviral trials. GACETA SANITARIA 2020; 35:264-269. [PMID: 32197784 DOI: 10.1016/j.gaceta.2019.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/20/2019] [Accepted: 11/27/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To explore the decisional process of people living with human immunodeficiency virus (HIV) currently enrolled in antiretroviral clinical trials. METHOD Cross-sectional retrospective study. Outcome variables were reasons to participate, perceived decisional role (Control Preference Scale), the Decisional Conflict Scale and the Decisional Regret Scale. Descriptive statistics were calculated, and associations among these variables and with sociodemographic and clinical characteristics were analyzed with non-parametric techniques. RESULTS Main reasons to participate were gratitude towards Fundación Huesped (47%), the doctor's recommendation (32%), and perceived difficulty to access treatment in a public hospital (28%). Most patients thought that they made their decision alone (54.8%) or collaboratively with the physician (43%). Decisional conflict was low, with only some conflict in the support subscale (median=16.67). Education was the only significant correlate of the total decisional conflict score (higher in less educated patients; p=0.018), whereas education, recent diagnosis, living alone, lower age, being man and doctor's recommendation to go to Fundación Huésped related to higher conflict in different subscales. Nobody regretted to participate. CONCLUSIONS The decision making regarding participation in HIV trials, from the perspective of participants, was made respecting their autonomy and with very low decisional conflict. Currently, patients show no signs of regret. However, even in this favorable context, results highlight the necessity of enhancing the decision support in more vulnerable patients (e.g., less educated, recently diagnosed or with less social support), thus warranting equity in the quality of the decision making process.
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Affiliation(s)
- Maria Feijoo-Cid
- Department of Nursing, Faculty of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; Grup de REcerca Multidisciplinar en SAlut i Societat (GREMSAS) (2017 SGR 917), Spain
| | - Amado Rivero-Santana
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Santa Cruz de Tenerife, Las Palmas de Gran Canaria, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.
| | - David Moriña
- Barcelona Graduate School of Mathematics (BGSMath), Bellaterra, Cerdanyola del Vallès, Barcelona, Spain; Departament de Matemàtiques, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Omar Sued
- Fundación Huésped, Buenos Aires, Argentina
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Regnante JM, Richie N, Fashoyin-Aje L, Hall LL, Highsmith Q, Louis J, Turner K, Hoover S, Lee SC, González E, Williams E, Adams H, Obasaju C, Sargeant I, Spinner J, Reddick C, Gandee M, Geday M, Dang J, Watson R, Chen MS. Operational strategies in US cancer centers of excellence that support the successful accrual of racial and ethnic minorities in clinical trials. Contemp Clin Trials Commun 2020; 17:100532. [PMID: 32055746 PMCID: PMC7005557 DOI: 10.1016/j.conctc.2020.100532] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 01/09/2020] [Accepted: 01/19/2020] [Indexed: 12/17/2022] Open
Abstract
Background Study populations in clinical research must reflect US changing demographics, especially with the rise of precision medicine. However, racial and ethnic minority groups (REMGs) have low rates of participation in cancer clinical trials. Methods Criteria were developed to identify cancer centers able to accrue a higher than average proportion of REMGs into clinical trials. Comprehensive interviews were conducted with leaders of these cancer centers to identify operational strategies contributing to enhanced accrual of REMGs. Results Eight US cancer centers reported a REMG accrual rate range in cancer research between 10 and 50% in a 12-month reporting period and met other criteria for inclusion. Fourteen leaders participated in this assessment. Key findings were that centers: had a metric collection and reporting approach; routinely captured race and ethnicity data within databases accessible to research staff; had operational standards to support access and inclusion; developed practices to facilitate sustained patient participation during clinical trials; had strategies to decrease recruitment time and optimize clinical study design; and identified low-resource strategies for REMG accrual. There was also a clear commitment to establish processes that support the patient's provider as the key influencer of patient recruitment into clinical trials. Conclusion We have identified operational practices that facilitate increased inclusion of REMGs in cancer trials. In order to establish a sustainable cancer center inclusion research strategy, it is valuable to include an operational framework that is informed by leading US cancer centers of excellence.
