Addressing Barriers and Facilitators to African Americans' and Hispanics' Participation in Clinical and Genomic Research Through a Bioethical Sensitive Video

Research advances on effective methods to prevent, diagnose, and treat cancer continue to emerge through clinical and genomic research. Most clinical trial and genomic research participants identify as White which limits the generalizability of research findings to non-White populations. With the development and access to technology, digital delivery of salient and tailored health education may provide innovative pathways to increase representation of African Americans (AA) and Hispanics in research. This project focused on the creation of a bioethical sensitive education video aimed at increasing participation in clinical trials and genomic research by bringing together experts from the community, healthcare, biomedical research, and public health. The goal was to utilize existing educational resources to create a tailored message to address AA/Hispanics' beliefs, values, and bioethical concerns related to participation in clinical and genomic research. Models of behavior change and communication theories were leveraged to frame key components of the message, which then informed the framework for the animated video. Development of the video consisted of six iterative phases: 1) writing sessions; 2) storyboarding; 3) animating; 4) screening/revisions; 5) acceptability testing; 6) finalization. The final animated video is approximately 5 min in length and covers several topics including the goal of clinical research, disparities in research participation, bioethical concerns, and genomic research regulations. Increasing AA and Hispanic participation in clinical and genomic research is imperative to achieving health equity. Tailored messages via short videos may assist in addressing the barriers and facilitators towards research participation and increase intentions to enroll in trials.

Addressing disparities in cancer clinical trials: a roadmap to more equitable accrual

The Georgia Center for Oncology Research and Education (Georgia CORE) and the Georgia Society of Clinical Oncology (GASCO) held a one-day summit exploring opportunities and evidence-based interventions to address disparities in cancer clinical trials. The purpose of the summit was to identify clear and concise recommendations aimed at decreasing clinical trial accrual disparities in Georgia for rural and minority populations. The summit included expert presentations, panel discussions with leaders from provider organizations throughout Georgia, and breakout sessions to allow participants to critically discuss the information presented. Over 120 participants attended the summit. Recognizing the need for evidence-based interventions to improve clinical trial accrual among rural Georgians and persons of color, summit participants identified four key areas of focus that included: improving clinical trial design, providing navigation for all, enhancing public education and awareness of cancer clinical trials, and identifying potential policy and other opportunities. A comprehensive list of takeaways and action plans was developed in the four key areas of focus with the expectation that implementation of the strategies that emerged from the summit will enhance cancer clinical trial accrual for all Georgians.

African American Cancer Survivors' Perspectives on Cancer Clinical Trial Participation in a Safety-Net Hospital: Considering the Role of the Social Determinants of Health

Although there has been an increase focus on recruitment of minority populations at safety-net hospitals into cancer clinical trials, there is still a paucity of research exploring minority participation in cancer clinical trials at safety-net settings. The study utilized a multi-level, qualitative approach to assess the clinical and non-clinical facilitators and barriers to African American participation in cancer clinical trials at a safety-net hospital. From June 2018 to July 2019, cancer survivors (n = 25) were recruited from a cancer center at a safety-net hospital in the southeastern USA and participated in a 60-min focus group. Data was coded and analyzed to identify the most prominent themes. Most participants were female (78%), with a mean age of 56 years. The majority were diagnosed with breast cancer (68%) and disabled or unemployed (55%). Major themes identified were (1) lack of understanding of cancer clinical trials, (2) perceptions and fears of cancer clinical trials, and (3) preferred role and characteristics of patient navigator. The barriers and facilitators to enrollment in cancer clinical trials were more pronounced in the safety-net setting, given the overdue burden of social determinants of health. Study findings yield important insights and essential practices for recruiting and engaging underrepresented Black cancer patients into cancer clinical trials, specifically for safety-net settings. Including patient navigators may help traverse potential barriers to cancer clinical trial participation and will allow for the attention to social determinants of health, and ultimately increase the number of African Americans participating in cancer clinical trials.

Unmet Needs in Oncology Clinical Research and Treatment in Africa: Focus on Ghana

Cancer incidence is increasing worldwide and is a major cause of mortality. The relative magnitude of the increase is remarkably high in low human development index (HDI; 95%) and medium HDI (64%) countries. On the African continent, a corresponding increase in cancer burden is predicted, particularly for sub-Saharan Africa. Current epidemiologic data indicate that mortality rates of certain cancers, such as breast and cervical cancers, in sub-Saharan Africa are the highest in the world, and the cancer risks are broadly comparable to the risks in high-income countries, such as the United States and Europe. Although emerging data alludes to the unique genetic profile of cancer in African populations, most cancer therapies are introduced to Africa without confirmatory clinical trials. Therefore, there is an increasing need for clinical trials directed toward prevention, screening, diagnosis, and identification of innovative treatments in the African context. This review will discuss the increasing cancer burden in Africa, with a particular focus on Ghana, unmet clinical needs in cancer, current medical systems, clinical trial regulatory systems, and challenges to clinical trial recruitment.

