Lessons Learned While Developing “Clinical Trials Education for Native Americans” Curriculum

Barriers and Strategies Related to Qualitative Research on Genetic Ancestry Testing in Indigenous Communities

Conducting genetics-related research with populations that have historically experienced considerable harm and little benefit from genetics research poses unique challenges for understanding community-based perceptions of new genetic technologies. This article identifies challenges and strategies for collecting qualitative data on the perceptions of direct-to-consumer (DTC) Genetic Ancestry tests (GAT) among diverse Indigenous communities. Based on a 3-year project related to perceptions, attitudes, and values associated with genetic ancestry testing among diverse Indigenous communities in Oklahoma, the engagement process revealed specific opportunities to improve the process of qualitative data collection related to GAT, and more broadly, to conduct genetics-related research with Indigenous communities in culturally and methodologically appropriate ways. Priority areas include issues related to participant recruitment and tribal advisory boards, challenges of self-identification as a recruitment mechanism, and the necessity of including Indigenous researchers in all aspects of the research process.

Responses to a theoretically adapted clinical trial education session: faith-based sites versus rural work site dissemination

The process for advancing biomedical knowledge depends upon recruiting an adequate and representative sample of individuals to voluntarily participate in research studies. A consistent personal barrier to cancer clinical trial participation is the lack of awareness and understanding related to trial availability, and the prevention and treatment roles participation represents. In particular, comprehensive community-based approaches to recruit and educate rural residents are needed. Moreover, consistent under representation of priority populations should be addressed with innovative outreach to collaborate in identifying culturally meaningful approaches. A theoretically adapted version of a component of the National Cancer Institute's "Clinical Trial Education Series" was assessed via educational sessions delivered through work sites and churches. From eight focus groups with 90 participants, we found that church leaders, congregants, and community members were receptive to education on cancer research, increased their short-term knowledge about it, and intent to participate in cancer studies, decreased their current anxiety about clinical trials participation, and provided specific suggestions for further adapting the educational session to be even more culturally relevant. These outcomes provide evidence to support the effectiveness of future customized recruitment strategies embedded within a community or faith-based environment that may increase knowledge, decrease anxiety and intent to actual participation in cancer studies, as well as impact study representativeness and address causes of health disparities.

Developing concurrency messages for the black community in Seattle, Washington

In the United States, Blacks are disproportionately impacted by HIV/AIDS. Sexual networks and concurrent relationships have emerged as important contributors to the heterosexual transmission of HIV. To date, Africa is the only continent where an understanding of the impact of sexual concurrency has been conveyed in HIV prevention messaging. This project was developed by researchers and members of the Seattle, Washington, African American and African-Born communities, using the principles of community-based participatory research (CBPR). Interest in developing concurrency messaging came from the community and resulted in the successful submission of a community-academic partnership proposal to develop and disseminate HIV prevention messaging around concurrency. The authors describe (a) the development of concurrency messaging through the integration of collected formative data and findings from the scientific literature; (b) the process of disseminating the message in the local Black community; and (c) important factors to consider in the development of similar campaigns.

Development of a cancer clinical trials multi-media intervention: clinical trials: are they right for you?

OBJECTIVE

To describe processes used to develop a multi-media psycho-educational intervention to prepare patients for a discussion about cancer clinical trials (CTs).

METHODS

Guided by a Steering Committee, formative research was conducted to develop an informative and engaging tool about cancer CTs. Twenty-three patients and caregivers participated in formative in-depth interviews to elicit information about perceptions of cancer CTs to inform production of a new media product.

RESULTS

Formative research revealed participants had concerns about experimentation, held beliefs that cancer CTs were for patients who had no other treatment options, and wanted a balance of information about pros and cons of CT participation. The value of physicians as credible spokespersons and the use of patients as role-models were supported. Using iterative processes, the production team infused the results into creation of a multimedia psycho-educational intervention titled Clinical Trials: Are they Right for You?

CONCLUSION

An intervention, developed through an iterative consumer-focused process involving multiple stakeholders and formative research, may result in an engaging informative product.

PRACTICE IMPLICATIONS

If found to be efficacious, Clinical Trials: Are they Right for You? is a low-cost and easily disseminated multimedia psycho-educational intervention to assist cancer patients with making an informed decision about cancer CTs.

Recommendations for enhancing clinical trials education: a review of the literature

This study aims to apply the evidence-based practice (EBP) process to determine the factors that influence patients' understanding of, participation in, and satisfaction with clinical trials, the informed consent process, and treatment decisions and to make recommendations for improving clinical trials education. Beginning with evidence retrieval, the authors identified key search terms and searched MEDLINE--Ovid, MEDLINE--PubMed, and the Cumulative Index to Nursing and Allied Health Literature to identify articles published between July 2001 and July 2006 that highlighted clinical trials education. The articles were reviewed for clinical trials patient education information, clinician methods of communicating clinical trial information to patients, and patient satisfaction with the clinical trials process, including the informed consent process. As a result, practice changes were recommended for the patient/family, staff/community, and institution. From the literature review, 81 articles were identified. Recurring themes included decision-making, patient education, staff education, and pediatrics. Most articles focused on methods and strategies aimed at improving education at the patient/family, staff/community, and institutional levels. The issues surrounding clinical trial education are complex due to multiple variables interfering with poor patient understanding of, participation in, and satisfaction with clinical trial treatment decisions. On the basis of our findings, we recommend that clinicians involved in educating patients, families, staff, and communities about clinical trials have an awareness of and understanding for very complex issues.

