"There's not enough studies": Views of black breast and ovarian cancer patients on research participation

Underrepresented populations in genomic research: a qualitative study of researchers' perspectives

BACKGROUND

The lack of diversity in genomic data limits researchers' ability to investigate the relationships between genetic profiles, disease manifestations, and responses to new therapies. As a result, innovations in treatment could have potentially harmful effects on a significant portion of the population due to incomplete or inaccurate genomic data. In addition, the lack of harmonization in the use of population descriptors in genomic studies raises both ethical and scientific concerns regarding which descriptors should be used to study and recruit underrepresented populations. Therefore, understanding the factors contributing to the lack of diversity in genomic research is an urgent scientific, clinical, and public health priority. This study aims to explore the social and contextual factors influencing the participation of underrepresented populations in genomic research, from the perspective of researchers in the field.

METHODS

A total of 13 semi-structured interviews were conducted with researchers experienced in genomic research in Canada and fluent in either French or English. The interview transcripts were analyzed using thematic analysis.

RESULTS

Researchers identified several factors contributing to the low participation of underrepresented populations in genomic research, with one key factor being the geographic distribution of research institutions and the disconnect between research efforts and the communities being studied. To address this issue, participants stressed the importance of moving away from colonial practices, such as conducting research on a community without consulting its members in the design phase. Furthermore, it was suggested that existing diversity, equity, and inclusion policies alone were insufficient to effectively address the challenge. Lastly, the study also highlighted a potential link between how study populations are categorized and the willingness of underrepresented groups to participate in genomic research.

CONCLUSION

Although researchers are generally aware of the literature on the causes, consequences, and potential solutions for increasing participation, confusion remains regarding the use of population descriptors. Our findings highlight the need for improved education, greater consensus, and expanded dialogue within the genomic research community to promote the harmonization of population descriptors.

A Review of Medical Mistrust Across the Cancer Continuum of Care and Current Interventions

Cancer disparities among populations in the United States are a persistent and ongoing challenge. Medical mistrust (MM), or the tendency to distrust individuals and systems even at the cost of one's own well-being, has been implicated in contributing to worse health outcomes. Thus, understanding the relationship between MM and cancer care disparities may inform effective interventions to improve outcomes for all. We conducted a two-step review: (1) a standard review to examine the relationship between MM and the cancer continuum of care, and (2) a systematic review to assess interventions targeted to mitigate MM in cancer care. The standard review included eleven studies, which revealed that MM impacted cancer screening, treatment adherence, clinical trial participation, and access to social support. Key mediators of MM included patient-provider discordance, health-related and sociodemographic-related discrimination, perceptions of Western medicine, low quality care, and health insurance. Our systematic review yielded twelve interventions-67% tailored towards screening, 17% towards patient navigation services, and 17% towards clinical trial participation. Key methods included adapting patient-centered (e.g. gathering patient perspectives, increasing racial and ethnic representation) and community-based approaches (e.g. use of churches and training family members to disseminate patient education) to overall create culturally tailored interventions against MM across the cancer continuum of care.

Building Better Medicine: Translational Justice and the Quest for Equity in US Healthcare

Despite considerable scientific progress and the evolution of regulatory pathways to ensure safety and efficacy, US healthcare continues to see increasing health disparities. This suggests that clinical translation in of itself cannot be the only measure of its own success, especially when the most marginalized patients, are neglected in the development and implementation of medical innovations. This raises the question of whether a system that is narrowly focused on technical achievement can meet the moral obligations of medicine and public health. We argue that traditional technocratic standards are failing to integrate normative considerations into biomedical translation. What is needed is a translational domain that moves beyond safety and efficacy toward anticipating how proposed technologies will be effective in society as it exists. We propose an additional metric of success: translational justice.

Speaking Out: Factors Influencing Black Americans' Engagement in COVID-19 Testing and Research

Black communities in the United States (U.S.) have faced stark inequalities in COVID-19 outcomes. The underrepresentation of Black participants in COVID-19 testing research is detrimental to the understanding of the burden of the disease as well as the impact of risk factors for disease acquisition among Black Americans. Prior scholarship notes that the reluctance to engage in medical research among Black people is, in part, due to the exploitation and abuse this community has seen from the medical field and other social institutions. To better understand the barriers and motivations for COVID-19 testing among Black Americans, this study utilized intersectionality as methodological and theoretical frameworks to examine and investigate the barriers and motivations influencing participation in COVID-19 serosurveys (blood test and interview) among the metro-Atlanta Black communities. From May to October 2021, we took a community-based participatory research approach and conducted 52 semi-structured interviews to uncover different Black communities' feelings and opinions towards COVID-19 testing. Key reasons participants agreed to the blood test include (1) curiosity; (2) health upkeep; (3) family/community/social responsibility; and (4) importance of research. Participants' reasons for rejecting the blood test were (1) unnecessary/no benefit; (2) fear (of the known and unknown); (3) fear of needles and/or blood; and (4) discomfort with test setting/procedure. Our findings show that perspectives on willingness to engagement in testing or to not participate varied across gender and age for Black individuals.

