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Rieder SM, Burgess E, Rutledge T, Sussman A, Boyce T, Pankratz VS, Kano M. Critical decisions: A mixed-methods study of decision-making among diverse gynecologic cancer patients considering therapeutic clinical trial enrollment. Gynecol Oncol 2024; 184:103-110. [PMID: 38301308 DOI: 10.1016/j.ygyno.2024.01.031] [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: 09/29/2023] [Revised: 01/16/2024] [Accepted: 01/20/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE Participation in therapeutic clinical trials does not reflect the diversity of gynecologic cancer patients, limiting access to novel therapeutics and generalizability of results. Reasons for inequities in participation among historically underrepresented populations remain undertheorized, as studies have shown equal willingness to participate among groups. We sought to apply a precarity framework to conceptualize the factors that impact patients' desire to enroll, to improve equity in gynecologic oncology clinical trial participation. METHODS Gynecologic cancer patients at a single tertiary care facility in the Southwestern United States who discussed participation in therapeutic clinical trial with their oncology provider from 2020 to 2021 were identified. Enrolled participants completed surveys and qualitative interviews regarding treatment experiences and decision-making. Oncology providers completed parallel surveys at the time of their patient's enrollment. Descriptive statistics and thematic coding were used to analyze data. RESULTS 30 patients were enrolled and participated in surveys and interviews. No differences were found in quantitative data assessing shared decision-making and patient-centered communication between those who enrolled and those who did not. Qualitative data demonstrated that patients who declined trial enrollment expressed concerns regarding uncertainty and loss of control, independence in decision-making, and significant resource challenges and financial toxicity of cancer treatment. CONCLUSIONS We identified a constellation of factors that contribute to desire to enroll in clinical trials, that we describe using the framework of precarity. Through identification of precarious patients and mitigation of burdens, we anticipate improved enrollment and retention in therapeutic clinical trials among diverse gynecologic oncology patients.
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Affiliation(s)
- Stephanie Margrit Rieder
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA; Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM, USA.
| | - Ellen Burgess
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Teresa Rutledge
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA; Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Andrew Sussman
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA; Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Tawny Boyce
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | | | - Miria Kano
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA; Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
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Warner E, Marron JM, Peppercorn JM, Abel GA, Hantel A. Shifting from Equality toward Equity: Addressing Disparities in Research Participation for Clinical Cancer Research. THE JOURNAL OF CLINICAL ETHICS 2024; 35:8-22. [PMID: 38373334 PMCID: PMC10983799 DOI: 10.1086/728144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
AbstractThere is societal consensus that cancer clinical trial participation is unjust because some sociodemographic groups have been systematically underrepresented. Despite this, neither a definition nor an ethical explication for the justice norm of equity has been clearly articulated in this setting, leading to confusion over its application and goals. Herein we define equity as acknowledging sociodemographic circumstances and apportioning resource and opportunity allocation to eliminate disparities in outcomes, and we explore the issues and tensions this norm generates through practical examples. We assess how equality-based enrollment structures in clinical cancer research have perpetuated historical disparities and what equity-based alternatives are necessary to achieve representativeness and an expansive conception of participatory justice in clinical cancer research. This framework addresses the breadth from normative to applied by defining the justice norm of equity and translating it into practical strategies for addressing participation disparities in clinical cancer research.
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Bright K. Understanding system barriers and facilitators in transnational clinical cancer research: The value of rapid and multimodal ethnographic inquiry. FRONTIERS IN SOCIOLOGY 2022; 7:991183. [PMID: 36530449 PMCID: PMC9751659 DOI: 10.3389/fsoc.2022.991183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/16/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION In middle and low resource countries worldwide, up to 70% of breast cancer cases are diagnosed as locally advanced (stages IIB-IIIC). Delays in referral from primary to specialty care have been shown to prolong routes to diagnosis and may be associated with higher burdens of advanced disease, but specific clinical and organizational barriers are not well understood. METHODS This article reports on the use of rapid ethnographic research (RER) within a largescale clinical trial for locally advanced breast cancer (LABC) in India, Mexico, South Africa, and the US. Our purpose is twofold. First, we demonstrate the value of ethnography as a mode of evaluative listening: appraising the perspectives of diverse patients and clinicians regarding prolonged routes to LABC diagnosis and treatment. Second, we show the value of ethnography as a compass for navigating among discrepant clinical research styles, IRB protocols, and institutional norms and practices. We discuss advantages and limits involved in each use of RER. RESULTS On the one hand, ethnographic interviews carried out before and during the clinical trial enabled more regular communication among investigators and research sites. On the other hand, the logistics of doing the trial placed limits on the extent and duration of inductive, immersive inquiry characteristic of traditional fieldwork. As a partial solution to this problem, we developed a multimodal ethnographic research (MER) approach, an augmentation of video-chat, phone, text, and email carried out with, and built upon the initial connections established in, the in-person fieldwork. This style has its limits; but it did allow us to materially improve the ways in which the medical research proceeded. DISCUSSION In conclusion, we highlight the value of not deferring to a presumed incommensurability of ethnographic fieldwork and clinical trialwork while still being appropriately responsive to moments when the two approaches should be kept apart.
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Affiliation(s)
- Kristin Bright
- Department of Anthropology, Middlebury College, Middlebury, VT, United States
- Department of Anthropology, University of Toronto, Toronto, ON, Canada
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4
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Rocque GB, Andrews C, Lawhon VM, Ingram SA, Frazier RM, Smith ML, Wagner LI, Zubkoff L, Wallner LP, Wolff AC. Physician Perspectives on Reducing Curative Cancer Treatment Intensity for Populations Underrepresented in Clinical Trials. Oncologist 2022; 27:1067-1073. [PMID: 36215065 PMCID: PMC9732232 DOI: 10.1093/oncolo/oyac191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Historically, clinical trials involved adding novel agents to standard of care to improve survival. There has been a shift to an individualized approach with testing less intense treatment, particularly in breast cancer where risk of recurrence is low. Little is known about physician perspectives on delivering less intense treatment for patients who are not well represented in clinical trials. METHODS Open-ended, individual qualitative interviews with medical oncologists explored their perspectives on trials that test less intense treatment for patients with cancer, with a focus on breast cancer. Interviews were audio-recorded and transcribed. Four independent coders utilized a content analysis approach to analyze transcripts using NVivo. Major themes and exemplary quotes were extracted. RESULTS Of the 39 participating physicians, 61.5% felt comfortable extrapolating, 30.8% were hesitant, and 7.7% would not feel comfortable extrapolating trial outcomes to underrepresented populations. Facilitators of comfort included the sentiment that "biology is biology" (such that the cancer characteristics were what mattered), the strength of the evidence, inclusion of subset analysis on underrepresented populations, and prior experience making decisions with limited data. Barriers to extrapolation included potential harm over the patient's lifetime, concerns about groups that had minimal participants, application to younger patients, and extending findings to diverse populations. Universally, broader inclusion in trials testing lowering chemotherapy was desired. CONCLUSIONS The majority (92%) of physicians reported that they would de-implement treatment for patients poorly represented in clinical trials testing less treatment, while expressing concerns about applicability to specific subpopulations. Further work is needed to increase clinical trial representation of diverse populations to safely and effectively optimize treatment for patients with cancer. TRIAL REGISTRATION NCT03248258.
