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Pulle J, Loue S, Kiwanuka GN, Francis B. Trust in Medical Research: A Comparative Study among Patients at a Regional Referral Hospital and Community Members in Lira District, Northern Uganda. J Empir Res Hum Res Ethics 2024; 19:48-57. [PMID: 38216325 PMCID: PMC10957324 DOI: 10.1177/15562646231224374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
Events such as the Tuskegee syphilis study shaped how the public perceives and trusts medical research globally. However, few studies have examined trust in medical research in developing countries. We tested the hypothesis that levels of trust may be lower among community members compared to hospitalized persons in Uganda. We enrolled 296 participants in rural northern Uganda, and 148(50%) were from the community, 192(65%) were female. Mean level of trust for medical research was higher among hospitalized persons compared to community members (p = 0.0001). Previous research participation (p = 0.03), and willingness to participate in future research (p = 0.001) were positively associated with trust. Medical personnel should engage more with the communities in which they practice fostering trust in medical research.
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Affiliation(s)
- Jafesi Pulle
- Department of Community Health, Mbarara University of Science and Technology, P.O. BOX 1410, Mbarara, Uganda
- Uganda Heart Institute, Kampala, Uganda
| | - Sana Loue
- Department of Bioethics, School of Medicine, Case Western Reserve University, Cleveland OH 44106, USA
| | - Gertrude N. Kiwanuka
- Department of Biochemistry, Mbarara University of Science and Technology, P.O. BOX 1410, Mbarara, Uganda
| | - Bajunirwe Francis
- Department of Community Health, Mbarara University of Science and Technology, P.O. BOX 1410, Mbarara, Uganda
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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. J Clin 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] [What about the content of this article? (0)] [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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Antoine-LaVigne D, Hayes T, Fortenberry M, Ohikhuai E, Addison C, Mozee S, McGill D, Shanks ML, Roby C, Jenkins BWC, Tchounwou PB. Trust and Biomedical Research Engagement of Minority and Under-Represented Communities in Mississippi, USA. Int J Environ Res Public Health 2023; 20:1592. [PMID: 36674346 PMCID: PMC9860548 DOI: 10.3390/ijerph20021592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/30/2022] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
Trust is critical to the development and maintenance of effective research collaborations and community engagement. The purpose of this study was to assess the current attitudes and level of trust pertaining to health research among residents of Central Mississippi, the priority health region for the Research Centers in Minority Institutions (RCMI) Center for Health Disparities Research (RCHDR) at Jackson State University. The cross-sectional study was conducted from November 2021 to April 2022. The data were analyzed using descriptive statistics carried out by SPSS statistical software. A total of 146 participants responded to the survey. The participants were predominately African American (99%) and female (75%). Historical research studies, the researchers' qualities, and potential benefits from participation were factors affecting the level of trust in the research process. Ninety percent (n = 131) expressed that it was important to be involved in the research process, and 98.5% (n = 144) agreed that discussing the research findings with the participants was important for establishing trust in the research process. While trust in the research process does not guarantee participation, trust is a precursor for those who decide to engage in health disparities research. Key findings will be integrated into the RCHDR research agenda to foster further development and implementation of innovative community-based participatory research toward the control and/or prevention of diseases that disproportionately affect minority and under-represented populations in Mississippi.