Abstract LB173: AACR President's initiative - 2020 by 2020: Democratizing precision cancer medicine and advancing health equity in the black belt

African Americans (AA) have higher incidence and mortality rates for several cancer types in comparison to their European American (EA) counterparts. Increasing participation in clinical research and patient registries, related to precision cancer medicine, will significantly improve cancer health equity. Many AA cancer patients are treated in community oncology clinics. Unfortunately, these health systems have limited access to Clinical Laboratory Improvement Amendments (CLIA) next generation sequence (NGS) germline and somatic DNA and RNA testing that are used to inform oncologists on the best treatment and/or clinical trial options for cancer patients. Indeed, AA CLIA NGS sample sets are poorly represented, which could presumably result in incomplete knowledge of genomic variants that could affect their treatment and overall outcomes. Hence, it is crucial to implement CLIA NGS efforts for all cancer patients. To address these disparities, Morehouse School of Medicine has formed the Comprehensive Approach to Reimagine health Equity Solutions (CARhES) consortium with Tuskegee University that has engaged community oncology practices in Alabama and Georgia - two of five Black Belt states. The CARhES consortium aims to implement precision cancer medicine to underserved and underrepresented communities that will improve the standard of cancer care by providing access to CLIA NGS testing, clinical trials, and personalized cancer care. Here we describe the first proof of concept of this approach with community oncology partners, i.e., Grady Health System, Wellstar Health System, Georgia Urology, Midtown Urology, and Maui Memorial Medical Center. At the time of consent, saliva, buccal, and tumor samples were collected from participants. Germline and somatic CLIA NGS was performed, and medical reports were returned to practitioners within 14 days. Prior to the COVID pandemic, the study enrolled over 880 patients with a 88% consent rate (n = 1000) in the first 11months of the program. At the start of the COVID pandemic, recruitment efforts were suspended for four months with a slow restart by June 2020. A decrease in the number of staff, office visits (67% reduction), and increase in COVID cases significantly limited recruitment efforts. During this slowdown, we established and improved eConsenting capabilities, which exist today. Community anxiety, due to the pandemic and SARS-CoV-19 vaccine efforts, resulted in a significant reduction in consent rates (88% to 60%). Nevertheless, this study began in April of 2019 and consented 1,750 participants in less than 2 years. Taken together, our study shows that a community-focused precision medicine approach requires meeting people where they are and providing them with access and understanding the benefit of clinical trial participation. The approximate 2,000 clinically annotated genomic AA datasets will greatly contribute to our understanding of cancer health disparities and among the first steps to democratize precision medicine.

This study was funded by the American Association for Cancer Research, The Pelotonia Foundation, the M2Gen Foundation, and the National Cancer Institute (U54CA118638).

Citation Format: Latrisha L. Horne, Gabriella M. Oprea-Ilies, Eddie R. Stanley, Carla M. Holloway, Margaret P. Hooker, Amina Isom, Derrick J. Beech, Ana Gaonkar, Shavette Harden, Jeffrey F. Hines, LaTonya Randolph, James K. Bennett, Daniel Canter, Darrell J. Carmen, Pooja Mishra, Giuseppe Del Priore, Roland Matthews, Brian M. Rivers, James W. Lillard. AACR President's initiative - 2020 by 2020: Democratizing precision cancer medicine and advancing health equity in the black belt [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr LB173.

Strengthening and Sustaining Inter-Institutional Research Collaborations and Partnerships

Inter-institutional collaborations and partnerships play fundamental roles in developing and diversifying the basic biomedical, behavioral, and clinical research enterprise at resource-limited, minority-serving institutions. In conjunction with the Research Centers in Minority Institutions (RCMI) Program National Conference in Bethesda, Maryland, in December 2019, a special workshop was convened to summarize current practices and to explore future strategies to strengthen and sustain inter-institutional collaborations and partnerships with research-intensive majority-serving institutions. Representative examples of current inter-institutional collaborations at RCMI grantee institutions are presented. Practical approaches used to leverage institutional resources through collaborations and partnerships within regional and national network programs are summarized. Challenges and opportunities related to such collaborations are provided.

Abstract A007: Disparities in cancer clinical trial participation: The influences of race and social support among cancer survivors

Background: Cancer clinical trials (CCTs) are essential to developing effective cancer treatments; however, there is a disparity in the number of Black CCT participants. Studies have found that Black cancer survivors' responses to some cancer treatments are less than ideal compared to their White counterparts. With less than 3% of eligible Blacks participating in CCTs nationwide, it is difficult to evaluate the effectiveness of cancer treatments for this group. Social support (SS), among other factors, influence survivors' decisions about participating in CCTs. Though survivors make the final decision to participate in a CCT, the input from family and friends is valuable to their decision-making process. The purpose of this study is to examine 1) survivors' awareness about CCTs via discussion with a provider; 2) CCT participation by race; and 3) the effect of SS in discussion about CCTs with a provider on CCT participation.

Methods: This study used constructs based on the Social Ecological Model at the individual, interpersonal, and organizational levels. We merged cohort data from the Health Information National Trends Survey for years 2012, 2014, and 2016. The study included 1,340 cancer survivors who self-identified as White or Black and were at least 18 years of age. Chi-square and binomial logistic regression analyses examined the associations between SS and CCT discussion with a provider and CCT participation.