Cancer outcomes and cardiopulmonary toxicities for Black patients with breast cancer treated with proton therapy

BACKGROUND

Black women have a 40% higher breast cancer mortality rate than White women and are at a higher risk of acquiring cardiovascular disease. Proton therapy can be used to mitigate cardiac radiation exposure; however, proton therapy remains a scarce resource in the United States. We report on the cardiovascular profiles of patients undergoing proton therapy to determine the potential benefit of the therapy for Black women compared with patients of other races.

METHODS

We retrospectively analyzed 599 patients with breast cancer who received proton therapy from June 2016 to December 2021 at the Maryland Proton Treatment Center. A variety of sociodemographic, disease, and treatment variables were analyzed using descriptive statistics.

RESULTS

With a median follow-up of 26 months (range = 0.47-90 months), Black patients made up 31.6% of the population and presented with higher rates of hypertension (P < .001), cardiopulmonary conditions (P < .001), and a higher median body mass index (P = .015) compared with the other cohort, a trend that persisted at the time of post-proton therapy follow-up. Black women had higher rates of triple-negative disease (P < .001), with subsequent greater receipt of neoadjuvant chemotherapy (P = .039). Pulmonary events were 2.6 times more likely to occur in Black patients than in the non-Black cohort after proton therapy (odds ratio = 2.60, 95% CI = 1.39 to 4.88; P = .003).

CONCLUSIONS

Black women presenting for proton therapy had higher baseline risks of cardiovascular co-morbidities combined with more aggressive breast cancer biology and a subsequent 2.6-fold increased risk of pulmonary events after proton therapy. Our findings support the use of advanced radiation techniques as a means of sparing important organs at risk, especially in historically marginalized populations.

The journey of patients in cancer clinical trials: A qualitative meta-synthesis on experiences and perspectives

OBJECTIVE

To synthesize findings from qualitative studies focusing on adult cancer patients and their experiences and perspectives on clinical trials.

METHODS

A meta-synthesis was conducted on the literature retrieved from Scopus, Embase, PubMed, and PsycInfo databases. Patient quotes from papers were coded line-by-line using Nvivo software, and themes were created.

RESULTS

45 papers were included. Three large themes were identified based on the timeline of trials: (1) "pre-trial participation" includes sub-themes regarding informational needs, experience with the decision, and representations. (2) "Ongoing trial" includes subthemes covering supportive care, practical and psycho-physical burdens, identity and comparison with others, and the importance of maintaining hope. (3) "Post-trial," with subthemes covering comprehension of results and attitudes towards data sharing, perception of being left unattended, and hindsight and regretful thoughts.

CONCLUSION

This work emphasizes the importance of contextualizing patient experiences and holistically viewing trials. Additionally, this review stresses that patient narratives in the post-trial period are underrepresented in the literature.

PRACTICE IMPLICATIONS

Further research should prioritize the post-trial stage to enhance patients' psychological well-being and address concerns such as regret to reduce trial dropout rates. Emphasizing patient connections, providing clear trial-related information, and offering remote participation options, particularly for rural patients, are crucial steps in improving patient experience and trial adherence.

Examining recollections of Black women with breast cancer who participated in clinical trials: A grounded practical theory study of patient-provider communication

The presence of strong barriers to research participation for Black women is indisputable. However, existing evidence supports the possibility of equal levels of participation among members of minoritized populations in past breast cancer (BC) clinical trials (CTs), demonstrating that while these participation barriers undoubtedly exist but are not insurmountable. This work aims to investigate patient-provider conversations to try to illuminate how providers can better engage Black women in communication that will positively influence their perceptions of breast cancer clinical trial participation. Fourteen women (N = 14) who self-identified as Black, Black American, or African American and who had previously or were currently involved in a BC CT participated in the grounded theory-guided study. These women were recruited through emails and social media platforms and interviewed regarding their communication with their medical providers and their pathway to CT participation. Findings revealed three primary categories: 1) participants reported the following provider types as most effective communicators: attentive, matter-of-fact, warm, or above-and beyond; 2) participants frequently received no information about CTs from their providers; and 3) cultural constructs including faith, word of mouth, and storytelling are important to the recruitment of these Black women to BC CTs. Our findings demonstrate the importance of healthcare providers adjusting their communication to meet one of the preferred provider archetypes of communication styles, understanding and incorporating cultural constructs in their communication, and providing information about BC CTs to Black women. Through improved patient-provider communication, healthcare providers may positively influence Black women's perceptions of and participation in BC CTs.