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Affiliation(s)
- Gabrielle B Rocque
- Corresponding author: Gabrielle B. Rocque, MD, MSPH, The University of Alabama at Birmingham, WTI 240E, Birmingham, AL 35294, USA. Tel: +1 205 975 2914;
| | - Courtney Andrews
- Institute for Human Rights, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Valerie M Lawhon
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stacey A Ingram
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rachel M Frazier
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Lisa Zubkoff
- O’Neal Comprehensive Cancer Center, Birmingham, AL, USA,Division of Preventive Medicine, , Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA,Birmingham/Atlanta Geriatric Research Education and Clinical Center (GRECC), Birmingham VA Healthcare System, Birmingham, AL, USA
| | - Lauren P Wallner
- Rogel Cancer Center, Departments of Internal Medicine and Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Antonio C Wolff
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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5
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Shim JK, Bentz M, Vasquez E, Jeske M, Saperstein A, Fullerton SM, Foti N, McMahon C, Lee SSJ. Strategies of inclusion: The tradeoffs of pursuing "baked in" diversity through place-based recruitment. Soc Sci Med 2022; 306:115132. [PMID: 35728460 DOI: 10.1016/j.socscimed.2022.115132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/17/2022] [Accepted: 06/10/2022] [Indexed: 10/18/2022]
Abstract
US funding agencies have begun to institutionalize expectations that biomedical studies achieve defined thresholds for diversity among research participants, including in precision medicine research (PMR). In this paper, we examine how practices of recruitment have unfolded in the wake of these diversity mandates. We find that a very common approach to seeking diverse participants leverages understandings of spatial, geographic, and site diversity as proxies and access points for participant diversity. That is, PMR investigators recruit from a diverse sampling of geographic areas, neighborhoods, sites, and institutional settings as both opportunistic but also meaningful ways to "bake in" participant diversity. In this way, logics of geographic and institutional diversity shift the question from who to recruit, to where. However, despite seeing geographic and site diversity as social and scientific 'goods' in the abstract and as key to getting diverse participants, PMR teams told us that working with diverse sites was often difficult in practice due to constraints in funding, time, and personnel, and inadequate research infrastructures and capacity. Thus, the ways in which these geographic and institutional diversity strategies were implemented resulted ultimately in limiting the meaningful inclusion of populations and organizations that had not previously participated in biomedical research and reproduced the inclusion of institutions that are already represented. These prevailing assumptions about and practices of "baked-in" diversity in fact exacerbate and produce other forms of inequity, in research capacity and research representation. These findings underscore how structural inequities in research resources must be addressed for diversity to be achieved in both research sites and research participants.
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Affiliation(s)
- Janet K Shim
- Department of Social and Behavioral Sciences, University of California, San Francisco, USA.
| | - Michael Bentz
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, USA
| | - Emily Vasquez
- Department of Sociology, University of Illinois-Chicago, USA
| | - Melanie Jeske
- Institute on the Formation of Knowledge, University of Chicago, USA
| | | | - Stephanie M Fullerton
- Department of Bioethics & Humanities, School of Medicine, University of Washington, USA
| | - Nicole Foti
- Department of Social and Behavioral Sciences, University of California, San Francisco, USA
| | - Caitlin McMahon
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, USA
| | - Sandra Soo-Jin Lee
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, USA
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6
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Borno HT, Zhang L, Zhang S, Kaplan C, Palmer NR, Bell A, Bakke B, Lin A, Aggarwal R, Small EJ. Mobile Clinical Trial Matching Technology in Medical Oncology Clinic: A Pilot Feasibility Study. JCO Clin Cancer Inform 2022; 6:e2100182. [PMID: 35584338 PMCID: PMC9173564 DOI: 10.1200/cci.21.00182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The internet is a common source of health information for patients and can be leveraged to provide patient-facing clinical trial information. This pilot study integrated an online prostate cancer clinical trial matching technology, called Trial Library (TL), in an academic medical oncology clinic from February 2019 to April 2021.
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Affiliation(s)
- Hala T Borno
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA.,Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Li Zhang
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA.,Department of Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Sylvia Zhang
- Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Celia Kaplan
- Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA
| | - Nynikka R Palmer
- Helen Diller Family Comprehensive Cancer Center, San Francisco, CA.,Department of Urology, University of California, San Francisco, San Francisco, CA.,Division of General Internal Medicine at Zuckerberg San Francisco General, San Francisco, CA
| | - Alexander Bell
- School of Medicine, University of California, San Francisco, San Francisco, CA
| | - Brian Bakke
- School of Medicine, University of California, San Francisco, San Francisco, CA
| | - Amy Lin
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA.,Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Rahul Aggarwal
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA.,Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Eric J Small
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA.,Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
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Besle S, Sarradon-Eck A. Chronicity and the patient's decision-making work. The case of an advanced cancer patient. Anthropol Med 2022; 29:76-91. [PMID: 35306943 DOI: 10.1080/13648470.2022.2041546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
This paper focuses on the particular situation of an advanced cancer patient whose condition has taken a chronic turn. We argue that chronicity of this kind sometimes falls at the frontier of Evidence Based Medicine because the uncertainty about the patient's condition can lead physicians to resort to clinical trials or non-licensed drugs to prevent the disease from progressing. This situation leaves plenty of scope for individual adjustments between patients and their doctors. Advanced cancer is regarded here not just as a biological event but as a chronic illness and a 'negotiated reality'. We argue that the chronicity of advanced cancer patients' situation broadens the patients' scope for 'work', and we have called this specific type of patient's work 'decision-making work'. This paper is based on a case study focusing on Patrick, a middle-aged Frenchman with metastatic lung cancer who underwent oncological treatment for seven years and was strongly determined to find new therapeutic options even if this meant having to go abroad. He actively orchestrated his therapeutic itinerary by reorganising his relationships with the medical world and coordinating the physicians' work. His particular social position enabled Patrick to bypass some of the current medical rules and to reorganise the usual pattern of distribution of medical responsibilities. The chronicity of his condition placed him at the very frontier of the health care system.