Results: The sample was mostly White (85.7%), female (59.0%), and married/living as married (62.5%), with a mean age of 65.83 (SD=14.751). Most of the sample had emotional support (87.5%) and instrumental support (tangible help) (77.9%). Only 9.3% of the sample discussed CCT as a treatment option, and 4% participated in a CCT. Bivariate analyses showed that survivors were more likely to have discussed CCT with their provider if they were retired (p=0.04), Black (p<0.001), and received a treatment summary (p< 0.001). Survivors were more likely to participate in a CCT if their employment status was disabled (p=0.012), they were Black (p=0.002), and they discussed CCT as a treatment option (p< 0.001). Binomial logistic regression analyses showed that survivors who were most likely to have discussed CCT as a treatment option were Black (p=0.01), had instrumental support (p=0.05), and participated in a CCT (p< 0.001) when controlling for sociodemographic and health-related variables. Survivors were more likely to have participated in a CCT if they were retired (p=.04) and discussed CCT as a treatment option (p< 0.001).

Conclusion: Findings indicate that Black cancer survivors have discussions about CCTs with providers if returned, received a treatment summary, had instrumental support, were disabled and discussed CCT as a treatment option; however, they are not more likely to participate in CCTs. Further research to determine factors that affect the discussion about CCT, CCT participation, and the direction SS drives CCT participation among Black cancer survivors is warranted.

Citation Format: Dexter L. Cooper, Desiree Rivers, Natalie D. Hernandez, Monica Harris, Lee Caplan, Lawrence McKinney, Brian M. Rivers. Disparities in cancer clinical trial participation: The influences of race and social support among cancer survivors [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 A007.

Abstract A008: Barriers and facilitator to minorities' participation in cancer clinical trials: Perspectives from a safety-net hospital

Introduction: Cancer clinical trials (CCTs) are vital to clinical oncology research, in that they provide a foundation for the development and implementation of effective cancer therapies. However, there is a disparity in CCT participation given that only 2.7% of all CCT participants in the U.S. are African-American (AA). Grady Memorial Hospital in Atlanta, Georgia, the setting for this study, is a safety-net hospital with over 80% of its patients on Medicare, Medicaid, or uninsured. The objective of this two-phase pilot study is to utilize a multilevel, qualitative approach to assess the clinical and nonclinical facilitators and barriers to AA participation in CCTs (Phase I) and develop and pilot a multilevel intervention (Phase II).

Methods: Study participants were recruited from a cancer center at a safety-net hospital in Atlanta, GA. Twenty key informant interviews were conducted with key stakeholders at the safety-net hospital and 2 focus groups with AA cancer survivors. Interview guides were adapted from the NIH-funded EMPACT study. The interviews and focus groups were recorded on digital devices upon which the data was transcribed and subsequently analyzed using NVIVO 11 software.

Results: The interview transcripts were analyzed using a combination of hand coding and NVIVO 11 software. Content analysis was conducted using an immersion/crystallizing analysis plan. Common themes regarding Barriers and Facilitators within the context of Institution-level, Participant-level, System-level, and Trial-level will be presented.

Conclusion: These findings will assist in the development and testing of culturally appropriate resources and interventions to increase AA participation in CCTs.

Citation Format: Brian M. Rivers, Monica Harris, Dexter L. Cooper, Nedra Lisovicz, Raegan Durant, Natalie D. Hernandez, Desiree Rivers, Lawrence McKinney, Bria Carmichael, Sarah B. Rutland, Ainny Shamim. Barriers and facilitator to minorities' participation in cancer clinical trials: Perspectives from a safety-net hospital [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 A008.

Abstract B032: African American cancer survivors’ perspectives on clinical trial participation at a safety-net hospital cancer center

Introduction: Clinical trial participation is essential to the progress of optimizing cancer care outcomes; however, there is a paucity of African American (AA) participation in cancer clinical trials (CCTs) resulting in significant gaps in treatment efficacy. There has been a robust amount of research on ways to increase AA participation in CCTs, but few studies have examined AA recruitment at safety-net hospitals. The objective of this study is to utilize a multilevel, qualitative approach to assess the clinical and non-clinical facilitators and barriers to AA participation in CCTs at a safety-net hospital from the perspective of AA cancer survivors. Methods: Study participants (n=25) were recruited from a cancer center at a safety-net hospital in the southeastern U.S. Eligible participants were individuals who: 1) self-identified as AA; 2) were 18-75 years old; 3) spoke and read English; 4) diagnosed with cancer; 5) had no functional limitations that would interfere with participation in a 60-minute focus group; and 6) be capable of providing written consent for study participation. Focus groups were digitally recorded and transcribed. Data was coded and analyzed to identify the most prominent themes representing unifying ideas and concepts. Results: Theme 1: Understanding of Cancer Clinical Trial Terminology (Barrier). For some of the participants this focus group session was the first conversation they had where they were able to discuss their cancer diagnosis with other survivors. Participants also expressed confusion between clinical trials and treatment; many did not know the difference between the terms. There were instances where patients used the terms incorrectly, especially during discussions about willingness to participate in trials. Theme 2: Perceptions of Cancer Clinical Trials (Barrier). Participants may have heard of clinical trials but did not know what a cancer clinical trial entailed. Once a clinical trial was explained participants expressed that they may have taken part. Some indicated that no medical professionals discussed a clinical trial or recruited them to participate. Participants who were knowledgeable about CCTs expressed that they were ineligible for the trial, although ineligibility also seemed to be confusing for them. Most reported receiving information from pamphlets. Theme 3: Role of Patient Navigator (Facilitator). In general, participants expressed trust in their physicians, particularly for medical information; however, some preferred resources and information from a patient navigator. All agreed that they would be willing to work with a patient navigator and saw the patient navigator’s role as providing social support and as a resource. Participants preferred a knowledgeable patient navigator that had cancer experience. Conclusion: Including cancer patient navigators as part of the treatment team staff may help traverse potential barriers to CCT participation, and ultimately increase the number of AAs diagnosed with cancer participating in CCTs.