The Barriers and Enablers to Participation in Oncology Clinical Trials for Ethnically Diverse Communities: A Qualitative Systematic Review Using Metaethnography

BACKGROUND

Racial and ethnic inequities exist in cancer clinical trial participation. Low recruitment across ethnically diverse communities contributes to health inequalities further disproportionately affecting these groups. Understanding barriers and enablers to clinical trial participation for ethnic minorities is key to developing strategies to address this problem.

OBJECTIVE

To explore, evaluate, and synthesize qualitative research surrounding patients' lived experiences and perceptions of participating in cancer clinical trials from ethnically diverse groups.

METHODS

Noblit and Hare's 7-stage metaethnography was used. Seven databases were searched. Inclusion criteria were as follows: qualitative studies published in English from January 1, 2012, to January 31, 2022; patients from any ethnic minority 18 years and older with a cancer diagnosis; and cancer patients' carers and healthcare professionals (HCPs)/healthcare leaders involved in the delivery of cancer clinical trials.

RESULTS

The majority of included articles were conducted in the United States. Interpretive qualitative synthesis resulted in 7 categories including patient perceptions and beliefs and HCP perception of trial burden and social determinants of health. Four lines of argument were established.

CONCLUSIONS

The findings capture the experience and perceptions of ethnic minority patients, their carers, HCPs, and healthcare leaders in this area of research. Incongruities exist between patient-reported barriers and those perceived by HCPs. Published empirical research outside the United States is limited.

IMPLICATIONS FOR PRACTICE

When developing strategies to increase clinical trial participation, research literacy, cultural safety, and unconscious biases within healthcare need to be addressed. Further research to examine intersectionality and the role of faith in decision-making among ethnic groups is warranted.

Disparities in cancer clinical trials information-seeking: Findings from the National Cancer Institute's Cancer Information Service

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.

Exploring Racial Disparities in Awareness and Perceptions of Oncology Clinical Trials: Cross-Sectional Analysis of Baseline Data From the mychoice Study

BACKGROUND

Black/African American adults are underrepresented in oncology clinical trials in the United States, despite efforts at narrowing this disparity.

OBJECTIVE

This study aims to explore differences in how Black/African American oncology patients perceive clinical trials to improve support for the clinical trial participation decision-making process.

METHODS

As part of a larger randomized controlled trial, a total of 244 adult oncology patients receiving active treatment or follow-up care completed a cross-sectional baseline survey on sociodemographic characteristics, clinical trial knowledge, health literacy, perceptions of cancer clinical trials, patient activation, patient advocacy, health care self-efficacy, decisional conflict, and clinical trial intentions. Self-reported race was dichotomized into Black/African American and non-Black/African American. As appropriate, 2-tailed t tests and chi-square tests of independence were used to examine differences between groups.

RESULTS

Black/African American participants had lower clinical trial knowledge (P=.006), lower health literacy (P<.001), and more medical mistrust (all P values <.05) than non-Black/African American participants. While intentions to participate in a clinical trial, if offered, did not vary between Black/African American and non-Black/African American participants, Black/African American participants indicated lower awareness of clinical trials, fewer benefits of clinical trials, and more uncertainty around clinical trial decision-making (all P values <.05). There were no differences for other variables.

CONCLUSIONS

Despite no significant differences in intent to participate in a clinical trial if offered and high overall trust in individual health care providers among both groups, beliefs persist about barriers to and benefits of clinical trial participation among Black/African American patients. Findings highlight specific ways that education and resources about clinical trials could be tailored to better suit the informational and decision-making needs and preferences of Black/African American oncology patients.

Psychosocial Factors That Influence a Woman's Decision to Enroll in a Clinical Trial: Implications on How to Improve Clinical Trial Enrollment Among Black Women

PURPOSE

Black women with breast cancer often present with more aggressive disease compared with other races, contributing to an increased risk of cancer mortality. Despite this inequity, Black women remain severely underrepresented in breast cancer clinical trials. We aim to characterize factors that influence a woman's decision to enroll in a clinical trial, with the goal of identifying clinical interventions to aid in the recruitment of vulnerable groups.