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Affiliation(s)
- Sylvain Besle
- Universite Claude Bernard Lyon, Villeurbanne, France.,Human and Social Sciences Department, Centre Léon Bérard, Lyon, France
| | - Aline Sarradon-Eck
- SESSTIM UMR 1252, CANBIOS, Marseille, France.,Paoli-Calmettes Institute, Marseille, France
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8
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Borno HT, Zhang L, Zhang S, Lin TK, Skafel A, Nieves E, Dornsife D, Johnson R, Rhoads K, Small E, Spicer D. Implementation of a Multisite Financial Reimbursement Program in Cancer Clinical Trials Integrated With Patient Navigation: A Pilot Randomized Clinical Trial. JCO Oncol Pract 2022; 18:e915-e924. [PMID: 35196064 PMCID: PMC9191303 DOI: 10.1200/op.21.00328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE: Cancer clinical trial participants face considerable indirect costs associated with participation, such as travel and lodging, which may contribute to poor enrollment. Here, we report the findings in IMproving Patient Access to Cancer clinical Trials, a pilot feasibility study investigating the efficacy of offering a financial reimbursement program (FRP) during a therapeutic clinical trial discussion with or without additional outreach in improving patient enrollment. METHODS: Study participants for this study were recruited at two National Cancer Institute–designated comprehensive cancer centers (CCCs) from April 8, 2019, to September 19, 2019. Eligible participants were adults with a cancer diagnosis being approached to consider enrollment in a clinical trial. Participants were randomly assigned 1:1 to receive no follow-up (usual care) or a follow-up telephone call to facilitate FRP utilization stratified by study site. The target enrollment was 132 patients, with 66 patients in each study arm. The primary outcome was the consent rate to the multisite interventional study on the FRP among participants enrolling in clinical trials. RESULTS: The study had a 78% consent rate and enrolled a total of 132 participants, of whom 51% were non-White compared with 28% of CCC treatment clinical trial participants in 2019. No difference in enrollment in clinical trials between the two study arms was observed as the proportion of enrollment was 70% for both study arms. The most common reason for not enrolling in a clinical trial was due to ineligibility determined through screening procedures (75%). CONCLUSION: The current study observed that implementation of FRP at CCCs is feasible and serves a diverse patient population. Future studies will measure the impact of programs on overall clinical trial accrual and among racial/ethnic minorities.
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Affiliation(s)
- Hala T Borno
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA.,Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Li Zhang
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA.,Helen Diller Family Comprehensive Cancer Center, San Francisco, CA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Sylvia Zhang
- Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Tracy K Lin
- Helen Diller Family Comprehensive Cancer Center, San Francisco, CA.,Department of Social and Behavioral Sciences, Institute of for Health and Aging, University of California, San Francisco, San Francisco, CA
| | - Andrea Skafel
- Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Elena Nieves
- Division of Oncology, Department of Medicine, University of Southern California, Los Angeles, CA
| | | | | | - Kim Rhoads
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA.,Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Eric Small
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA.,Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Darcy Spicer
- Division of Oncology, Department of Medicine, University of Southern California, Los Angeles, CA
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9
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Accelerating cancer clinical trial recruitment through a financial reimbursement program integrated with patient navigation: an interrupted time series analysis. J Cancer Policy 2021; 30:100305. [DOI: 10.1016/j.jcpo.2021.100305] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 08/27/2021] [Accepted: 08/31/2021] [Indexed: 11/21/2022]
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10
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Bogicevic I, Svendsen MN. Taming Time: Configuring Cancer Patients as Research Subjects. Med Anthropol Q 2021; 35:386-401. [PMID: 33866608 DOI: 10.1111/maq.12647] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/17/2021] [Accepted: 03/25/2021] [Indexed: 11/30/2022]
Abstract
This article explores how incurable cancer patients in the affluent Danish welfare state are recruited to clinical trials. We show that patients' impending death constitutes their potential for being configured as research subjects. To produce valuable data, patients who enroll in trials and health care professionals must engage in daily "time practices" that prolong the threshold between life and death. When death becomes inevitable, the limit of configuring dying cancer patients as research subjects is reached. Navigating this temporal logic, health care professionals balance the boundary between patients' instrumental worth as research subjects and their intrinsic worth as dying cancer patients. Whereas previous studies have critically uncovered how clinical trials operate at socioeconomic margins, we point to the ways in which clinical trials operate through temporal margins. We argue that clinical trials are dependent on configuring marginal societal spaces and marginal bodies from which to produce knowledge.
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11
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Fayanju OM, Ren Y, Thomas SM, Greenup RA, Hyslop T, Hwang ES, Stewart JH. A Case-Control Study Examining Disparities in Clinical Trial Participation Among Breast Surgical Oncology Patients. JNCI Cancer Spectr 2020; 4:pkz103. [PMID: 32211583 PMCID: PMC7083236 DOI: 10.1093/jncics/pkz103] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 11/07/2019] [Accepted: 12/01/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Clinical trial participation among racial and ethnic minorities remains low despite national efforts. We sought to determine how participation in clinical trials by breast surgical oncology patients has changed over time and what characteristics are associated with participation. METHODS Women with breast cancer enrolled in National Cancer Institute-sponsored, cooperative-group trials from 2000 to 2012 and who underwent oncologic surgery (n = 17 125) were compared with trial-eligible women in the National Cancer Database diagnosed in 2000-2012 (n = 792 719). Race-specific trial participation was plotted over time by income and reported as a proportion of the combined cohorts. Factors associated with trial participation were estimated using logistic regression; we report odds ratios (ORs) with 95% confidence intervals (CIs). A P value less than .05 was considered statistically significant for all analyses. All tests were two-sided. RESULTS Participation declined across all groups over time because of a decrease in the scale and number of trials. In 2000-2003, Asian-Pacific Islander (7.17%), Hispanic (3.48%), and white (7.13%) patients from the highest income group had higher participation than their lower-income counterparts (Asian-Pacific Islander: 3.95%; Hispanic: 2.67%; white: 5.96%), but by 2008-2012, only high-income white patients participated more than lower-income whites (0.32% vs 0.25%, all P < .01). Black (OR = 0.80, 95% CI = 0.75 to 0.85) and Hispanic (OR = 0.84, 95% CI = 0.77 to 0.92) patients were less likely to participate than whites, but there were statistically significant interactions between income and race and ethnicity, with high-income black patients being approximately 50% less likely to participate than lower-income blacks (all P < .001). CONCLUSIONS Multifaceted interventions addressing the intersectionality of race, ethnicity, and other patient characteristics are needed to address persistent disparities in trial participation among breast surgical oncology patients.