Increasing Asian American women's research participation: the Asian grocery store-based cancer education program

BACKGROUND

Research study participants with diverse characteristics produce the most generalizable outcomes, but recruiting heterogeneous samples is difficult.

METHODS

This pilot study tests whether Asian women (N=1079) with diverse language proficiencies, who were personally recruited to one study by a linguistically and culturally aligned recruiter, would enroll in another study with a single mailed invitation in English.

RESULTS

The 134 participants in the second study represented 17.2% of those 779 women who had completed both baseline and follow-up surveys in the original study, making this characteristic the best predictor of future study participation. Of the 303 women in the first study who said they would be willing to participate in future studies, 17% (51) participated in the second study. Of the 733 who said they would not be willing to participate in future studies, 11% (83) participated. However, given the larger size of this group, researchers may recruit a greater absolute number of participants from it. While this rate of participation was less than the 25% rate achieved in the first study, the second study's single, mailed English language invitation was likely a barrier to participation.

CONCLUSION

Securing IRB-approval to invite prior study participants from traditionally underrepresented communities to a new study is a strategy investigators can use to increase the diversity of their samples. Further research is warranted to determine whether Asian women who have participated in one study might also become effective recruiters for future studies.

A model of effects of narrative as culture-centric health promotion

Health promotion interventions designed for specific cultural groups often are designed to address cultural values through culturally adapted messages. Recent trends in health promotion incorporate narrative theory, locating culture within the narratives of cultural members, and suggesting that narrative may provide a central, grounded medium for expressing and shaping health behavior. We suggest that culturally grounded narratives are a natural choice for identifying and shaping health messages for specific audiences. A Model of Culture-Centric Narratives in Health Promotion is proposed based on previous persuasion and health promotion research. This model may be used to guide the development and testing of the narrative characteristics and psychosocial mediators of behavior change in a broad range of health interventions. Implications, boundaries, and limitations of the model are discussed.

Overcoming barriers to cancer care through health navigation programs

OBJECTIVES

To provide an overview of theoretical concepts in community-based, culturally tailored health navigation programs that have improved access to health care for ethnic minority populations, particularly for Asian Americans and Pacific Islanders.

DATA SOURCES

Published articles, reports, book chapters, government documents, research findings.

CONCLUSION

Community-based patient navigation interventions provide promising strategies for providing culturally tailored programs that are more likely to succeed in eliminating cancer disparities in screening and early detection of cancers for diverse cultural communities.

IMPLICATIONS FOR NURSING PRACTICE

Nurses need to be more involved in developing and delivering effective, culturally competent community-based cancer screening and treatment navigation programs through education, practice, research, and policy improvement.

Challenges in community-based participatory research implementation: experiences in cancer prevention with Pacific Northwest American Indian tribes

BACKGROUND

Much has been written about community-based participatory research (CBPR) history and principles, but few have addressed challenges in implementation in transcultural situations. The goal of this discussion is to address CBPR implementation issues in cancer prevention research with American Indian tribal communities in the Pacific Northwest.

METHOD

Information in this discussion is drawn from qualitative research conducted over a 10-year period in which CBPR was employed in cancer prevention research with Pacific Northwest Indian tribes. CBPR principles provide the framework for the discussion: establishing trusting relationships, assuring participation, sharing power, and communicating.

RESULTS

In this work, we found that CBPR is appropriate for use in Pacific Northwest Indian tribal communities and is compatible with cultural values. We also found that there are many challenges. Recommendations are provided on needed institutional and structural changes.

CONCLUSIONS

CBPR is an important research approach in addressing cancer prevention health disparities among American Indian tribal communities. Continued effort needs to be directed toward creating systems and structures to support researchers in utilizing this method. Findings are of value to researchers aiming to implement CBPR in Indian communities and to practitioners, policy makers, and administrators who make decisions about CBPR funding and support structures.

Walking forward: the South Dakota Native American project

BACKGROUND

The "Walking Forward" program is a scientific collaborative program between Rapid City Regional Hospital, the University of Wisconsin, the Mayo Clinic, and partnerships with the American Indian community in western South Dakota-3 reservations and 1 urban population. The purpose is to increase participation of health disparities populations on National Cancer Institute clinical trials as part of the Cancer Disparities Research Partnership program. Clinical practice suggests that Native American cancer patients present with more advanced stages of cancer and hence have lower cure rates and higher treatment-related morbidities. It is hypothesized that a conventional course of cancer treatment lasting 6 to 8 weeks may be a barrier.

METHODS

Innovative clinical trials have been developed to shorten the course of treatment. A molecular predisposition to treatment side effects is also explored. These clinical endeavors will be performed in conjunction with a patient navigator research program.

RESULTS AND CONCLUSIONS

Research metrics include analysis of process, clinical trials participation, treatment outcome, and assessment of access to cancer care at an early stage of disease.