Citation Format: Natalie D Hernandez, Raegan W Durant, Dexter L Cooper, Desiree Rivers, Ebony Repress, Nedra Lisovicz, Brian M Rivers. African American cancer survivors’ perspectives on clinical trial participation at a safety-net hospital cancer center [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B032.

Abstract B033: Patient navigation at NCI-designated, safety-net, and rural cancer centers: Why is tailoring necessary?

Introduction: Recent studies suggest where patients receive cancer care is a determinant of survivorship outcomes. As a culturally and individually tailored approach to addressing barriers to cancer care and other contributors to cancer disparities, patient navigation (PN) is an effective strategy to enhance the efficiency of healthcare systems and continuity of care. Patient navigation programs have emerged as a strategy to reduce morbidity and mortality for cancer and associated late and long-term effects of treatment. This study utilized the Community-Based Participatory Research (CBPR) framework to evaluate an enhanced ‘care coordination model’, linking navigators with cancer patients at an NCI-designated cancer center, a safety-net hospital cancer center, and a rural hospital cancer center. The purpose of this study is to characterize the implementation of the patient navigation model in three unique clinical settings for cancer care delivery. Methods: Eligible participants were identified from the partnership between Morehouse School of Medicine (MSM), Tuskegee University (TU) and the O’ Neal Comprehensive Cancer Center at UAB sites by the health-systems patient navigator (HSPN). The HSPN screened patients to assess their need for navigation services. Those in need of navigation were introduced to the study at their prospective treatment facilities. Patients were linked with community-based patient navigators (CBPNs) to ensure continuity of addressing the clinical and non-clinical effects of treatment. Findings: Navigators aided with service requests; however, there were differences in the types of services requested based on cancer center and treatment status. Participants who were in treatment the NCI-designated cancer center (n=35) were mostly Black (62.9%), female (91.4%), single (45.7%), employed (34.3%), had Medicare (28.6%) and a yearly household income $5,001 to $10,000. They mostly requested assistance with gas (88.6%), social support (74.3%) financial assistance (48.6%), and lodging (20%). Participants who completed treatment at the safety-net hospital cancer center (n=20) were mostly Black (85%), female (80%), single (50%), disabled (45%), had Medicaid (55%), and a yearly household income of less than $5,000 a year (23.5%) and $15,001 -$25,000 (23.5%) a year. These survivors requested assistance with food procurement (75%), financial assistance (50%), education (35%), transportation (25%), and clothing (25%). Participants who were in treatment at the rural hospital cancer center (n=4) were all Black (85%), mostly male (75%), and half were married (50%). These survivors requested assistance with transportation (50%) and financial assistance (50%). Conclusion: The work of navigators, whether they are health-systems or community patient navigators, is dynamic and valuable to the care of cancer survivors, especially for disparate populations. The adaptability of this model based on the dynamics of the clinical setting emphasizes the utility of this model.

Citation Format: Dexter L Cooper, Vivian Carter, Natalie D Hernandez, Mindy Le, Kimberly Robinson, Shawn J Ennis, Mona Fouad, Brian M Rivers. Patient navigation at NCI-designated, safety-net, and rural cancer centers: Why is tailoring necessary? [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B033.

Are Men Making Informed Decisions According to the Prostate-Specific Antigen Test Guidelines? Analysis of the 2015 Behavioral Risk Factor Surveillance System

The prostate-specific antigen (PSA) screening recommendation endorses the opportunity for men to make an informed decision about whether or not to screen. This entails speaking with a provider to discuss the potential advantages, disadvantages, and uncertainties about the PSA screening test. The purpose of this study was to examine (a) the reported level of being informed about the PSA test by race and (b) the association between the receipt of the PSA test and participants reporting that they were informed about the test. U.S. adult males (ages 40–74 years) were identified from the 2015 Behavioral Risk Factors Surveillance System (BRFSS; n = 3,877). Chi-square analysis assessed bivariate differences among men who received different levels of PSA screening information. Binomial logistic regression models assessed the relationship of race/ethnicity and the receipt of the PSA test on being informed about the PSA test. Over half (54.3%) of the sample had a PSA test and most (72.0%) reported that they did not receive information about both the advantages and disadvantages (being informed) of the PSA test. Black men (40.3%) were significantly most likely to report being informed (p < .001), and 61.3% reported receipt of a recommendation from their provider (p < .001). White men (63.1%) were significantly more likely to report receiving the PSA test. Findings indicate that more men reported receiving the PSA test than men who reported being informed about it. Future research and interventions should strive for men of all racial and ethnic backgrounds to be informed about the PSA test before making a decision.