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Affiliation(s)
- Donna Antoine-LaVigne
- RCMI Center for Health Disparities Research, Jackson State University, Jackson, MS 39217, USA
| | - Traci Hayes
- School of Health Professions, University of Southern Mississippi, Hattiesburg, MS 39406, USA
| | - Marty Fortenberry
- RCMI Center for Health Disparities Research, Jackson State University, Jackson, MS 39217, USA
| | - Evidence Ohikhuai
- RCMI Center for Health Disparities Research, Jackson State University, Jackson, MS 39217, USA
| | - Clifton Addison
- Jackson Heart Study Graduate Training and Education Center, School of Public Health, Jackson State University, Jackson, MS 39213, USA
| | - Sam Mozee
- Mississippi Urban Research Center, Jackson State University, Jackson, MS 39201, USA
| | - Dorothy McGill
- Innovative Behavioral Services, Ridgeland, MS 39157, USA
| | - Mangle L. Shanks
- Shanks Health Housing, Employment, Education & Training Services, Inc., Jackson, MS 39289, USA
| | | | - Brenda W. Campbell Jenkins
- Jackson Heart Study Graduate Training and Education Center, School of Public Health, Jackson State University, Jackson, MS 39213, USA
| | - Paul B. Tchounwou
- RCMI Center for Health Disparities Research, Jackson State University, Jackson, MS 39217, USA
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Smirnoff M, Wilets I, Ragin D, Adams R, Holohan J, Rhodes R, Winkel G, Ricc E, Clesca C, Richardson LD. A paradigm for understanding trust and mistrust in medical research: The Community VOICES study. AJOB Empir Bioeth 2018; 9:39-47. [PMID: 29368998 PMCID: PMC6092744 DOI: 10.1080/23294515.2018.1432718] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND To promote justice in research practice and rectify health disparities, greater diversity in research participation is needed. Lack of trust in medical research is one of the most significant obstacles to research participation. Multiple variables have been identified as factors associated with research participant trust/mistrust. A conceptual model that provides meaningful insight into the interplay of factors impacting trust may promote more ethical research practice and provide an enhanced, actionable understanding of participant mistrust. METHODS A structured survey was developed to capture attitudes toward research conducted in emergency situations; this article focuses on items designed to assess respondents' level of trust or mistrust in medical research in general. Community-based interviews were conducted in English or Spanish with 355 New York City residents (white 42%, African American 29%, Latino 22%). RESULTS Generally favorable attitudes toward research were expressed by a majority (85.3%), but many respondents expressed mistrust. Factor analysis yielded four specific domains of trust/mistrust, each of which was associated with different demographic variables: general trustworthiness (older age, not disabled); perceptions of discrimination (African American, Latino, Spanish language preference); perceptions of deception (prior research experience, African American); and perceptions of exploitation (less education). CONCLUSIONS The four domains identified in the analysis provide a framework for understanding specific areas of research trust/mistrust among disparate study populations. This model offers a conceptual basis for the design of tailored interventions that target specific groups to promote trust of individual researchers and research institutions as well as to facilitate broader research participation.
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Affiliation(s)
| | - I Wilets
- Icahn School of Medicine at Mount Sinai
| | | | | | - J. Holohan
- New York Presbyterian Weill Cornell Hospital
| | - R. Rhodes
- Icahn School of Medicine at Mount Sinai
| | - G. Winkel
- Icahn School of Medicine at Mount Sinai
| | | | - C. Clesca
- Icahn School of Medicine at Mount Sinai
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Robinson BN, Newman AF, Tefera E, Herbolsheimer P, Nunes R, Gallagher C, Randolph-Jackson P, Omogbehin A, Dilawari A, Pohlmann PR, Mohebtash M, Lee Y, Ottaviano Y, Mohapatra A, Lynce F, Brown R, Mete M, Swain SM. Video intervention increases participation of black breast cancer patients in therapeutic trials. NPJ Breast Cancer 2017; 3:36. [PMID: 28944289 PMCID: PMC5603544 DOI: 10.1038/s41523-017-0039-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 07/24/2017] [Accepted: 08/03/2017] [Indexed: 11/24/2022] Open
Abstract
There is a striking racial and ethnic disparity in incidence and mortality of cancer yet minorities remain markedly underrepresented in clinical trials. This pilot study set out to determine the impact of a 15-min culturally tailored educational video on three outcomes relating to clinical trials: likely participation, attitudes (assessed based on six barriers), and actual enrollment. Breast cancer patients with Stage I-III, if diagnosed within previous 6 months, or metastatic disease who self-identified as black or African American were invited to participate. The primary outcome measure was the decision to participate in a therapeutic clinical trial after the intervention. Patients’ intention to enroll on a therapeutic clinical trial and the change in attitudes toward clinical trials were measured by the previously developed Attitudes and Intention to Enroll in Therapeutic Clinical Trials (AIET) questionnaire. Of the 200 patients that participated, 39 (19.5%) patients signed consent to participate in a therapeutic clinical trial; 27 (13.5%) patients enrolled, resulting in a 7.5% increase from our baseline comparison of 6% clinical trial enrollment rate in black cancer patients (p < .001). Pre-test versus post-test assessment demonstrated the proportion of patients expressing likelihood to enroll in a therapeutic trial following the intervention increased by 14% (p < .001). Among 31 AIET items, 25 (81%) showed statistically significant and positive change post-intervention. The findings suggest the promising utility of a culturally tailored video intervention for improving black patients’ attitudes regarding clinical trial participation and resultant enrollment. Future efforts should continue to target facilitators of population-specific recruitment, enrollment, and retention in therapeutic and non-therapeutic clinical trials. A culturally tailored educational video can boost participation among black patients in clinical trials of new breast cancer treatments. A US team led by Sandra Swain from Georgetown University Medical Center in Washington, DC, created a 15-min video designed to address six of the concerns commonly cited by blacks about human subjects research. The researchers showed the video to 200 black patients, and saw a large bump in the number of women willing to sign up for a therapeutic trial. On average, only 6% of black cancer patients typically enroll in clinical trials. But in the video intervention study, 19.5% agreed to participate and then 13.5% went ahead with a trial. Video watchers also reported a positive change in their attitude toward clinical research. The study points to the need for population-specific recruitment efforts.
