Race, education, and knowledge of bone marrow registry: indicators of willingness to donate bone marrow among African Americans and Caucasians

An undergraduate service-learning project to teach immunology concepts while increasing healthcare equity by enhancing access to stem cell donors among underrepresented populations

Active learning has been shown to increase STEM student engagement and decrease the achievement gap among underrepresented students. As a parallel to the lack of equity in STEM education, BIPOC patients who require a life-saving hematopoietic cell transplantation (HCT) are much less likely-sometimes less than half as likely-than individuals of White-European descent to find a suitable donor when using the National Marrow Donation Program (NMDP). The Be the Match (BtM) Registry has made significant improvements in the likelihood of matching underrepresented patients, but the disparity persists. This activity uses a service-learning project to teach undergraduate students about stem cell donation and to add potential stem cell donors to the BtM Registry. A small data set of pre-/post-surveys from one cohort shows learning gains on the topic of HCT. The approach is flexible and scalable, and students overwhelmingly reported the project as a great use of class time and very rewarding.

Factors Influencing Individuals' Decision-Making Regarding Hematopoietic Stem Cell Donation: A Cross-Sectional Study in Saudi Arabia

INTRODUCTION

Hematopoietic stem cell transplantation (HSCT) is a vital medical intervention for treating various conditions. The preferred methods, i.e., bone marrow transplantation and peripheral blood stem cell transplantation, have saved lives and attracted attention. Saudi Arabia, with a high sickle cell disease and leukemia incidence, faces the challenge of matching donors for HSCT. Factors like knowledge, attitudes, cultural beliefs, and access to information impact donation decisions.

METHODS

In May 2023, a cross-sectional online survey was conducted in Saudi Arabia, targeting the general population. Data were collected through an online questionnaire, analyzing demographics, knowledge, attitudes, and factors influencing donation intention.

RESULTS

Demographic analysis showed that females, younger individuals (18-25 years), those with higher education, and healthcare workers had better knowledge. Attitudes toward donation varied: 42.4% were willing to donate, while 57.6% were not. Psychological barriers, health concerns, pain, and inadequate knowledge influenced donation reluctance. Of the participants, 3.5% were registered stem cell donors, with 58.8% expressing willingness but not registered. Donors' intent was influenced by family members' need for transplants and knowledge. A majority (56.6%) supported employer support for health programs, while 65.7% believed government funding should assist donors.

CONCLUSION

HSCT is vital in treating diseases like sickle cell and leukemia in Saudi Arabia. While many recognize its importance, knowledge gaps about its specifics and donation deter potential donors. Enhanced awareness campaigns and support from employers and the government could increase donor registrations.

Regional Differences Among Bone Marrow Registrants: The Results of a Cross-Sectional Telephone-Based Survey

INTRODUCTION

In the most western and northeastern provincial branches of China where ethnic minorities reside the registry sizes are compatibly small. Our goal was to address the following questions: 1. Do registrants in the 4 regions differ across 4 categories of characteristics associated with decisions to proceed with bone marrow donation? 2. What are the differences in their motivation to attend the CMDP (China Marrow Donor Program)? 3. What possible suggestions could this study supply for the recruitment work of these 4 regions in the future?

MATERIAL AND METHOD

A random sampling procedure was conducted to include 2% of 229,204 newly registered potential bone marrow donors. Participants were contacted to complete a 30-minute structured telephone review.

RESULT

There is a statistically significant effect of region on the causes of donor attrition. For both the opted-out group and ambivalent group of western region registrants, the knowledge (were not fully informed when enrolled) reason was significantly higher than in the other 3 regions. None of the northeast registrants chose "health" as a reason for their ambivalence, in contrast, east registrants had a significantly higher proportion to worry about their health status was not suitable for donation.

DISCUSSION

The results illustrate that in China at least, the mode of registration differs according to the region, which can guide the registry in their retention strategy. The western regions are more likely to be affected by people around and hope to be contacted regularly to confirm the willingness of donation. Interventions that encouraged bone marrow donors to share their experience in their communities might in turn foster an enhanced registration rate. The northeastern regions were more likely to be affected by the newspaper so the media propaganda will be useful for donor recursion. They were also more likely to have questions about the knowledge of bone marrow donation. Continual communication will help registrants secure information to retain favorable beliefs about donation.