Biological and Clinical Significance of the CCR5/CCL5 Axis in Hepatocellular Carcinoma

Despite the improvement in survival for patients with liver cancer (LCa) in recent decades, only one in five patients survive for 5 years after diagnosis. Thus, there is an urgent need to find new treatment options to improve patient survival. For various cancers, including LCa, the chemokine CCL5 (RANTES) facilitates tumor progression and metastasis. Since the function of the CCR5/CCL5 interaction in LCa cell proliferation and migration is poorly understood, the present study was undertaken to investigate the role of the CCR5/CCL5 axis in these processes. Flow cytometry, RT-PCR, Western blot, and immunofluorescence techniques were used to quantify the expression of CCR5 and CCL5 in LCa cells. To determine the biological significance of CCR5 expressed by LCa cell lines, a tissue microarray of LCas stained for CCR5 and CCL5 was analyzed. The results showed higher expression (p < 0.001) of CCR5 and CCL5 in hepatocellular carcinoma (HCC) tissues compared to non-neoplastic liver tissues. Furthermore, to delineate the role of the CCR5/CCL5 interaction in LCa cell proliferation and migration, various LCa cells were treated with maraviroc, a CCR5 antagonist, in the presence of CCL5. These data demonstrated the biological and clinical significance of the CCR5/CCL5 axis in LCa progression. The targeting of this axis is a promising avenue for the treatment of LCa.

Predictors of genetic beliefs toward cancer risk perceptions among adults in the United States: Implications for prevention or early detection

The objective of this study is to assess predictors of genetic beliefs toward cancer risk perceptions among adults, aged 18 years and over, in the United States (US). Data were obtained from the National Cancer Institute's (NCI) Health Information National Trends Survey 2014 (HINTS) 4 Cycle 4. Bivariate and multivariable logistic regression analyses were conducted to assess factors associated with an individual's beliefs about genetic and cancer risk perceptions. The results showed that African Americans, Non-White Hispanics, Non-Hispanic Asians, individuals with a high school education or less, and annual household incomes less than $20,000 and do not believe that health behaviors play some role in determining whether a person will develop cancer was significantly less likely to report that genetics plays at least some role in whether a person will develop cancer. Findings of this study provide an opportunity for genetic counselors to address beliefs about genetics and cancer risk perceptions among minority populations and promote health equity.

Utilizing Community-based Participatory Research Principles in a Safety-Net Hospital to Develop a Research Partnership

Research at safety-net hospitals may require additional planning to ensure the ethical conduct of research with vulnerable populations. This report discusses application of the principles of community-based participatory research and bioethics to establish a research partnership with a safety-net hospital in the southern U.S.

Affecting African American men's prostate cancer screening decision-making through a mobile tablet-mediated intervention

African American men experience a 60% higher incidence of prostate cancer and are more than twice as likely to die from it than White men. Evidence is insufficient to conclude that definitively screening for prostate cancer reduces the likelihood of morbidity or death. Patients are encouraged to discuss screening alternatives with health care providers for informed decision-making (IDM). The extent of IDM in clinical or community setting is not known. This study uses data from a community-based, computer-mediated, IDM intervention that targeted 152 African American aged 40 to 70. Pretest-posttest differences in means for prostate cancer knowledge, screening decisional conflict, and screening decisional self-efficacy were examined by two-tailed t-tests. Overall, the intervention significantly improved respondents' prostate cancer knowledge (p&lt;.0001), significantly improved decisional self-efficacy (p&lt;.0001) and significantly reduced decisional conflict (p&lt;.0001). Specifically, the intervention significantly promoted IDM among men who reported more education, being married, having financial resources, and younger age.

Predictors of Cancer Screening Among Culturally Diverse Men

Men have higher rates of all cancers and are more likely to die from cancer than women; however, men are less likely to utilize disease prevention services. African American/Black men and Hispanic men have lower cancer survival rates and are less likely to utilize health care services than non-Hispanic White men. The present study examined demographic variables (age, household income, education, marital status, race/ethnicity, health insurance status), motivators to engage in healthy eating, and motivators to engage in physical activity as predictors of culturally diverse, medically underserved men's likelihood of getting a cancer screening (a) at the present time, (b) if no cancer symptoms are present, and (c) if a doctor discovers some cancer symptoms. Analyses were conducted using data from 243 men (47.3% non-Hispanic Black, 29.5% Hispanic, 16.5% non-Hispanic White, and 6.8% "other") recruited at the Men's Health Forum in Tampa, Florida. Age, having a medical or health condition that benefits from eating healthy, and having a commitment to physical activity were significant positive predictors of the likelihood of receiving a cancer screening. Motivation to engage in physical activity because of a personal priority was a significant negative predictor of the likelihood of getting a cancer screening. The findings from this study suggest that interventions to increase cancer screenings among culturally diverse, medically underserved men should be informed at least in part by an assessment of participating men's motivators for engaging in health promoting lifestyle behaviors such as physical activity and healthy eating.