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Affiliation(s)
- Brandi N Robinson
- MedStar Health Research Institute, Hyattsville, MD USA.,Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC USA
| | - Antoinette F Newman
- MedStar Health Research Institute, Hyattsville, MD USA.,Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC USA
| | - Eshetu Tefera
- MedStar Health Research Institute, Hyattsville, MD USA
| | - Pia Herbolsheimer
- Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC USA
| | - Raquel Nunes
- Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC USA
| | | | | | - Adedamola Omogbehin
- Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC USA
| | - Asma Dilawari
- Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, DC USA
| | - Paula R Pohlmann
- Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, DC USA
| | | | - Young Lee
- MedStar Harbor Hospital, Baltimore, MD USA
| | | | - Avani Mohapatra
- Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC USA
| | - Filipa Lynce
- Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC USA.,Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, DC USA
| | - Richard Brown
- Virginia Commonwealth University School of Medicine, Richmond, VA USA
| | - Mihriye Mete
- MedStar Health Research Institute, Hyattsville, MD USA
| | - Sandra M Swain
- Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC USA.,Lombardi Comprehensive Cancer Center, MedStar Georgetown University Hospital, Washington, DC USA
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Braunack‐Mayer AJ, Gibson OR. Including minority populations in research: we must do better. Med J Aust 2017; 207:22-23. [DOI: 10.5694/mja17.00305] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 05/03/2017] [Indexed: 11/17/2022]
Affiliation(s)
| | - Odette R Gibson
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA
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Jecker NS, Wightman AG, Rosenberg AR, Diekema DS. From protection to entitlement: selecting research subjects for early phase clinical trials involving breakthrough therapies. J Med Ethics 2017; 43:391-400. [PMID: 28408724 DOI: 10.1136/medethics-2016-103868] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 01/25/2017] [Accepted: 02/13/2017] [Indexed: 06/07/2023]
Abstract
Our goals are to (1) set forth and defend a multiprinciple system for selecting individuals who meet trial eligibility criteria to participate in early phase clinical trials testing chimeric antigen receptor (CAR T-cell) for acute lymphoblastic leukaemia when demand for participation exceeds spaces available in a trial; (2) show the relevance of these selection criteria to other breakthrough experimental therapies; (3) argue that distinct distributive justice criteria apply to breakthrough experimental therapies, standard research and healthcare and (4) argue that as evidence of benefit increases, the emphasis of justice in research shifts from protecting subjects from harm to ensuring fair access to benefits.
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Affiliation(s)
- Nancy S Jecker
- University of Washington School of Medicine, Department of Bioethics & Humanities, Seattle, Washington, USA
| | - Aaron G Wightman
- University of Washington School of Medicine, Department of Pediatrics and Seattle Children's Hospital, Division of Nephrology, Seattle, Washington, USA
| | - Abby R Rosenberg
- University of Washington School of Medicine, Department of Pediatrics and Seattle Children's Hospital, Division of Hematology-Oncology, Seattle, Washington, USA
| | - Douglas S Diekema
- University of Washington Department of Pediatrics and Seattle Children's Hospital, Division of Emergency Medicine, Seattle, Washington, USA
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Brown RF, Davis R, Wilson Genderson M, Grant S, Cadet D, Lessard M, Alpert J, Ward J, Ginder G. African-American patients with cancer Talking About Clinical Trials (TACT) with oncologists during consultations: evaluating the efficacy of tailored health messages in a randomised controlled trial-the TACT study protocol. BMJ Open 2016; 6:e012864. [PMID: 27986738 PMCID: PMC5168644 DOI: 10.1136/bmjopen-2016-012864] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Low rates of accrual of African-American (AA) patients with cancer to therapeutic clinical trials (CTs) represent a serious and modifiable racial disparity in healthcare that impedes the development of promising cancer therapies. Suboptimal physician-patient consultation communication is a barrier to the accrual of patients with cancer of any race, but communication difficulties are compounded with AA patients. Providing tailored health messages (THM) to AA patients and their physician about CTs has the potential to improve communication, lower barriers to accrual and ameliorate health disparities. OBJECTIVE (1) Demonstrate the efficacy of THM to increase patient activation as measured by direct observation. (2) Demonstrate the efficacy of THM to improve patient outcomes associated with barriers to AA participation. (3) Explore associations among preconsultation levels of: (A) trust in medical researchers, (B) knowledge and attitudes towards CTs, (C) patient-family member congruence in decision-making, and (D) involvement/information preferences, and group assignment. METHODS AND ANALYSIS First, using established methods, we will develop THM materials. Second, the efficacy of the intervention is determined in a 2 by 2 factorial randomised controlled trial to test the effectiveness of (1) providing 357 AA patients with cancer with THM with 2 different 'depths' of tailoring and (2) either providing feedback to oncologists about the patients' trial THM or not. The primary analysis compares patient engaged communication in 4 groups preconsultation and postconsultation. ETHICS AND DISSEMINATION This study was approved by the Virginia Commonwealth University Institutional Review Board. To facilitate use of the THM intervention in diverse settings, we will convene 'user groups' at 3 major US cancer centres. To facilitate dissemination, we will post all materials and the implementation guide in publicly available locations. TRIAL REGISTRATION NUMBER NCT02356549.
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Affiliation(s)
- R F Brown
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - R Davis
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - M Wilson Genderson
- Siminoff Research Group, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA
| | - S Grant
- Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - D Cadet
- Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - M Lessard
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - J Alpert
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - J Ward
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - G Ginder
- Massey Cancer Center, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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French C, Stavropoulou C. Specialist nurses' perceptions of inviting patients to participate in clinical research studies: a qualitative descriptive study of barriers and facilitators. BMC Med Res Methodol 2016; 16:96. [PMID: 27515557 PMCID: PMC4982234 DOI: 10.1186/s12874-016-0204-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 07/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increasing the number of patients participating in research studies is a current priority in the National Health Service (NHS) in the United Kingdom. The role of specialist nurses in inviting patients to participate is important, yet little is known about their experiences of doing so. The aim of this study was to explore the perceptions of barriers and facilitators held by specialist nurses with experience of inviting adult NHS patients to a wide variety of research studies. METHODS A cross-sectional qualitative descriptive study was conducted between March and July 2015. Participants were 12 specialist nurses representing 7 different clinical specialties and 7 different NHS Trusts. We collected data using individual semi-structured interviews, and analysed transcripts using the Framework method to inductively gain a descriptive overview of barriers and facilitators. RESULTS Barriers and facilitators were complex and interdependent. Perceptions varied among individuals, however barriers and facilitators centred on five main themes: i) assessing patient suitability, ii) teamwork, iii) valuing research, iv) the invitation process and v) understanding the study. Facilitators to inviting patients to participate in research often stemmed from specialist nurses' attitudes, skills and experience. Positive research cultures, effective teamwork and strong relationships between research and clinical teams at the local clinical team level were similarly important. Barriers were reported when specialist nurses felt they were providing patients with insufficient information during the invitation process, and when specialist nurses felt they did not understand studies to their satisfaction. CONCLUSION Our study offers several new insights regarding the role of specialist nurses in recruiting patients for research. It shows that strong local research culture and teamwork overcome some wider organisational and workload barriers reported in previous studies. In addition, and in contrast to common practice, our findings suggest research teams may benefit from individualising study training and invitation procedures to specialist nurses' preferences and requirements. Findings provide a basis for reflection on practice for specialist nurses, research teams, policymakers, and all with an interest in increasing patient participation in research.