Predicting the Availability of Hematopoietic Stem Cell Donors Using Machine Learning

Hematopoietic stem cell transplantation (HSCT) is firmly established as an important curative therapy for patients with hematologic malignancies and other blood disorders. Apart from finding HLA-matched donors during the HSCT process, donor availability remains a key consideration as the time taken from diagnosis to transplant is recognized to adversely affect patient outcome. In this study, we aimed to develop and validate a machine learning approach to predict the availability of stem cell donors. We retrospectively collected a data set containing 10,258 verification typing requests made during the HSCT process in the British Bone Marrow Registry (BBMR) between January 1, 2013, and December 31, 2018. Three machine learning algorithms were implemented and compared, including boosted decision trees (BDTs), logistic regression, and support vector machines. Area under the receiver operating characteristic curve (AUC) was primarily used to assess the algorithms. The experimental results showed that BDTs performed better in predicting the availability of BBMR donors. The overall predictive power of the model, using AUC on the test cohort of 2052 records, was found to be 0.826. Our findings show that machine learning can predict the availability of donors with a high degree of accuracy. We propose the use of the BDT machine learning approach to predict the availability of BBMR donors and use the predictive scores during the HSCT process to ensure patients with blood cancers or disorders receive a transplant at the optimum time.

Does Being A Cancer Patient or Family Caregiver of A Cancer Patient Affect Stem Cell Donation Awareness?

Objective:

One of the most difficult challenges regarding hematopoietic stem cell transplantation in Turkey is finding donors for allogeneic transplantation candidates who do not have related donors. This study aims to determine whether there is any difference in the awareness of stem cell donation and transplantation between cancer and noncancer patients and their family caregivers. In addition, this study aims to determine the awareness of stem cell donation and transplantation in the entire study population.

Methods:

This descriptive study was conducted in Turkey using a data collection form comprising questions about demographics, stem cell transplantations, donations, and medical history. On analyzing the research data, variables were expressed as mean ± standard deviation and as numbers (n) and percentages (%). The Chi-square and Fisher's exact tests were performed to evaluate differences among cancer and noncancer diagnosed patients and their family members.

Results:

A total of 192 patients and 169 family caregivers participated in the study. In comparison with noncancer patients, cancer patients showed more awareness on what stem cell transplantation is, how lifesaving it is, and how to donate stem cells. Similarly, the family caregivers of cancer patients were more aware of what stem cell transplantation is and how to donate stem cells.

Conclusions:

The results of this study showed that cancer patients and their families were more aware of stem cell donation and transplantation; however, most of the patients and families did not know enough about the national registry program and how to donate stem cells.

Machine Learning Approach to Predicting Stem Cell Donor Availability

The success of unrelated donor stem cell transplants depends on not only finding genetically matched donors, but also donor availability. On average 50% of potential donors in the National Marrow Donor Program database are unavailable for a variety of reasons, after initially matching a patient, with significant variations in availability among subgroups (eg, by race or age). Several studies have established univariate donor characteristics associated with availability. Individual consideration of each applicable characteristic is laborious. Extrapolating group averages to the individual-donor level tends to be highly inaccurate. In the current environment with enhanced donor data collection, we can make better estimates of individual donor availability. We propose a machine learning based approach to predict availability of every registered donor, and evaluate the predictive power on a test cohort of 44,544 requests to be .77 based on the area under the receiver-operating characteristic curve. We propose that this predictor should be used during donor selection to reduce the time to transplant.

Effects of Framing Health Messages in Terms of Benefits to Loved Ones or Others: An Experimental Study

Many health officials believe the future of public health is in prevention of infectious diseases like pandemic influenza. Vaccine promotion is becoming an increasingly important area for health communication researchers. One strategy health promoters can consider is to emphasize that getting vaccinated protects not only the self, but also loved ones, and unknown others to whom the disease could be spread. The set of experiments described here tested whether such a strategy (called "benefit-target framing") could prove useful in promoting vaccine intentions. In two experiments, subjects from an online panel were randomized to receive a vaccination message focused on the benefits either to the self, to loved ones, or to society as a whole. Outcome measures included intentions to receive the vaccine and intentions to seek more information (n = 495). Results from two virtually identical studies were pooled to maximize power. Results suggest that messages framed in terms of benefits to society were more successful than those focused on the self, but messages focused on loved ones were not different from either of the others. Possible explanations for the findings, and implications for future research, are discussed.