A Community-Level Assessment of Barriers to Preventive Health Behaviors Among Culturally Diverse Men

There are significant gender disparities in health outcomes and health care utilization in the United States, with men experiencing more of these disparities. It is critical to ascertain the interplay between societal conditions, health behaviors, and access to services and the impact of these factors on health outcomes and utilization of health care. The present study is part of a larger initiative titled, The Men's Health Study: Addressing Healthy Lifestyle Behaviors, which has two purposes-to annually assess the motivators of and barriers to health-promoting behaviors among culturally diverse men attending the Men's Health Forum (MHF) and to use this information to develop an intervention program that facilitates healthy lifestyle behaviors among men. The MHF is a community-driven initiative for medically underserved men in Tampa, Florida that offers free health screenings and wellness exhibitors in order to empower men to lead a healthy lifestyle. The purpose of this article is to identify barriers to engaging in health-smart behaviors (e.g., cancer screenings, physical activity) among culturally diverse men who participated in the MHF and to detect any demographic differences among these barriers. A total of 254 men participated in the study. Findings identify that age was the only demographic variable that had a statistically significant association with any of the cancer-screening barriers. Some cancer-screening barriers appear to exist among all demographic groups since no statistical demographic differences were discovered. Income and education were significantly associated with barriers to engaging in health-smart behaviors. This may give researchers, health educators, and providers information needed to customize interventions to promote health and preventive health care among culturally diverse men.

Opportunities and challenges of using technology to address health disparities

During a panel presentation at the American Association for Cancer Research Cancer Health Disparities Conference titled 'Opportunities and challenges of using technology to address health disparities', the latest scientific advances in the application and utilization of mobile technology and/or mobile-health (mHealth) interventions to address cancer health disparities were discussed. The session included: an examination of overall population trends in the uptake of technology and the potential of addressing health disparities through such media; an exploration of the conceptual issues and challenges in the construction of mHealth interventions to address disparate and underserved populations; and a presentation of pilot study findings on the acceptability and feasibility of using mHealth interventions to address prostate cancer disparities among African-American men.

Informed decision making among first-degree relatives of prostate cancer survivors: a pilot randomized trial

BACKGROUND

First degree relatives (FDRs) of men diagnosed with prostate cancer (PCa) are at increased risk for developing the disease, due in part to multiple concurrent risk factors. There is a lack of innovative targeted decision aids to help FDRs make an informed decision about whether or not to undergo PCa screening.

PURPOSE

This randomized pilot trial evaluated the efficacy of a targeted PCa screening decision aid in unaffected FDRs of PCa survivors.

METHODS

Seventy-eight Black and White FDRs were randomized to one of two decision aid groups; 39 to a FDR-targeted decision aid and 39 to a general decision aid. The targeted decision aid group received a general PCa decision aid booklet plus a newly developed decision aid DVD targeted specifically for FDRs. PCa screening decision outcomes included knowledge, decisional conflict, distress, and satisfaction with screening decision. Outcomes were assessed at baseline and 4 weeks after baseline.

RESULTS

There were no differences by intervention group for knowledge, decisional conflict, distress, or satisfaction with screening decision (p>0.05). However, men in both groups had significant increases in knowledge and decreases in decisional conflict (p<0.001). These changes were most pronounced (p<0.05) for younger men compared to older men.

CONCLUSION

Results suggest that general and targeted information can play an important role in increasing knowledge and decreasing decisional conflict among FDRs. Additional research is needed to identify subgroups of men who benefit the most and better understand the outcomes of a screening decision aid among diverse samples of FDRs.

Establishing the infrastructure to comprehensively address cancer disparities: a model for transdisciplinary approaches

The Center for Equal Health (CEH), a transdisciplinary Center of Excellence, was established to investigate cancer disparities comprehensively and achieve health equity through research, education, training, and community outreach. This paper discusses challenges faced by CEH, strategies employed to foster collaborations, lessons learned, and future considerations for establishing similar initiatives.

American Cancer Society prostate cancer survivorship care guidelines

Prostate cancer survivors approach 2.8 million in number and represent 1 in 5 of all cancer survivors in the United States. While guidelines exist for timely treatment and surveillance for recurrent disease, there is limited availability of guidelines that facilitate the provision of posttreatment clinical follow-up care to address the myriad of long-term and late effects that survivors may face. Based on recommendations set forth by a National Cancer Survivorship Resource Center expert panel, the American Cancer Society developed clinical follow-up care guidelines to facilitate the provision of posttreatment care by primary care clinicians. These guidelines were developed using a combined approach of evidence synthesis and expert consensus. Existing guidelines for health promotion, surveillance, and screening for second primary cancers were referenced when available. To promote comprehensive follow-up care and optimal health and quality of life for the posttreatment survivor, the guidelines address health promotion, surveillance for prostate cancer recurrence, screening for second primary cancers, long-term and late effects assessment and management, psychosocial issues, and care coordination among the oncology team, primary care clinicians, and nononcology specialists. A key challenge to the development of these guidelines was the limited availability of published evidence for management of prostate cancer survivors after treatment. Much of the evidence relies on studies with small sample sizes and retrospective analyses of facility-specific and population databases.

Perceptions of Prostate Cancer Screening Controversy and Informed Decision Making: Implications for Development of a Targeted Decision Aid for Unaffected Male First-Degree Relatives

PURPOSE

First-degree relatives (FDRs) of prostate cancer (PC) patients should consider multiple concurrent personal risk factors when engaging in informed decision making (IDM) about PC screening. This study assessed perceptions of IDM recommendations and risk-appropriate strategies for IDM among FDRs of varied race/ethnicity.