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Affiliation(s)
- Caroline French
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University London, 4 Newark Street, London, E1 2AT UK
| | - Charitini Stavropoulou
- School of Health Sciences, City University London, Northampton Square, London, EC1V 0HB UK
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Glickman SW, Ndubuizu A, Weinfurt KP, Hamilton CD, Glickman LT, Schulman KA, Cairns CB. Perspective: The case for research justice: inclusion of patients with limited English proficiency in clinical research. Acad Med 2011; 86:389-393. [PMID: 21248607 DOI: 10.1097/acm.0b013e318208289a] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Persons with limited English proficiency (LEP) constitute a growing portion of the U.S. population, yet they are underrepresented in clinical research. This inherently limits the societal benefits of the research and its generalizability to ethnic populations living in the United States. To illustrate the complexity associated with including LEP participants in clinical research, the authors critically evaluated LEP consent requirements posted on the Web sites of 134 academic health centers in March 2008. They found wide variability with regard to consent policies and striking interinstitutional differences in posted IRB policies and attitudes toward consent of LEP patients in research. The authors argue this variation highlights competing concerns between autonomy and justice. Outcomes-based justice requires inclusion of LEP patients in the research, yet the consent process is often resource-intensive and complex. The authors suggest that more uniform and specific guidance from federal agencies for enrollment of LEP patients in clinical research be established and that this guidance explicitly recalibrate the current balance between autonomy and justice. Investigators and institutional review boards should also develop streamlined best practices to reduce unnecessary effort and expense associated with recruitment of LEP individuals. LEP individuals should have fair access to clinical research in order to fully realize individual and societal benefits of their participation and to ensure the generalizability of scientific discovery.
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Affiliation(s)
- Seth W Glickman
- University of North Carolina, Chapel Hill, North Carolina, USA.
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Frye RL, Simari RD, Gersh BJ, Burnett JC, Brumm S, Myerle K, Jaffe AS, Holmes DR, Lerman A, Terzic A. Ethical Issues in Cardiovascular Research Involving Humans. Circulation 2009; 120:2113-21. [DOI: 10.1161/circulationaha.107.752766] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Braunstein JB, Sherber NS, Schulman SP, Ding EL, Powe NR. Race, medical researcher distrust, perceived harm, and willingness to participate in cardiovascular prevention trials. Medicine (Baltimore) 2008; 87:1-9. [PMID: 18204365 DOI: 10.1097/md.0b013e3181625d78] [Citation(s) in RCA: 189] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Minority underrepresentation exists in medical research including cardiovascular clinical trials, but the hypothesis that this relates to distrust in medical researchers is unproven. Therefore, we examined whether African American persons differ from white persons in perceptions of the risks/benefits of trial participation and distrust toward medical researchers, and whether these factors influence willingness to participate (WTP) in a clinical drug trial. Participants were self-administered a survey regarding WTP in a cardiovascular drug trial given to 1440 randomly selected patients from 13 Maryland outpatient cardiology and general medicine clinics. Patients reported their WTP, rated their perceived chances of experiencing health benefit and harm, and rated their distrust toward researchers. Of eligible participants, 70% responded, and 717 individuals were included: 36% African American and 64% white. African American participants possessed lower WTP than white participants (27% vs. 39%, p = 0.001) and had higher mean distrust scores than whites (p < 0.0001). African American participants more frequently reported that doctors would less fully explain research participation to them (24% vs. 13%, p < 0.001), use them as guinea pigs without their consent (72% vs. 49%, p < 0.001), prescribe medication as a way of experimenting on people without their knowledge (35% vs. 16%, p < 0.001), and ask them to participate in research even if it could harm them (24% vs. 15%, p = 0.002). African American participants also more often believed they could less freely ask their doctor questions (8% vs. 2%, p < 0.001) and that doctors had previously experimented on them without their consent (58% vs. 25%, p < 0.001). African American participants expressed lesser WTP than white participants after controlling for racial differences in age, sex, socioeconomic status and cardiovascular disease risk profiles (multivariable odds ratio [OR], 0.57; 95% confidence interval [CI], 0.39-0.85). The impact of race was attenuated and nonsignificant after adjustment for potential mediating factors of racial differences in medical researcher distrust and perceived risk of harm (explanatory model OR, 0.84; 95% CI 0.54-1.30). In summary, African American participants expressed markedly greater concerns about experiencing harm from participation in clinical trials and distrust toward medical researchers than white participants. These factors, in turn, appear to explain much of the resistance among African American persons to participate in clinical trials compared to white persons.
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Affiliation(s)
- Joel B Braunstein
- From Center for Outcomes Research and Evaluation (JBB), Yale School of Medicine, New Haven, Connecticut; Department of Dermatology (NSS), Johns Hopkins School of Medicine; Division of Cardiology (SPS) and Division of General Internal Medicine (NRP), Department of Medicine, Johns Hopkins Hospital; Department of Health Policy and Management (NRP), Johns Hopkins Bloomberg School of Public Health; and Welch Center for Prevention, Epidemiology and Clinical Research (NRP), Johns Hopkins Medical Institutions, Baltimore, Maryland; Division of Preventive Medicine (ELD), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; and Departments of Epidemiology and Nutrition (ELD), Harvard School of Public Health, Boston, Massachusetts
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