Effects of targeted education for first-year university students on knowledge and attitudes about stem cell transplantation and donation

OBJECTIVES

Hematopoietic stem cell transplantation is a life-saving treatment, but donor numbers are lacking in Turkey and elsewhere. Increased awareness of hematopoietic stem cell transplantation among university students might help expand donation. We evaluated the effect of a brief targeted educational intervention on knowledge and attitudes about hematopoietic stem cell transplantation and donation among first-year university students in Turkey.

MATERIALS AND METHODS

There were 301 first-year university students (median age, 18 y) who volunteered: 163 medical students (54%) and 138 law students (46%). Before and after a brief lecture about hematopoietic stem cell transplantation, students answered a 5-item yes-or-no questionnaire regarding (1) knowledge about health benefits of hematopoietic stem cell transplantation; (2) knowledge about stem cell banking and donation in Turkey; (3) knowledge about the transplantation procedure; (4) prior experience and/or willingness to donate blood; and (5) willingness to donate stem cells. Reasons for motivation to donate blood and/or stem cells were categorized. Results before and after the lecture were evaluated with univariate and multivariate analyses.

RESULTS

The response rate was 100%. Significantly greater proportions of students had knowledge about hematopoietic stem cell transplantation and willingness to donate blood and stem cells after the lecture. There were no differences between medical and law students before the lecture. After the lecture, a significantly greater proportion of medical students indicated knowledge about health benefits of hematopoietic stem cell transplantation, stem cell banking and donation in Turkey, and the transplantation procedure.

CONCLUSIONS

Brief education about hematopoietic stem cell transplantation for university students can increase knowledge and awareness about hematopoietic stem cell transplantation and cause more positive attitudes about stem cell donation.

Identifying belief targets to increase bone marrow registry participation among students who have never donated blood

New members on bone marrow registries worldwide are needed to allow sufficient diversity in the donor pool to meet patient needs. We used the theory of planned behaviour belief-basis and surveyed students who had not donated blood previously (i.e. non-donors) (N = 150) about the behavioural, normative, and control beliefs informing their intentions to join the Australian Bone Marrow Donor Registry. Key beliefs predicting non-donors' intentions included: viewing bone marrow donation as an invasion of the body (β = -.35), normative support from parents (β = .40), anticipating pain/side effects from giving blood (β = -.27), and lack of knowledge about how to register (β = -.30). Few non-donors endorsed these beliefs, suggesting they are ideal targets for change in strategies encouraging bone marrow donor registration.

Race and ethnicity in decisions about unrelated hematopoietic stem cell donation

Large international registries of potential unrelated hematopoietic stem cell (HSC) donors, including the National Marrow Donor program (NMDP), continue to face difficulties finding matched donors for racial/ethnic minorities. One reason, in addition to the generally less common HLA types among minority patients, is the much higher registry attrition rate of racial/ethnic minorities compared with whites. Reasons for the higher attrition among minority potential donors remain unexplained. The goal of our cross-sectional telephone interview study was to generate a diverse sample of potential HSC donors who have preliminarily matched a patient and to identify factors associated with race/ethnicity and with the decision to continue toward potential donation or to opt out of the registry. Multiple culturally related, psychosocial, and donation-related factors were associated both with race/ethnic group membership and attrition from the registry. The most consistent factor associated with opting out of the registry across all race/ethnic groups was ambivalence about donation: doubts and worries, feeling unsure about donation, wishing someone else would donate in one's place. Our findings suggest that universal donor recruitment and management approaches based on reducing donation-related ambivalence and tailored messages and strategies for each of the individual race/ethnic groups are important.

Exploring the role of gender and risk perceptions in people's decisions to register as a bone marrow donor

Increasing the number of bone marrow (BM) donors is important to ensure sufficient diversity on BM registries to meet the needs of patients. This study used an experimental approach to test the hypothesis that providing information about the risks of BM donation to allay unsubstantiated fears would reduce male and female participants' perceptions of risk for donation and joining the Australian Bone Marrow Donor Registry (ABMDR). Males' and females' intentions to register on the ABMDR and their attitudes, norms and perceived behavioural control (efficacy) in relation to registering were also explored. Participants were allocated randomly to either a risk (exposed to risk information about BM donation) or no-risk (not exposed to risk information) condition. In partial support of hypotheses, exposure to risk information did reduce perceived risk for registering on the ABMDR for males only. Participants in the risk condition also demonstrated lower scores on attitude (males only) and intention compared with participants in the no-risk condition. These findings highlight the complex role of risk perceptions and gender differences in understanding people's decisions to join a BM registry.