DESIGN

A cross-sectional, qualitative study design was used.

SETTING

Study setting was a cancer center in southwest Florida.

PARTICIPANTS

The study comprised 44 participants (24 PC patients and 20 unaffected FDRs).

METHOD

Focus groups and individual interviews were conducted and analyzed using content analysis and constant comparison methods.

RESULTS

Patients and FDRs found the PC screening debate and IDM recommendations to be complex and counterintuitive. They overwhelmingly believed screening saves lives and does not have associated harms. There was a strongly expressed need to improve communication between patients and FDRs. A single decision aid that addresses the needs of all FDRs, rather than one separating by race/ethnicity, was recommended as sufficient by study participants. These perspectives guided the development of an innovative decision aid that deconstructs the screening controversy and IDM processes into simpler concepts and provides step-by-step strategies for FDRs to engage in IDM.

CONCLUSION

Implementing IDM among FDRs is challenging because the IDM paradigm departs from historical messages promoting routine screening. These contradictions should be recognized and addressed for men to participate effectively in IDM. A randomized pilot study evaluating outcomes of the resulting decision aid is underway.

The men's health forum: an initiative to address health disparities in the community

Racial/ethnic, socioeconomic, and gender disparities in health and access to and use of health care services currently exist. Health professionals are continually striving to reduce and eliminate health disparities within their own community. One such effort in the area of Tampa Bay, Florida was the creation of the African American Men's Health Forum, currently referred to as the Men's Health Forum. The African American Men's Health Forum was the result of the community's desire to reduce the gap in health outcomes for African American men. Later, it was recognized that the gap in health outcomes impacts other communities; therefore, it was broadened to include all men considered medically underserved (those who are uninsured, underinsured, or without a regular health care provider). The Men's Health Forum empowers men with the resources, knowledge, and information to effectively manage their health by providing health education and screenings to the community. This article provides an explanation of the key components that have contributed to the success of the Men's Health Forum, including challenges and lessons learned. It is intended that this information be replicated in other communities in an effort to eliminate health disparities.

Understanding the psychosocial issues of African American couples surviving prostate cancer

African Americans are disproportionately affected by prostate cancer, yet less is known about the most salient psychosocial dimensions of quality of life. The purpose of this study was to explore the perceptions of African American prostate cancer survivors and their spouses of psychosocial issues related to quality of life. Twelve African American couples were recruited from a National Cancer Institute Comprehensive Cancer Center registry and a state-based non-profit organization to participate in individual interviews. The study was theoretically based on Ferrell's Quality of Life Conceptual Model. Common themes emerged regarding the psychosocial needs of African American couples. These themes were categorized into behavioral, social, psychological, and spiritual domains. Divergent perspectives were identified between male prostate cancer survivors and their female spouses. This study delineated unmet needs and areas for future in-depth investigations into psychosocial issues. The differing perspectives between patients and their spouses highlight the need for couple-centered interventions.

Abstract A33: African American men's perceptions of the informed decision-making process for prostate cancer screening: Implications for design and development

Introduction: Although prostate cancer mortality rates are on the decline, rates in African American men remain more than twice as high as those in white men. Men at risk for prostate cancer are encouraged to utilize informed decision making (IDM) to determine the most appropriate strategy for screening and prevention. However, multiple barriers exist in the provision of culturally and linguistically appropriate IDM models on prostate cancer for African American men, including mistrust of the health system, fear of cancer, and concerns about discrimination and racism. Multimedia approaches have been determined to be an effective means for the dissemination of culturally and linguistically appropriate IDM models for African Americans that minimize barriers within the community.

Methods: Focus groups were conducted with African American men in the Tampa Bay area to determine core elements for the design of a video-based patient decision aid for prostate cancer screening. Lay health advisors from the community recruited African American men to participate in this formative research. The inclusion criteria were: African American men; aged 40 to 70 years; and no diagnosis of prostate cancer or any other type of cancer. The focus groups were transcribed verbatim and analyzed using a combination of content analysis and the constant comparison method with Atlas.ti software.

Results: A total of 18 African American men, ranging in age from 41 to 65 years, were recruited (mean age=48.5 years). Overall, men had limited knowledge regarding prostate cancer, and slightly more than one-third (38.9%) of the men had previously been screened for prostate cancer. Multiple themes emerged through the conduct of focus groups, including the influence of cultural beliefs in screening, the need for more information on risk and protective factors for prostate cancer, the involvement of spouses and family members in decision-making, and the importance of culturally-appropriate educators, advocates, and role models.

Conclusions: Overall, there is a lack of information regarding prostate cancer among African American men. Cultural perceptions and beliefs play a critical role in the determination of screening practices in this community. Patient decision aids on prostate cancer for African American men require the utilization of African American health professionals and peers as purveyors of information. Furthermore, messaging should be tailored for African American men, as well as their spouses and families, to aid in the determination of appropriate prevention and screening strategies. These findings will assist in the design and development of culturally and linguistically appropriate educational resources and interventions on prostate cancer for the African American community.

Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A33.