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Affiliation(s)
- Oluwadamilola M Fayanju
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
- Women’s Cancer Program, Duke Cancer Institute, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Forge, Duke University, Durham, NC, USA
- Department of Surgery, Durham VA Medical Center, Durham, NC, USA
| | - Yi Ren
- Biostatistics Shared Resource, Duke Cancer Institute, Durham, NC, USA
| | - Samantha M Thomas
- Biostatistics Shared Resource, Duke Cancer Institute, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Rachel A Greenup
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
- Women’s Cancer Program, Duke Cancer Institute, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Terry Hyslop
- Biostatistics Shared Resource, Duke Cancer Institute, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - E Shelley Hwang
- Department of Surgery, Duke University School of Medicine, Durham, NC, USA
- Women’s Cancer Program, Duke Cancer Institute, Durham, NC, USA
| | - John H Stewart
- Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
- Department of Surgery, University of Illinois Cancer Center, Chicago, IL, USA
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12
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Hart RI, Hallowell N, Harden J, Jesudason AB, Lawton J. Clinician-researchers and custodians of scarce resources: a qualitative study of health professionals' views on barriers to the involvement of teenagers and young adults in cancer trials. Trials 2020; 21:67. [PMID: 31924260 PMCID: PMC6954521 DOI: 10.1186/s13063-019-3942-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 11/28/2019] [Indexed: 12/15/2022] Open
Abstract
Background Equipoise and role conflict have been previously identified as important factors in professionals’ engagement with trials, inducing behaviours which can impact on recruitment. We explored these phenomena as potential explanations for the low levels of involvement of teenagers and young adults (TYA) with cancer in clinical trials in oncology. Methods We report findings from interviews with 30 purposively sampled direct-care professionals involved in delivering cancer care and/or facilitating clinical trials in Scotland. We undertook qualitative descriptive analysis, focussed on identifying key issues and themes. Results Interviewees largely identified as clinician–researchers and portrayed oncology as a specialty in which research was integral to care. They saw their primary responsibility as ensuring patients received the best treatment, but asserted that, in general, trials provided a vehicle for optimal care. Role conflict in its traditional form was rarely evident; however, other tensions were manifest. Professionals found the significant time costs of delivering trials difficult to reconcile with the increasing pressures on clinical services. They felt a responsibility to make prudent choices about the trials with which to engage. Guided by utilitarian principles, these choices were oriented towards benefiting the largest number of patients. This favoured trials in high volume diseases; as TYA tend to have rarer forms of cancer, professionals’ support for—and TYA’s access to—relevant trials was, by default, more limited. Conclusions Neither lack of individual equipoise nor experiences of traditional forms of role conflict accounted for the low levels of involvement of TYA with cancer in clinical trials. However, prominent tensions around the management of scarce resources provided an alternative explanation for TYA’s limited access to cancer trials. The prevailing approach to decision-making about whether and which trials to support was recognised as contributing to inequalities in access and care. Professionals’ choices, however, were made in the context of scarcity, and structured by incentives and sanctions understood by them as signalling governmental priorities. A franker discussion of the extent and distribution of the costs and benefits of trials work is needed, for change to be achieved.
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Affiliation(s)
- Ruth I Hart
- Usher Institute, University of Edinburgh, Edinburgh, EH8 9AG, UK.
| | - Nina Hallowell
- Wellcome Centre for Ethics and Humanities and Ethox Centre, Nuffield Department of Population Health, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, OX3 7LF, UK
| | - Jeni Harden
- Usher Institute, University of Edinburgh, Edinburgh, EH8 9AG, UK
| | - Angela B Jesudason
- Royal Hospital for Sick Children, Department of Paediatric Haematology and Oncology, Sciennes Road, Edinburgh, EH9 1LF, UK
| | - Julia Lawton
- Usher Institute, University of Edinburgh, Edinburgh, EH8 9AG, UK
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13
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Borno HT, Bakke BM, Kaplan C, Hebig-Prophet A, Chao J, Kim YJ, Yeager J, Cinar P, Small E, Boscardin C, Gonzales R. A step towards equitable clinical trial recruitment: a protocol for the development and preliminary testing of an online prostate cancer health information and clinical trial matching tool. Pilot Feasibility Stud 2019; 5:123. [PMID: 31720002 PMCID: PMC6839161 DOI: 10.1186/s40814-019-0516-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 10/15/2019] [Indexed: 12/20/2022] Open
Abstract
Background Recruitment of a diverse participant pool to cancer clinical trials is an essential component of clinical research as it improves the generalizability of findings. Investigating and piloting novel recruitment strategies that take advantage of ubiquitous digital technologies has become an important component of facilitating broad recruitment and addressing inequities in clinical trial participation. Equitable and inclusive recruitment improves generalizability of clinical trial outcomes, benefiting patients, clinicians, and the research community. The increasing prevalence of online connectivity in the USA and use of the Internet as a resource for medical information provides an opportunity for digital recruitment strategies in cancer clinical trials. This study aims to measure the acceptability, preliminary estimates of efficacy, and feasibility of the Trial Library intervention, an Internet-based cancer clinical trial matching tool. This study will also examine the extent to which the Trial Library website, designed to address the linguistic and literacy needs of broader patient populations, influences patient-initiated conversations with physicians about clinical trial participation. Methods This is a study protocol for a non-randomized, single-arm pilot study. This is a mixed methods study design that utilizes the statistical analysis of quantitative survey data and the qualitative analysis of interview data to assess the participant experience with the Trial Library intervention. This study will examine (1) acceptability as a measure of participant satisfaction with this intervention, (2) preliminary measure of efficacy as a measure of proportion of participants with documented clinical trial discussion in the electronic medical record, and (3) feasibility of the intervention as a measure of duration of clinical visit. Discussion The principles that informed the design of the Trial Library intervention aim to be generalizable to clinical trials across many disease contexts. From the ground up, this intervention is built to be inclusive of the linguistic, literacy, and technological needs of underrepresented patient populations. This study will collect essential preliminary data prior to a multi-site randomized clinical trial of the Trial Library intervention. Trial registration This study has received institutional approval from the Committee of Human Subjects Research at the University of California, San Francisco.