METHODS AND MATERIALS

A cross-sectional, descriptive study was conducted using a questionnaire adapted from 2 prevalidated surveys investigating factors influencing clinical trial enrollment. The survey was administered to women with curable breast cancer during a single follow-up visit at 4 different sites within a university medical system where all patients are screened for clinical trial eligibility. Chi-square tests and Mann-Whitney U tests were used to assess associations or differences between the populations.

RESULTS

One hundred ninety-four out of 209 women completed the survey, giving a compliance rate of 93%. Twenty-six percent of women self-identified as Black, most women were located at community sites (67.1%), most women had diagnoses of early-stage disease (I: 57.7%, II: 29.4%), and 81% of women had some collegiate-level education. Black women were younger at diagnosis (P = .005) and less likely to be married (P = .012) but more often lived with family members (P = .003) and had a lower median income (P < .001). According to the survey, Black women were less likely to trust their care team (P = .032), more likely to believe that research ultimately harms minorities (P < .001), and had a stronger belief in God's will determining illness and wellness (P < .001). Recurring themes of trust in the health care team, patient education, and advancement of cancer treatments were discussed in the focus groups.

CONCLUSIONS

Failure to offer clinical trials and mistrust in research institutions may pose the greatest hindrances to the enrollment of Black women in clinical trials. Empowering women through education and fostering trustworthy relationships can encourage greater clinical trial participation.

"Let them be": Family members' perspectives on the participation of advanced cancer patients in nursing research: A qualitative descriptive study

BACKGROUND

Recruiting advanced cancer patients is crucial for nursing research in cancer care. However, nurse researchers often face various socio-cultural challenges, particularly in mainland China, where cultural taboos around death pose significant obstacles. An unexplored constraint in this context is the pivotal role Chinese family members play in patients' healthcare decision-making. This research gap underscores the need for a deeper understanding of Chinese family members' perspectives on the engagement of advanced cancer patients in nursing research.

OBJECTIVE

To explore the perceptions and concerns of family members regarding the recruitment and participation of advanced cancer patients in nursing research.

DESIGN

A qualitative descriptive study was conducted.

SETTINGS

Three cancer hospitals in mainland China.

PARTICIPANTS

A purposive sample of 18 family members, consisting of children or spouses of advanced cancer patients, was recruited as participants.

METHODS

Semi-structured interviews were conducted to collect data between September 2022 and January 2023. The thematic analysis method was used to analyze the data.

RESULTS

Three themes were identified: The absence of prior participation, Family members' reluctance to facilitate patient involvement, and Strategies to encourage patients' future participation. Family members were hesitant to allow their relatives with advanced cancer to engage in nursing research, primarily due to concerns about distressing patients, the use of potential sensitive language, stigma, and the risks involved in participation. To address these concerns, they emphasized the importance of gaining family approval prior to patient enrolment. They highlighted the need of family involvement on behalf of sick relatives in research, advocating for the inclusion of a wide range of patients rather than targeting specific subgroups. They also reiterated the significance of choosing the right time for participation and avoiding using sensitive terms such as 'cancer', 'dying', and 'death' when engaging with patients. Moreover, they proposed the recruitment of patients by trusted professionals, shortening the duration of research activities and simplifying research procedures.

CONCLUSIONS

This study provides fresh insights into the perspectives of family members concerning the recruitment and engagement of advanced cancer patients in nursing research. It emphasizes the importance of addressing their concerns and recommendations, aiding nurse researchers in developing culturally sensitive recruitment strategies and fostering the inclusive participation of advanced cancer patients in nursing research within the context of family-centered care and cultural taboos surrounding death.

A review of racial disparities in ovarian cancer and clinical trials

PURPOSE OF REVIEW

Ovarian cancer ranks fifth in mortality among women with cancer and accounts for more death compared to any other gynecological cancers. This review summarizes the most recent literature on disparities in ovarian cancer as well as within recent clinical trials.

RECENT FINDINGS

Recent studies have identified a notable disparity in genetic testing utilization, disease stage at the time of diagnosis, and adherence to treatment guidelines between Black women and their White counterparts, ultimately leading to increased mortality rates among Black women from ovarian cancer. Additionally, there is an underreporting of race in clinical trials and those that do report race demonstrate significant racial disparities within trial participants with the majority of participants being White.

SUMMARY

It is imperative that we address the significant racial disparities within ovarian cancer and clinical trials to establish a framework of equitable healthcare provision. Multiple determinants, such as implicit bias, provider mistrust, accessibility hurdles, and socioeconomic influences, appear to contribute to the current disparities faced by women of color. Further investigation is warranted, encompassing a deeper understanding of diverse patient perspectives and identifying barriers to receiving optimal care and participating in clinical trials.