Psychosocial issues related to sexual functioning among African-American prostate cancer survivors and their spouses

OBJECTIVE

Focus on cancer survivorship and quality of life (QOL) is a growing priority. The aim of this study was to identify and describe the most salient psychosocial concerns related to sexual functioning among African-American (AA) prostate cancer survivors and their spouses.

METHODS

Twelve AA prostate cancer survivors and their spouses participated in semi-structured individual interviews. The interviews assessed couples' experiences with psychosocial adjustment and sexual functioning posttreatment for localized prostate cancer. The data were analyzed using the constant comparison method and content analysis.

RESULTS

In this qualitative study of couples surviving prostate cancer, there were divergent views between the male prostate cancer survivors and their female partners, particularly regarding sexual functioning. For the males, QOL issues emerged as the primary area of concern, whereas survival of their husbands was considered most important among the female spouses. The male respondents expressed unease with the sexual side effects of their cancer treatment, such as erectile dysfunction and decreased sexual desire and satisfaction. Female spouses recognized decreased sexual desire in their partners following treatment, but this was not considered a primary concern.

CONCLUSIONS

Patients and their spouses may have differing perceptions regarding QOL and the impact of sexual functioning on survivorship. This study points to the need for further research and intervention development to address these domains with a goal to improve QOL.

Barbershop communications on prostate cancer screening using barber health advisers

OBJECTIVE

The authors report the outcomes of a community-based, barber health adviser pilot intervention that aims to develop customized educational materials to promote knowledge and awareness of prostate cancer (CaP) and informed decision making about prostate cancer screening (PCS) among a predominantly African American clientele.

METHOD

First, the authors implemented a series of learner verification processes with barbershop clients (n=15) to adapt existing CaP health promotion materials. Following intervention implementation in the barbershop, they conducted structured surveys with barbershop clients (n=40) to evaluate the intervention.

RESULTS

Findings from the posttest showed both a significant increase in barbershop clients' self-reported knowledge of CaP and in the likelihood of discussing PCS with a health care provider (p<.001). The client's cultural model of CaP risk factors revealed cultural consensus (eigenratio=3.3) and mirrored the biomedical model. All clients surveyed reported positively on the contents of the educational materials, and more than half (53%) had discussed CaP at least twice with their barber in the last month.

CONCLUSION

Based on the pilot results, the barber-administered intervention was an appropriate and viable communication channel for promoting CaP knowledge and awareness in a priority population, African American men.

Barbers against prostate cancer: a feasibility study for training barbers to deliver prostate cancer education in an urban African American community

The goal of this pilot study was to assess the feasibility of training barbers to deliver a brief culturally and literacy appropriate prostate cancer educational intervention to urban African American men. Eight barbers received training to deliver a 2-month educational intervention in the barbershop and completed pre- and posttest training assessments. The training workshops led to a significant increase in mean prostate cancer knowledge scores among the barbers (60% before vs. 79% after; P < 0.05). The barbers also reported positively on the intervention in terms of satisfaction and relative ease of engaging clients. Training barbers to deliver a prostate cancer educational intervention is a feasible strategy for raising prostate cancer awareness of the disease among a priority population.

Reducing prostate cancer morbidity and mortality in African American men: issues and challenges

Prostate cancer is the most commonly diagnosed cancer in men in the United States. It disproportionately affects African American men when compared to other ethnic groups. African American men are two to three times more likely to die of prostate cancer than white men. The reasons for the disparity remain unclear, but several factors may be involved, such as age, race, nationality, nutrition, exercise, and family history of cancer. Detection of prostate cancer in high-risk African Americans is important but continues to be controversial. This article reviews the current issues and challenges regarding prostate cancer in African American men. Nurses play a vital role in the health care and education of patients; therefore, they must be aware of the issues.

Awareness and knowledge of the U.S. Public Health Service syphilis study at Tuskegee: implications for biomedical research

The purpose of this review was to collect and interpret the findings of all published qualitative or quantitative research that assessed African Americans' 1) general awareness and/or specific knowledge of the U.S. Public Health Service (USPHS) Syphilis Study at Tuskegee, and 2) attitudes towards and/or willingness to participate in biomedical research. An exhaustive review of the literature produced eight articles that fit the aforementioned selection criteria. All articles that assessed both awareness and knowledge found that familiarity with the USPHS Syphilis Study at Tuskegee did not necessarily ensure accurate knowledge of it. Four studies also found that awareness of the USPHS Syphilis Study at Tuskegee did not relate to willingness to participate in biomedical research. In addition to awareness and knowledge of the USPHS Syphilis Study at Tuskegee, published studies suggest that a broad array of structural and sociocultural factors influence minorities' willingness to participate in biomedical studies.

Mentoring: a framework for developing health disparities researchers

Health disparities have been conceptualized as being the result of a confluence of factors: environmental, social, biological, economic, and cultural to name a few. Given the increasingly deleterious impact of health disparities on the lives of all Americans, new research methodological research approaches are needed to adequately understand and address the component parts of health disparities. To effectively address health disparities, an increased focus is needed on implementing transdisciplinary approaches to health disparities research. One approach is to focus on mentoring young investigators and students. This article discusses the centrality of mentoring in developing young health disparities researchers. An overview of health disparities research and researchers, and a summary of the different aspects of mentoring are provided. In addition, a case study of the implementation of a transdisciplinary mentoring framework at a higher education institution is presented.