Irradiated allogeneic cells enhance umbilical cord blood stem cell engraftment in immunodeficient mice

Umbilical cord blood (UCB) is a readily available source of hematopoietic stem cells for transplantation. UCB hematopoietic SCT for average- and large-sized patients is often limited by the number of cells available in a single unit. To address this limitation, we performed experiments to determine if adjunctive therapy with third-party human allogeneic cells enhances the engraftment of human UCB in immunodeficient mice. UCB cells with or without sequential infusion of irradiated third-party allogeneic cells were used in transplantation studies of NOD/SCID and NOD/SCID-IL2Rγ null mice. We studied the impact of irradiated allogeneic cells on colony formation in vitro using long-term culture assays also. Our studies demonstrate that short- and long-term UCB engraftment of immunodeficient mice is enhanced by irradiated allogeneic cells. Secondary transplants demonstrate the durability of engraftment. These preclinical studies support the further development of irradiated allogeneic cells as an adjunct to single UCB transplantation when limiting numbers of cells are available.

Predictors of refusal during a multi-step recruitment process for a randomized controlled trial of arthritis education

OBJECTIVE

Randomized controlled trials in patient education often have difficulty enrolling vulnerable populations-specifically, older, poorer, and less educated individuals. We undertook a randomized controlled trial (RCT) of an educational intervention for arthritis management, which included strategies to remove literacy-related barriers to participation. This paper reports on the multi-stage recruitment process and assesses whether refusal to participate was related to education, age, gender, working status, or insurance status.

METHODS

The recruitment protocol was designed to eliminate literacy-related barriers to participation. Patients were never asked to read or fill out forms. Interactions were oral, using everyday terms and short, clear sentences. Patients who declined during a screening call were considered Stage 1 Refusers. Patients who initially expressed interest but neither completed a baseline questionnaire nor provided consent were considered Stage 2 Refusers. Patients who consented were considered Enrollees. Age, gender, and insurance status were compared between Stage 1 Refusers and Enrollees. A second analysis compared these variables, plus educational attainment and working status, between Stage 2 Refusers, and Enrollees.

RESULTS

Of 408 eligible patients, there were 193 (47.3%) Stage 1 Refusers, 81 (19.9%) Stage 2 Refusers and 134 (32.8%) Enrollees. A higher proportion of Stage 1 Refusers than Enrollees were > or = 65 years old (58% vs. 37%, p = .0003). Multivariate analysis, adjusting for gender and insurance status, confirmed the effect of older age on refusal (OR = 2.3 (1.4, 3.6)). There were no significant differences between Stage 2 Refusers and Enrollees.

CONCLUSION

We found no evidence of refusal to participate due to educational attainment, working status, insurance status, or gender. Older patients were more likely to refuse participation at the first stage of recruitment.

PRACTICE IMPLICATIONS

Researchers should continue efforts to increase participation among older patients, particularly when studies are designed to be generalized to an elderly population as is the case with arthritis research. Strategies used in this recruitment protocol designed to remove literacy-related barriers to recruitment may be responsible for the observation that subjects with lower education did not have a higher rate of refusal. Such strategies deserve further study.

Bone marrow donation: factors influencing intentions in African Americans

PURPOSE/OBJECTIVES

To identify factors influencing the intentions of African Americans to donate or not to donate bone marrow.

DESIGN

Exploratory, descriptive.

SETTING

Participants were recruited from three churches, four public housing developments, and a university teaching hospital-all in the Philadelphia, PA, area.

SAMPLE

African American adults aged 18-60 years and able to read, write, and speak English.

METHODS

Focus groups were conducted for the purpose of instrument development. A factor analysis was conducted on questionnaire data. A multiple regression was conducted of the demographic variables and the factors that contributed to behavioral intention to donate or not to donate bone marrow.

MAIN RESEARCH VARIABLES

Attitudes, subjective norms, perceived behavioral control, and behavioral intentions regarding bone marrow donation.

FINDINGS

"Fear or not trusting," "external influences," and "concerned about resources" correlated significantly with the intention not to donate bone marrow. Helping others, approval of people, and value of knowledge correlated significantly with the intention to donate bone marrow.

CONCLUSIONS

Greater attention must be paid to increasing donations and improving the critical need for bone marrow donors. Patient education programs should be expanded to improve African Americans' knowledge of the importance of bone marrow donation, including the process, associated costs, and resources available to donors.

IMPLICATIONS FOR NURSING

Nurses--irrespective of practice areas--are key contributors to increase the rate of bone marrow donation, particularly among African Americans.