An evaluation of stakeholder engagement in comparative effectiveness research: lessons learned from SWOG S1415CD

Aim: Stakeholder engagement is central to comparative effectiveness research yet there are gaps in definitions of success. We used a framework developed by Lavallee et al. defining effective engagement criteria to evaluate stakeholder engagement during a pragmatic cluster-randomized trial. Methods: Semi-structured interviews were developed from the framework and completed to learn about members' experiences. Interviews were analyzed in a deductive approach for themes related to the effective engagement criteria. Results: Thirteen members participated and described: respect for ideas, time to achieve consensus, access to information and continuous feedback as areas of effective engagement. The primary criticism was lack of diversity. Discussion: Feedback was positive, particularly among themes of respect, trust and competence, and led to development of a list of best practices for engagement. The framework was successful for evaluating engagement. Conclusion: Standardized frameworks allow studies to formally evaluate their stakeholder engagement approach and develop best practices for future research.

Abstract IA28: Advocate Perspective: Diversity in research: A missing link to eliminate health disparities

The literature shows that whites, mostly males, make up the majority (more than 80%) of the participants in cancer treatment and prevention studies. This is of great concern as the finding of these studies are generalized among different population groups. The federal government began taking action to address diversity in research since 1993 with the National Institute of Health Revitalization Act directed to increase participation of women and minorities in clinical research. Other government initiatives and programs have followed, such as the Minority Health and Health Disparities Research and Education Act, National Center for Minority Health and Health Disparities, and Excellence Center to Eliminate Ethnic and Racial Disparities, among others. Despite the government's efforts to increase diversity in research for more than 25 years, women and racial/ethnic minorities continue to be under-represented. Furthermore, as we keep moving into the era of precision medicine, fast-accumulating evidence suggests that the gap will grow even bigger. Understanding molecular biology in health disparities of cancer across populations and studying the interaction of biologic factors and other factors that contribute to the differences in cancer burden should become even more a research priority. To increase the participation of women and minorities in research, strategies such as having recruitment as a separate criterion in research proposal evaluations could result in a more thorough approach. This could lead to the consideration of cultural as well as other important aspects of the population group of interest. Also, specific strategies to overcome patients' barriers to enrollment in research should be implemented. In order to address under-representation in research, one has to consider tackling diversity from many angles. Diversity goes beyond recruiting diverse populations. Attention should also be given to diversity in researchers, research teams, study sections, research staff, physicians recruiting for clinical trials, and patient advocates. Moreover, journals and their editors play a key role in reducing the gap.

Citation Format: Barbara Segarra-Vazquez. Advocate Perspective: Diversity in research: A missing link to eliminate health disparities [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr IA28.

Feasibility of a digital medicine program in optimizing opioid pain control in cancer patients (SWOG S1916)

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Background: The undertreatment of pain in patients with advanced or metastatic cancer is well described in cancer research. Overcoming barriers that prevent successful use of opioid analgesics for cancer pain requires a clear understanding of how individuals use oral medications at home. The Proteus Discover is a digital medicine program (DMP) consisting of an FDA-approved ingestible sensor made of dietary minerals co-encapsulated with patients’ medications, a wearable sensor patch, and a mobile device app that enables patients to electronically transmit their medication adherence patterns. Use of the DMP has demonstrated improved clinical outcomes vs. usual care in patients with diabetes and hypertension, shown superiority over directly-observed therapy in tuberculosis and has been studied in the treatment of patients with hepatitis C, HIV, cancer and severe mental illness, but it has not been previously studied with opioids or in monitoring cancer-related pain. Methods: We are conducting a multicenter pilot study at SWOG NCORP sites to test the feasibility of using the DMP to monitor opioid use in the treatment of metastatic cancer pain. Eligible patients must have a diagnosis of metastatic cancer, have a baseline Brief Pain Inventory worst pain score of ≥3, be deemed by their physician to need initiation or up-titration of oxycodone-acetaminophen for pain control, and be able to read English. Primary outcomes include: (1) study accrual of 60 patients within six months of study activation at all participating sites; (2) patient retention defined as ≥50 patients completing the study, and; (3) adherence to the DMP defined as ≥66% of patients wearing the sensor patch for ≥28 days of the 42-day observation period. Secondary outcomes include change in Brief Pain Inventory pain scores, opioid medication consumption, number of safety alert triggers for high consumption, hospital or emergency room visits for pain, activity levels, and frequency of changes to the pain control regimen. The study will enroll patients at six sites; the first patient was enrolled on 1/20/2020. If successful, this study will inform design of a randomized controlled trial of the DMP vs. usual care in optimizing medication utilization and controlling cancer-related pain. Clinical trial information: NCT04194528 .