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Affiliation(s)
- Hala T Borno
- 1Department of Medicine, Division of Hematology/Oncology, University of California at San Francisco, 550 16th Street, 6th Floor, Box 3211, Office 6554, San Francisco, CA 94158 USA
| | - Brian M Bakke
- 2School of Medicine, University of California at San Francisco, San Francisco, USA
| | - Celia Kaplan
- 3Department of Medicine, Division of General Internal Medicine, University of California at San Francisco, San Francisco, USA
| | - Anke Hebig-Prophet
- 4Clinical Innovation Center, University of California at San Francisco, San Francisco, USA
| | - Jessica Chao
- 4Clinical Innovation Center, University of California at San Francisco, San Francisco, USA
| | - Yoon-Ji Kim
- 4Clinical Innovation Center, University of California at San Francisco, San Francisco, USA
| | - Jan Yeager
- 4Clinical Innovation Center, University of California at San Francisco, San Francisco, USA
| | - Pelin Cinar
- 1Department of Medicine, Division of Hematology/Oncology, University of California at San Francisco, 550 16th Street, 6th Floor, Box 3211, Office 6554, San Francisco, CA 94158 USA
| | - Eric Small
- 1Department of Medicine, Division of Hematology/Oncology, University of California at San Francisco, 550 16th Street, 6th Floor, Box 3211, Office 6554, San Francisco, CA 94158 USA.,3Department of Medicine, Division of General Internal Medicine, University of California at San Francisco, San Francisco, USA
| | - Christy Boscardin
- 4Clinical Innovation Center, University of California at San Francisco, San Francisco, USA
| | - Ralph Gonzales
- 4Clinical Innovation Center, University of California at San Francisco, San Francisco, USA
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Nickell A, Stewart SL, Burke NJ, Guerra C, Cohen E, Lawlor C, Colen S, Cheng J, Joseph G. Engaging limited English proficient and ethnically diverse low-income women in health research: A randomized trial of a patient navigator intervention. PATIENT EDUCATION AND COUNSELING 2019; 102:1313-1323. [PMID: 30772115 PMCID: PMC8846431 DOI: 10.1016/j.pec.2019.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 02/05/2019] [Accepted: 02/09/2019] [Indexed: 05/20/2023]
Abstract
OBJECTIVE Evaluate a community-based navigator intervention to increase breast cancer patients' and survivors' access to information about health research participation opportunities. METHODS In the context of a Community Based Participatory Research collaboration, we conducted a prospective randomized controlled trial of the Health Research Engagement Intervention with pre- and post-intervention surveys (n = 133). The primary outcome was health research information-seeking behavior. Secondary outcomes were health research knowledge, willingness to participate in health research, and health empowerment. Qualitative interviews (n = 11) elucidated participant perspectives on the intervention. RESULTS There was no statistically significant difference between intervention and control groups' information-seeking behavior. Knowledge that not all health research studies are about drugs or treatments increased significantly from pre- to post-test among intervention group participants (32% to 48%, p = 0.012), but not in the control group (43% to 30%, p = 0.059); the difference between arms was statistically significant (p = 0.0012). Although survey responses indicated willingness to participate, qualitative interviews identified competing priorities that limited participants' motivation to seek enrollment information. CONCLUSIONS AND PRACTICE IMPLICATIONS Community-based navigators are a trusted, and therefore promising link between health research and low-income underserved communities. However, systemic barriers in health research infrastructures need to be addressed to include low income, LEP and immigrant populations.
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Affiliation(s)
| | - Susan L Stewart
- Department of Public Health Sciences, Division of Biostatistics, University of California, Davis, USA
| | - Nancy J Burke
- Public Health University of California, Merced, USA; Department of Anthropology, History & Social Medicine, University of California, San Francisco USA
| | - Claudia Guerra
- Department of Anthropology, History & Social Medicine, University of California, San Francisco USA
| | - Elly Cohen
- BreastCancerTrials.org, San Francisco, USA
| | | | | | - Janice Cheng
- Department of Anthropology, History & Social Medicine, University of California, San Francisco USA
| | - Galen Joseph
- Department of Anthropology, History & Social Medicine, University of California, San Francisco USA.
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Abstract
Since the turn of the millennium, conceptual and practice-oriented shifts in global
health have increasingly given emphasis to health indicator production over research and interventions
that emerge out of local social practices, environments and concerns. In this special
issue of Anthropology in Action, we ask whether such globalised contexts allow for, recognise
and sufficiently value the research contributions of our discipline. We question how global
health research, ostensibly inter- or multi-disciplinary, generates knowledge. We query ‘not-knowing’
practices that inform and shape global health evidence as influenced by funders’
and collaborators’ expectations. The articles published here provide analyses of historical and
ethnographic field experiences that show how sidelining anthropological contributions results
in poorer research outcomes for the public. Citing experiences in Latin America, Angola, Senegal,
Nigeria and the domain of global health evaluation, the authors consider anthropology’s
roles in global health.
