Community Health Builders Program: A Collaborative Model Connecting National Health Thought Leaders With Community-Level Champions

Make Well Known Foundation (MWKF), a nonprofit organization focused on supporting the health of minoritized and underserved populations, piloted the Community Health Builders (CHB) program. This connected MKWF Steering Committee members-national thought leaders in health-with leaders of underserved populations in Greensboro, NC, with the goal of translating research into practice. Steering Committee members provided education, instruction, and resources to community leaders that could then be transferred to area residents to cultivate better health. A roundtable meeting was first organized to allow community leaders to share insights into the highest priority needs of Greensboro's Black residents. Four topics resulted that became the focus of the training modules (called "accelerator forums") that formed the core of the CHB program. Each accelerator forum was led by Steering Committee members and local-level topic experts to educate and share resources with community leaders. The program concluded with a local health and resource fair, which exposed Greensboro residents to the resources shared during CHB program trainings. Overall, the CHB program pilot demonstrated success in the collaborative engagement between national- and community-level leaders based on measures of increased knowledge and self-efficacy in supporting Greensboro residents in the four accelerator forum topics. In a final debrief session, CHB participants shared their perspective that the progress achieved in the community needed to be sustained through continued national- and community-level collaboration and ongoing community training. This key insight and the need for sustained engagement will be incorporated into all future programs.

Best practices in achieving patient diversity in oncology clinical trials

87

Background: The underrepresentation of Black patients in cancer clinical trials in the United States has been well documented. While a multitude of recommendations exist from government organizations, academic institutions, industry sponsors, and commercial groups on approaches designed to increase enrollment, there is a lack of evidence as to the effectiveness of these recommendations in real-world settings. The West Cancer Center & Research Institute (WCCRI), a community oncology center in the greater Memphis, TN area, has consistently conducted trials in which Black patients are well-represented. Of all oncology clinical trials conducted at WCCRI in 2021, Black patients represented 29.9% of the total enrolled population. To further extend the literature on successful methods to achieve greater trial diversity, enrollment tactics used by WCCRI were explored to understand best practices and assess scalability to other oncology centers. Methods: A total of 35 qualitative in-depth interviews were conducted with multiple constituencies associated with WCCRI to obtain a holistic view of clinical trial practices. Interviews were held between March and April 2022. Included were Black patients who participated in a clinical trial, Black patients that declined participation in a clinical trial, caregivers of these patients, WCCRI staff, and community leaders in the Memphis, TN area. All patients interviewed had a history of solid malignancies and were treated at WCCRI between January 2018 and December 2021. The study was considered minimal risk research and all participants provided informed consent before study participation. Results: This research underscored the fact that barriers to enroll Black patients are complex and involve challenges at various structural levels including the system, individual, and interpersonal levels. WCCRI practices were found to incorporate tactics at each of these levels, leading to the ability of this community oncology center to enroll representative proportions of Black patients into its oncology trials. Examples of tactics that reach into the community include coordinating with local leaders to provide residents with health education; outreach by Black WCCRI staff, diverse PIs, and ambassadors to dispel myths about a cancer diagnosis and treatment; and faith-based leaders guiding patients to helpful resources and supportive services provided by WCCRI. Conclusions: Results of this research build upon previous literature that suggest although some success has been identified through interventions at any one level, the greatest opportunity for achieving diversity in oncology trials comes from multilevel interventions. Emphasis should be placed on crafting tactics that simultaneously address factors in each of these levels to consistently achieve enrollment diversity.

Prospective assessment of contralateral prophylactic mastectomy decision-making in women with average risk: an application of perceptual mapping

Women with early-stage unilateral breast cancer and no familial or genetic risk factors are increasingly electing contralateral prophylactic mastectomy (CPM), despite the lack of evidence demonstrating improved outcomes. To better understand and extend the literature focused on treatment decision-making, a survey was conducted among women with early-stage breast cancer and no associated risk factors, who were in the process of making a surgical decision. This prospective study sought to expand our understanding of the factors that influence patients' decision to have CPM, with the goal of providing healthcare providers with useful guidance in supporting breast cancer patients who are making treatment decisions. Data were collected for this prospective study through an internet survey. Results were analyzed using perceptual mapping, a technique that provides visual insight into the importance of specific variables to groups of women making different surgical decisions, not available through conventional analyses. Results suggest that women more likely to elect CPM demonstrate greater worry about breast cancer through experiences with others and feel the need to take control of their health through selection of the most aggressive treatment option. The information obtained offers guidance for the development of targeted intervention and counsel that will support patients' ability to make high quality, informed decisions.

Comparing standard versus prosocial internet support groups for patients with breast cancer: a randomized controlled trial of the helper therapy principle

PURPOSE

Internet support group (ISG) members benefit from receiving social support and, according to the helper therapy principle, by providing support to others. To test the mental health benefits of providing support to others, this trial compared the efficacy of a standard ISG (S-ISG) and an enhanced prosocial ISG (P-ISG).

METHODS

A two-armed randomized controlled trial with 1-month pretest and post-test assessments was conducted with women (N = 184) diagnosed in the past 36 months with nonmetastatic breast cancer who reported elevated anxiety or depression. Women were randomly assigned to either the S-ISG or P-ISG condition. Both conditions included six professionally facilitated live chat sessions (90-minute weekly sessions) and access to an asynchronous discussion board; P-ISG also included structured opportunities to help and encourage others.

RESULTS

Relative to the S-ISG, participants in the P-ISG condition exhibited more supportive behaviors (emotional, informational, and companionate support), posted more messages that were other-focused and fewer that were self-focused, and expressed less negative emotion (P < .05). Relative to the S-ISG, participants in the P-ISG condition had a higher level of depression and anxiety symptoms after the intervention (P < .05).

CONCLUSION

Despite the successful manipulation of supportive behaviors, the P-ISG did not produce better mental health outcomes in distressed survivors of breast cancer relative to an S-ISG. The prosocial manipulation may have inadvertently constrained women from expressing their needs openly, and thus, they may not have had their needs fully met in the group. Helping others may not be beneficial as a treatment for distressed survivors of breast cancer.