Abstract P1-16-01: Susan G. Komen advocates in science (AIS): Bringing patients’ perspectives to research

Susan G. Komen® is committed to ensure the unique, valuable perspectives of breast cancer patients, survivors, and co-survivors are integrated into scientific discussions and decisions impacting Komen’s progress toward ending breast cancer. Advocates in Science (AIS) was formed to build a cadre of skilled, knowledgeable and broadly-networked breast cancer research advocates; and engage them throughout the research process. AIS members provide real-world understanding of what matters to patients and a sense of urgency to find better solutions to prevent, diagnose, treat, and cure breast cancer. AIS, led by an AIS Steering Committee, is a multi-pronged approach to research advocacy:

• A Diverse & Engaged Membership: The latest survey was sent to 230 members. 146 (65%) completed it. AIS has a wide range of research advocacy experience. This latest survey showed a shift toward more experienced advocates. AIS members with metastatic disease increased 1.5%; co-survivors (friend & family caregivers) increased 5%; and younger members increased 6.4%. AIS had a slight increase in diversity: 6.7% African American; 0.8% Asian; and 2.1% Hispanic.

• Ongoing Education & Training: Komen is committed to developing the next generation of breast cancer research advocates and strengthening the skills and knowledge of all AIS members. AIS provides opportunities for advocates to learn more about research and strengthen their research advocacy skills through a variety of educational sessions and rigorous training programs. New resources are developed based on members’ suggestions and offer varied formats: online tools, webinars, face-to-face meetings, and peer-to-peer mentoring.

• Networking & Communications: The AIS Update (email) keeps advocates current on recent scientific advances in breast cancer, Komen’s research and its impact, and upcoming education and involvement opportunities for advocates. The Voice offers member-to-member highlights from advocate activities. The AIS Facebook page offers networking and member-to-member sharing.

• Involvement in Komen’s Research Grant Strategy and Peer Review: Through AIS, Komen seeks to match advocates to Komen activities best fitting their training, experience and preference. Some advocates serve on advisory boards, providing strategic guidance and input on Komen’s research grant focus. Many others serve as research grant reviewers.

• Engagement in Komen-funded Research Projects: Advocate involvement is required in most Komen-funded grants. AIS together with researchers created a toolkit of resources to enable productive advocate researcher relationships. It includes resources and training for researchers to spur greater understanding of the value advocates can bring to their research and how to effectively engage them on their team. AIS assists researchers in identifying AIS members to work with researchers.

AIS members bring patients’ insights and wisdom to research from bench to bedside to curbside and back. Many AIS members are active in their communities, serving as bridges connecting advocates, scientists and Komen Affiliates. Their efforts foster greater understanding, excitement and support for research and its funding; build stronger researcher community connections; and energize hope for better answers and cures.

Citation Format: Anne Meyn, Wayne Dornan, Cheryl Jernigan, Marian Johnson-Thompson, Rebecca Seago-Coyle, Barbara Segarra-Vazquez, Sandra Spivey, Meryl Weinreb, Sandra Finestone. Susan G. Komen advocates in science (AIS): Bringing patients’ perspectives to research [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-16-01.

The influence of patient engagement on the design and implementation of a clinical trial to improve cancer care delivery

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Background: We have engaged 10 patient partners in the development and implementation of S1415CD, a five-year pragmatic clinical trial currently in year 3 assessing the effectiveness of a guideline-based colony stimulating factor standing order intervention (NCT02728596). Patient partners serve as part of a 21-person External Stakeholder Advisory Group (ESAG), which also includes providers, payers and guidelines experts. This abstract explores the influence of patient partners on the design, tools and implementation of S1415CD Methods: Patient partners advise the study team on protocol development, patient-facing materials and implementation challenges over four teleconferences each year, annual in-person meetings and targeted email communication. All patient partner input from 2014-2017 was tracked, collected and reviewed for impact on the trial. Results: Input from patient partners led to the refinement of the study’s patient-reported outcome (PRO) survey questions, the creation of a highly utilized patient brochure, and the formation of talking points for clinic staff to help explain the study. Patient partners in conjunction with high performing sites helped develop strategies for sites with lower patient accrual to optimize the approach and consent of study participants. Conclusions: The sustained engagement of patient partners in S1415CD ensured patient-centeredness in trial design and guided the development of PRO surveys and relevant, high quality patient-facing materials. Drawing on experiential knowledge and insights from their roles as caregivers and advocates, patient partners provided valuable feedback that influenced patient approach and engagement in the study. Embedding patient partners in the research continuum has catalyzed critical discussions and problem solving among the patient partners and study team, which has led to patient-centered solutions to study challenges. Clinical trial information: NCT02728596.