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Borno H, George DJ, Schnipper LE, Cavalli F, Cerny T, Gillessen S. All Men Are Created Equal: Addressing Disparities in Prostate Cancer Care. Am Soc Clin Oncol Educ Book 2019; 39:302-308. [PMID: 31099647 DOI: 10.1200/edbk_238879] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The global cancer burden is estimated to have risen to 18.1 million new cases and 9.6 million deaths in 2018. By 2030, the number of cancer cases is projected to increase to 24.6 million and the number of cancer deaths, to 13 million. Global data mask the social and health disparities that influence cancer incidence and survival. Inequality in exposure to carcinogens, education, access to quality diagnostic services, and affordable treatments all affect the probability of survival. Worryingly, despite the fact that many cancers could be prevented by stronger public health actions and many others could be largely cured by better access to diagnostics and affordable treatments, the international community has yet to make a substantial move to tackle this challenge. In prostate cancer, studies show that there are geographic and racial/ethnic distribution differences as well as a number of other variables, including environmental factors, limited access to standard cancer treatments, reduced probability to be included in trials, and the financial burden of cancer treatments. Financial burden for the patients can result in poor adherence, increased debt, and poor long-term outcomes. The following article will discuss some of the important causes for disparity in prostate cancer and prostate cancer care, focused on the current situation in the United States, as well as possible remedies to address these causes.
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Affiliation(s)
- Hala Borno
- 1 University of California, San Francisco, CA
| | | | | | - Franco Cavalli
- 4 Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Thomas Cerny
- 5 Kantonsspital St. Gallen, St. Gallen, Switzerland
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Cho HL, Danis M, Grady C. The ethics of uninsured participants accessing healthcare in biomedical research: A literature review. Clin Trials 2018; 15:509-521. [PMID: 30070143 PMCID: PMC6133717 DOI: 10.1177/1740774518792277] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background/aims Sparse literature exists on the challenges and ethical considerations of including people with limited access to healthcare, such as the uninsured and low-income, in clinical research in high-income countries. However, many ethical issues should be considered with respect to working with uninsured and low-income participants in clinical research, including enrollment and retention, ancillary care, and post-trial responsibilities. Attention to the uninsured and low-income is particularly salient in the United States due to the high rates of uninsurance and underinsurance. Thus, we conducted a scoping review on the ethical considerations of biomedical clinical research with uninsured and low-income participants in high-income countries in order to describe what is known and to pinpoint areas of needed research on this issue. Methods MEDLINE/PubMed, Embase, and Scopus databases were searched using terms that described main concepts of interest (e.g., uninsured, underinsured, access to healthcare, poverty, ethics, compensation, clinical research). Articles were included if they met four inclusion criteria: (1) English, (2) high-income countries context, (3) about research participants who are uninsured or low-income, which limits their access to healthcare, and in biomedical clinical research that either had a prospect of direct medical benefit or was offered to them on the basis of their ill health, and (4) recognizes and/or addresses challenges or ethical considerations of uninsured or low-income participants in biomedical clinical research. Results The searches generated a total of 974 results. Ultimately, 23 papers were included in the scoping review. Of 23 articles, the majority (n = 19) discussed enrollment and retention of uninsured or low-income participants. Several barriers to enrolling uninsured and low-income groups were identified, including limited access to primary or preventive care; lack of access to institutions conducting trials or physicians with enough time or knowledge about trials; overall lack of trust in the government, research, or medical system; and logistical issues. Considerably fewer articles discussed treatment of these participants during the course of research (n = 5) or post-trial responsibilities owed to them (n = 4). Thus, we propose a research agenda that builds upon the existing literature by addressing three broad questions: (1) What is the current status of uninsured research participants in biomedical clinical research in high-income countries? (2) How should uninsured research participants be treated during and after clinical research? (3) How, if at all, should additional protections for uninsured research participants affect their enrollment? Conclusions This review reveals significant gaps in both data and thoughtful analysis on how to ethically involve uninsured research participants. To address these gaps, we propose a research agenda to gather needed data and theoretical analysis that addresses three broad research questions.
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Affiliation(s)
- Hae Lin Cho
- The Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Marion Danis
- The Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Christine Grady
- The Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, MD, USA
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Kerr A, Ross E, Jacques G, Cunningham‐Burley S. The sociology of cancer: a decade of research. SOCIOLOGY OF HEALTH & ILLNESS 2018; 40:552-576. [PMID: 29446117 PMCID: PMC5901049 DOI: 10.1111/1467-9566.12662] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Biomedicine is often presented as the driving force behind improvements in cancer care, with genomics the latest innovation poised to change the meaning, diagnosis, treatment, prevention and lived experience of cancer. Reviewing sociological analyses of a diversity of patient and practitioner experiences and accounts of cancer during the last decade (2007-17), we explore the experiences of, approaches to and understandings of cancer in this period. We identify three key areas of focus: (i) cancer patient experiences and identities; (ii) cancer risk and responsibilities and (iii) bioclinical collectives. We explore these sociological studies of societal and biomedical developments and how sociologists have sought to influence developments in cancer identities, care and research. We end by suggesting that we extend our understanding of innovations in the fields of cancer research to take better account of these wider social and cultural innovations, together with patients, activists' and sociologists' contributions therein.
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Affiliation(s)
- Anne Kerr
- School of Sociology and Social PolicyUniversity of LeedsUK
| | - Emily Ross
- The Usher InstituteEdinburgh Medical SchoolUniversity of EdinburghUK
| | - Gwen Jacques
- School of Sociology and Social PolicyUniversity of LeedsUK
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Kadam R, Borde S, Madas S, Nagarkar A, Salvi S, Limaye S. Opinions and perceptions regarding the impact of new regulatory guidelines: A survey in Indian Clinical Trial Investigators. Perspect Clin Res 2016; 7:81-7. [PMID: 27141474 PMCID: PMC4840796 DOI: 10.4103/2229-3485.179437] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: Clinical research in India experienced dramatic changes with series of stringent guidelines introduced by regulatory authorities. These guidelines posed significant challenges for the clinical trial industry. Objective: To assess the perceptions and opinion of Indian Investigators about the new regulatory guidelines. Methods: We developed a survey questionnaire on recent regulatory guidelines which was hosted on a web portal. Seventy-three investigators from India participated in the survey. Results: Central registration of Ethics Committees (ECs) was agreed by 90.1% participants, 76.8% participants agreed to compensation of subjects for study related Serious Adverse Events (SAE's). The compulsion to include government sites in clinical trials was not agreed by 49.3% participants while 21.2% agreed to it. Restriction on a number of trials per investigator was agreed by 49.3% of participants while 40.9% disagreed. Participants (50.7%) disagreed to the introduction of audio-video (AV) recording of informed consent, 36.6% agreed and 12.7% were neutral. Discussion: Participants observed that post central registration; ECs have improved systems with adequate member composition, functional Standard Operating Procedures, and timely approvals. Participants agreed that compensation of study related SAE's would assure subject protection and safety. The introduction of AV consenting was strongly debated sighting sociocultural issues in the implementation of the same. Conclusion: Participants endorsed guidelines pertaining to the central registration of ECs, SAE related compensation. Restrictions on a number of trials per investigator and AV consenting were debated ardently. The response of the survey participants who are clinical trial investigators in India showed general acceptance, effectiveness and anticipated compliance to the new regulatory guidelines.