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Affiliation(s)
- Jeanne M Regnante
- Center for Sustainable Health Care Quality and Equity, 1201 15th Street, NW, Suite 340, Washington, DC, 20005, USA
| | - Nicole Richie
- Genentech, 1 DNA Way, South San Francisco, 94080, USA
| | - Lola Fashoyin-Aje
- Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD, 20993, USA
| | - Laura Lee Hall
- Center for Sustainable Health Care Quality and Equity, 1201 15th Street, NW, Suite 340, Washington, DC, 20024, USA
| | | | - J'Aimee Louis
- Center for Sustainable Health Care Quality and Equity, 1201 15th Street, NW, Suite 340, Washington, DC, 20024, USA
| | - Kenneth Turner
- Johnson & Johnson, One Johnson & Johnson Plaza, New Brunswick, NJ, 08933, USA
| | - Spencer Hoover
- Henry Ford Cancer Institute, 2850 W. Grand Blvd, Detroit, MI, 48202, Ste 2, USA
| | - Simon Craddock Lee
- Harold C. Simmons Comprehensive Cancer Center, Ut Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9179, USA
| | - Evelyn González
- Fox Chase Cancer Center/Temple Health, 333 Cottman Ave, Philadephia, PA, 19111, USA
| | - Erin Williams
- Harold C. Simmons Comprehensive Cancer Center, Ut Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9179, USA
| | - Homer Adams
- Janssen Research and Development, 800 Ridgeview Drive, Horsham PA, USA
| | - Coleman Obasaju
- Eli Lilly and Company, 893 S Delaware St, Indianapolis, IN, 46225, USA
| | - Ify Sargeant
- Ismedica Ltd, Wrinehill, Staffordshire, CW3 9BW, UK
| | - Jovonni Spinner
- Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD, 20993, USA
| | - Christopher Reddick
- Takeda Pharmaceutical Company, One Takeda Parkway, Deerfield, IL, 60015, USA
| | - Marianne Gandee
- Association of Community Cancer Centers, 11600 Nebel St. Suite 201. Rockville, MD, 20852, USA
| | - Madeline Geday
- Merck & Company, Inc, Merck and Co., Inc, 2000 Galloping Hill Road, Kenilworth, NJ, 07033, USA
| | - Julie Dang
- UC Davis Comprehensive Cancer Center, UCDCCC, 2279 45th St, Sacramento, CA, 95817, USA
| | - Rayneisha Watson
- Deloitte Consulting, 1919 N Lynn St Ste 1500, Arlington, VA, 22209, USA
| | - Moon S Chen
- Uc Davis Comprehensive Cancer Center, UCDCCC, 4501 X Street, Suite 3016, Sacramento, CA, 95817, USA
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Russell L, Ugalde A, White V, Pitcher M, Jorgenssen S, Whitfield K, Rasmussen B, Livingston P. Relevance of mindfulness practices for culturally and linguistically diverse cancer populations. Psychooncology 2019; 28:2250-2252. [PMID: 31487412 DOI: 10.1002/pon.5221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/15/2019] [Accepted: 09/01/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Lahiru Russell
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Anna Ugalde
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Vicki White
- School of Psychology, Faculty of Health, Deakin University, Burwood, Victoria, Australia.,Cancer Information and Support Services, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Meron Pitcher
- Breast Unit, Western Health Hospital, Melbourne, Victoria, Australia
| | - Sara Jorgenssen
- Breast Unit, Western Health Hospital, Melbourne, Victoria, Australia
| | - Kathryn Whitfield
- Department of Health and Human Services, Melbourne, Victoria, Australia
| | - Bodil Rasmussen
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Patricia Livingston
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Burwood, Victoria, Australia
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Understanding patient choices regarding breast reconstruction after mastectomy for breast cancer. Support Care Cancer 2018; 27:2135-2142. [PMID: 30251065 DOI: 10.1007/s00520-018-4470-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE In Australia, about 40% of patients undergo mastectomy to treat breast cancer, with negative impacts on body image, sexual function and quality of life. Whilst breast reconstruction is associated with increased patient self-esteem and a greater sense of wholeness and well-being, the national reconstruction rate is low at 18%. This study aimed to compare demographics, treatment factors and information provision about breast reconstruction in women who had and did not have breast reconstruction following mastectomy treatment and identify goals and concerns underpinning women's reconstruction decisions. METHODS Female patients who had a mastectomy to treat breast cancer between 2010 and 2014 in a culturally and linguistically diverse (CALD) and socially disadvantaged region participated in a cross-sectional study, completing a questionnaire in their language of choice (English, Vietnamese, Chinese or Arabic). RESULTS Completed surveys were returned by 168 women (42% response rate; 77% English-speaking), of whom only 19.0% (n = 32) reported having had breast reconstruction. Reconstruction rates were significantly lower in women who reported speaking a language other than English at home versus only English (37.5% vs 62.5%, p = 0.03). However, all women expressed a desire for more information about breast reconstruction and more support to make their decision about breast reconstruction. CONCLUSIONS Patients identified a need for greater information provision on breast reconstruction, highlighting an urgent need for resources specifically about breast reconstruction, particularly for non-English-speaking patients. Greater provision of information prior to mastectomy is critical to underpin breast cancer patients' decisions about breast reconstruction, especially for non-English speaking patients.
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