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Affiliation(s)
- Rashmi Kadam
- Chest Research Foundation, Marigold Premises, Pune, Maharashtra, India
| | - Sanghratna Borde
- Chest Research Foundation, Marigold Premises, Pune, Maharashtra, India
| | - Sapna Madas
- Chest Research Foundation, Marigold Premises, Pune, Maharashtra, India
| | - Aarti Nagarkar
- Interdisciplinary School of Health Sciences, University of Pune, Pune, Maharashtra, India
| | - Sundeep Salvi
- Chest Research Foundation, Marigold Premises, Pune, Maharashtra, India
| | - Sneha Limaye
- Chest Research Foundation, Marigold Premises, Pune, Maharashtra, India
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Holmberg C, Whitehouse K, Daly M, McCaskill-Stevens W. Gaining control over breast cancer risk: Transforming vulnerability, uncertainty, and the future through clinical trial participation - a qualitative study. SOCIOLOGY OF HEALTH & ILLNESS 2015; 37:1373-87. [PMID: 26235092 PMCID: PMC4609249 DOI: 10.1111/1467-9566.12307] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Concepts of disease risk and its management are central to processes of medicalisation and pharmaceuticalisation. Through a narrative perspective, this paper aims to understand how such macro-level developments may (or may not) be experienced individually, and how an algorithm that is used for recruitment into a clinical trial may structure individual notions of being 'at risk' and 'in need of treatment'. We interviewed 31 women participating in the Study of Tamoxifen and Raloxifene (STAR), a chemoprevention trial conducted in the US between 1999 and 2006. Interviews were thematically analysed. Women in the study had experienced the threat of breast cancer and felt vulnerable to developing the disease prior to STAR participation. The diagnosis of 'being at risk' for cancer through an algorithm that determined risk-eligibility for STAR, opened up the possibility for the women to heal. The trial became a means to recognise and collectivise the women's experiences of vulnerability. Through medication intake, being cared for by study coordinators, and the sense of community with other STAR participants, trial participation worked to transform women's lives. Such transformative experiences may nevertheless have been temporary, enduring only as long as the close links to the medical institution through trial participation lasted.
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Affiliation(s)
- Christine Holmberg
- Berlin School of Public Health, Charité - Universitätsmedizin Berlin, Germany
| | - Katie Whitehouse
- Berlin School of Public Health, Charité - Universitätsmedizin Berlin, Germany
| | - Mary Daly
- Fox Chase Cancer Center, Philadelphia, USA
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Monahan T, Fisher JA. 'I'm still a hustler': entrepreneurial responses to precarity by participants in phase I clinical trials. ECONOMY AND SOCIETY 2015; 44:545-566. [PMID: 27524854 PMCID: PMC4978131 DOI: 10.1080/03085147.2015.1113703] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
This paper questions the implications of entrepreneurial responses to conditions of employment precarity by 'healthy volunteers' in phase I clinical trials in the United States. Such individuals are typically serial participants who often identify as professional volunteers and seek out drug studies as their primary source of income. Drawing on extensive qualitative research, this paper illustrates how healthy volunteers selectively import the identity of 'hustler' from the street environment and reposition it as connoting a set of valuable creative skills that give them a competitive edge over other participants. An entrepreneurial ethos allows them to view personal sacrifice and exposure to potentially dangerous drugs as smart investments leading to financially stable futures. These discursive moves normalize extractive, and at times dehumanizing, labour relations that offload expenses and risks to workers.
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Affiliation(s)
- Torin Monahan
- Department of Communication, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3285, USA
| | - Jill A. Fisher
- Department of Social Medicine and Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7240, USA
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Nickell A, Burke NJ, Cohen E, Caprio M, Joseph G. Educating low-SES and LEP survivors about breast cancer research: pilot test of the Health Research Engagement Intervention. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2014; 29:746-52. [PMID: 24744119 PMCID: PMC4428555 DOI: 10.1007/s13187-014-0650-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The Health Research Engagement Intervention (HREI) aims to reduce information and access disparities for breast cancer research opportunities among low-socioeconomic status (SES) and limited English proficient (LEP) breast cancer survivors by providing neutral, non-trial-specific information about health research via a trusted patient navigator. Qualitative methods in the context of a community-based participatory research design were used to iteratively design the HREI in collaboration with community-based care navigators from a trusted community organization, Shanti Project, and to locate appropriate research studies in collaboration with a web-based trial-matching service, BreastCancerTrials.org (BCT). Navigators were first trained in clinical trials and health research and then to deliver the HREI, providing feedback that was incorporated into both the HREI design and BCT's interface. Our intervention pilot with low SES and LEP survivors (n = 12) demonstrated interest in learning about "health research." All 12 participants opted to obtain more information when offered the opportunity. Post-intervention questionnaires showed that three of 11 (27 %) participants independently pursued additional information about research opportunities either online or by phone in the week following the intervention. Post-intervention navigator questionnaires indicated that navigators could confidently and efficiently deliver the intervention. LEP patients who pursued information independently faced language barriers. The HREI is a promising and potentially scalable intervention to increase access to neutral information about breast cancer research opportunities for low-SES and LEP individuals. However, in order for it to be effective, systems barriers to participation such as language accessibility at sources of health research information must be addressed.
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Affiliation(s)
- Alyssa Nickell
- Shanti Project, 730 Polk Street, San Francisco, CA 94109, USA
| | - Nancy J. Burke
- Department of Anthropology, History and Social Medicine, University of California, 1450 Third Street, Room 551, San Francisco, CA 94158, USA
| | - Elly Cohen
- BreastCancerTrials.org., San Francisco, CA, USA; Department of Surgery, University of California, San Francisco, USA
| | - Maria Caprio
- Shanti Project, 730 Polk Street, San Francisco, CA 94109, USA
| | - Galen Joseph
- Department of Anthropology, History and Social Medicine, University of California, 1450 Third Street, Room 551, San Francisco, CA 94158, USA
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Factors influencing patient pathways for receipt of cancer care at an NCI-designated comprehensive cancer center. PLoS One 2014; 9:e110649. [PMID: 25329653 PMCID: PMC4203812 DOI: 10.1371/journal.pone.0110649] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 09/24/2014] [Indexed: 11/29/2022] Open
Abstract
Background Within the field of oncology, increasing access to high quality care has been identified as a priority to reduce cancer disparities. Previous research reveals that the facilities where patients receive their cancer care have implications for cancer outcomes. However, there is little understanding of how patients decide where to seek cancer care. This study examined the factors that shape patients’ pathways to seek their cancer care at a National Cancer Institute-designated comprehensive cancer center (NCI-CCC), and differences in these factors by race, income and education. Methods In-depth interviews and survey questionnaires were administered to a random sample of 124 patients at one NCI-CCC in the Northeast US. In-depth interview data was first analyzed qualitatively to identify themes and patterns in patients’ pathways to receive their cancer care at an NCI-CCC. Logistic Regression was used to examine if these pathways varied by patient race, income, and education. Results Two themes emerged: following the recommendation of a physician and following advice from social network members. Quantitative data analysis shows that patient pathways to care at an NCI-CCC varied by education and income. Patients with lower income and education most commonly sought their cancer care at an NCI-CCC due to the recommendation of a physician. Patients with higher income and education most commonly cited referral by a specialist physician or the advice of a social network member. There were no statistically significant differences in pathways to care by race. Conclusions Our findings show that most patients relied on physician recommendations or advice from a social network member in deciding to seek their cancer care at an NCI-CCC. Due to the role of physicians in shaping patients’ pathways to the NCI-CCC, initiatives that strengthen partnerships between NCI-CCCs and community physicians who serve underserved communities may improve access to NCI-CCCs.
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Dang JHT, Rodriguez EM, Luque JS, Erwin DO, Meade CD, Chen MS. Engaging diverse populations about biospecimen donation for cancer research. J Community Genet 2014; 5:313-27. [PMID: 24664489 PMCID: PMC4159470 DOI: 10.1007/s12687-014-0186-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 03/10/2014] [Indexed: 01/14/2023] Open
Abstract
Clinical research increasingly relies upon the availability of appropriate genetic materials; however, the proportion of biospecimens from racial/ethnic minority patients and healthy controls are underrepresented, which preclude equitable research across all patient groups for cancer treatment. National Cancer Institute-funded Community Network Program Centers in California, Florida, and New York collaborated with local community partners to conduct three independent formative research studies with diverse (African American, Asian American, Hispanic, and White) participants to explore their knowledge, attitudes, and beliefs about biobanking, and their experiences with the donation of biospecimens. Our findings demonstrated similarities in overall low knowledge and understanding about the use of biospecimens for research. This was exacerbated for non-English speakers. Racial and ethnic groups differed with regard to a number of factors that are obstacles for participation, e.g., continuing medical mistrust (African Americans), lack of benefit (Hispanics), apprehension about the physical toll of donating (Vietnamese), usage of biospecimen for research (Hmong and Chinese), and suspicion of exploitation by corporate entities (Whites). However, participants uniformly reported general interest and willingness to participate in biobanking for altruistic purposes, particularly to benefit future generations. This interest was framed with a strong admonition that donations should be accompanied by transparency about study sponsorship and ownership, distribution and use of biospecimens, and study information that fit participants' backgrounds and experiences. This cross-cultural regional analysis offers significant insights into the similarities and variations in opinions and perceptions about biobanking and the collection of biospecimens for use in cancer research.
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Affiliation(s)
- Julie H. T. Dang
- />UC Davis Comprehensive Cancer Center, 4800 2nd Avenue, FSSB, Suite 2200, Sacramento, CA 95817 USA
| | - Elisa M. Rodriguez
- />Cancer Prevention and Population Sciences, Center for Personalized Medicine, Rosewell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY 14263 USA
| | - John S. Luque
- />Jiann-Ping Hsu College of Public Health, Georgia Southern University, PO Box 8015, Statesboro, GA 30460 USA
| | - Deborah O. Erwin
- />Cancer Prevention and Population Sciences, Rosewell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY 14263 USA
| | - Cathy D. Meade
- />Division of Population Science, Health Outcomes & Behavior, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612 USA
| | - Moon S. Chen
- />UC Davis Comprehensive Cancer Center, 4800 2nd Avenue, FSSB, Suite 2200, Sacramento, CA 95817 USA
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Engaging diverse populations about biospecimen donation for cancer research. J Community Genet 2014. [PMID: 24664489 DOI: 10.1007/s12687-014-0186-0.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022] Open
Abstract
Clinical research increasingly relies upon the availability of appropriate genetic materials; however, the proportion of biospecimens from racial/ethnic minority patients and healthy controls are underrepresented, which preclude equitable research across all patient groups for cancer treatment. National Cancer Institute-funded Community Network Program Centers in California, Florida, and New York collaborated with local community partners to conduct three independent formative research studies with diverse (African American, Asian American, Hispanic, and White) participants to explore their knowledge, attitudes, and beliefs about biobanking, and their experiences with the donation of biospecimens. Our findings demonstrated similarities in overall low knowledge and understanding about the use of biospecimens for research. This was exacerbated for non-English speakers. Racial and ethnic groups differed with regard to a number of factors that are obstacles for participation, e.g., continuing medical mistrust (African Americans), lack of benefit (Hispanics), apprehension about the physical toll of donating (Vietnamese), usage of biospecimen for research (Hmong and Chinese), and suspicion of exploitation by corporate entities (Whites). However, participants uniformly reported general interest and willingness to participate in biobanking for altruistic purposes, particularly to benefit future generations. This interest was framed with a strong admonition that donations should be accompanied by transparency about study sponsorship and ownership, distribution and use of biospecimens, and study information that fit participants' backgrounds and experiences. This cross-cultural regional analysis offers significant insights into the similarities and variations in opinions and perceptions about biobanking and the collection of biospecimens for use in cancer research.
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