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Cheung CK, Miller KA, Goings TC, Thomas BN, Lee H, Brandon RE, Katerere-Virima T, Helbling LE, Causadias JM, Roth ME, Berthaud FM, Jones LP, Ross VA, Betz GD, Simmons CD, Carter J, Davies SJ, Gilman ML, Lewis MA, Lopes G, Tucker-Seeley RD. BIPOC experiences of (anti-)racist patient engagement in adolescent and young adult oncology research: an electronic Delphi study. Future Oncol 2024; 20:547-561. [PMID: 38197386 PMCID: PMC10988539 DOI: 10.2217/fon-2023-0771] [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] [Received: 09/07/2023] [Accepted: 12/06/2023] [Indexed: 01/11/2024] Open
Abstract
Aims: To characterize Black, Indigenous and People of Color (BIPOC) adolescent and young adult (AYA) cancer patients' experiences of patient engagement in AYA oncology and derive best practices that are co-developed by BIPOC AYAs and oncology professionals. Materials & methods: Following a previous call to action from AYA oncology professionals, a panel of experts composed exclusively of BIPOC AYA cancer patients (n = 32) participated in an electronic Delphi study. Results: Emergent themes described BIPOC AYA cancer patients' direct experiences and consensus opinion on recommendations to advance antiracist patient engagement from BIPOC AYA cancer patients and oncology professionals. Conclusion: The findings reveal high-priority practices across all phases of research and are instructional for advancing health equity.
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Affiliation(s)
| | - Kimberly A Miller
- Department of Preventive Medicine and Dermatology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | | | - Bria N Thomas
- Temple University School of Podiatric Medicine, Philadelphia, PA 19107, USA
| | - Haelim Lee
- University of Maryland School of Social Work, Baltimore, MD 21201, USA
| | - Rachel E Brandon
- University of Michigan School of Social Work, Ann Arbor, MI 48109, USA
| | | | - Laura E Helbling
- University of Maryland School of Social Work, Baltimore, MD 21201, USA
| | - José M Causadias
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University, Tempe, AZ 85287, USA
| | - Michael E Roth
- Department of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | | | | | - Valentina A Ross
- University of Maryland School of Social Work, Baltimore, MD 21201, USA
| | - Gail D Betz
- University of Maryland Baltimore Health Sciences & Human Services Library, Baltimore, MD 21201, USA
| | - Cole D Simmons
- Bryn Mawr Graduate School of Social Work and Social Research, Bryn Mawr, PA 19010, USA
| | - Jay Carter
- University of Maryland School of Social Work, Baltimore, MD 21201, USA
| | | | - Megan L Gilman
- AYA Psychiatry, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Mark A Lewis
- Department of Gastrointestinal Oncology, Intermountain Healthcare, Salt Lake City, UT, 84107 USA
| | - Gilberto Lopes
- Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
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Cheung CK, Miller KA, Davies S, Gilman M, Lewis MA, Lopes G, Betz G, Berthaud FM, Thomas BN, Lee H, Ross VA, Brandon RE, Katerere-Virima T, Helbling LE, Tucker-Seeley R. Vital best practices for antiracist patient engagement in AYA oncology research and advocacy: A Delphi study of BIPOC AYA experts. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.12136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12136 Background: In the thick of the ongoing global crises of the COVID-19 pandemic, uprisings against anti-Black racism and police brutality, and anti-Asian racism and violence, Black, indigenous, and people of color (BIPOC) adolescent and young adult (AYA) cancer patients may be particularly vulnerable and exploited. Whilst embroiled in sociopolitical complexity, BIPOC AYAs are increasingly called upon to contribute as patient advocates in AYA oncology research and advocacy. Researchers, clinicians, and advocates in AYA oncology must dismantle long-standing racism and create meaningful structural change. The purpose of this study is to derive vital best practices for implementing antiracist patient engagement in AYA oncology research and advocacy that are co-developed by BIPOC AYA cancer patients and oncology professionals. Methods: We utilized a modified Delphi technique with a panel of BIPOC AYA cancer patients (n = 32) to build consensus opinions on professional recommendations from a prior study ( Cheung et al., 2021 ), and to generate antiracist best practices in patient engagement. The Delphi study was comprised of three consecutive and iterative survey rounds over the course of 8 months in 2021; participants were BIPOC AYAs diagnosed with cancer between ages 15-36 years. Results: Results detail best practices for the implementation of antiracist patient engagement across all research activities within the Patient-Centered Outcomes Research Institute’s (PCORI) Framework for Patient Engagement. For example, BIPOC AYAs agreed with oncology professionals’ high priority recommendation for including BIPOC AYAs at the highest levels of decision making in research topic selection. As such, a best practice is for researchers to ensure that such representatives not only hold BIPOC AYA identity, but also hold direct experience with the particular oncology diagnosis, issue, or other outcome of interest. Additionally, BIPOC AYAs concurred with oncology professionals’ high priority for “transparency, honesty, and trust” as a core principle for best practices in patient engagement. They further explained that trustworthy relationships are especially important when collaborating with teens and young adults, who are developmentally just coming into their own. When describing successful experiences of inclusion, participants ranked “build collaborative relationships with BIPOC AYA communities and listen to patients not usually heard” and “recruit a diverse range of BIPOC patients and let them give actual input into the study” as the highest priority best practices. Conclusions: Findings from this study are instructional for AYA oncology researchers, clinicians, and advocates to prevent harmful tokenism and implement genuine antiracist inclusion to advance health equity. Future research should investigate best practices within unique clinical settings.
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Affiliation(s)
| | | | | | - Megan Gilman
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Gilberto Lopes
- University of Miami Miller School of Medicine, Miami, FL
| | - Gail Betz
- University of Maryland, Baltimore, Baltimore, MD
| | | | - Bria N Thomas
- Geisinger Commonwealth School of Medicine, Scranton, PA
| | - Haelim Lee
- University of Maryland, Baltimore, Baltimore, MD
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Cheung CK, Tucker-Seeley R, Davies S, Gilman M, Miller KA, Lopes G, Betz GD, Katerere-Virima T, Helbling LE, Thomas BN, Lewis MA. A call to action: Antiracist patient engagement in adolescent and young adult oncology research and advocacy. Future Oncol 2021; 17:3743-3756. [PMID: 34263658 PMCID: PMC10918508 DOI: 10.2217/fon-2020-1213] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 06/25/2021] [Indexed: 12/13/2022] Open
Abstract
Amidst the concurrent global crises of coronavirus disease 2019 (COVID-19), uprisings against Anti-Black racism and police brutality, as well as anti-Asian racism and violence, the field of medicine found itself simultaneously called upon to respond as essential workers in the public health devastation of COVID-19, and as representatives of healthcare institutions wrought with the impacts of systemic racism. Clinicians, researchers, and advocates in adolescent and young adult (AYA) oncology, must come together in authentic activism to begin the work of creating structural change to advance antiracist approaches to patient engagement in AYA oncology research and advocacy. Critical review of existing practices is needed to ensure that ethical and effective research methods are employed when engaging with racial and ethnic minority AYA patients with cancer, who may be particularly vulnerable and exploited in the current context.
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Affiliation(s)
- Christabel K Cheung
- University of Maryland School of Social Work, 525 West Redwood St., Baltimore, MD 21201, USA
| | - Reginald Tucker-Seeley
- University of Southern California, Leonard Davis School of Gerontology, Los Angeles, CA 90089, USA
| | | | - Megan Gilman
- AYA Psychiatry, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Kimberly A Miller
- Department of Preventive Medicine, USC Center for Young Adult Cancer Survivorship Research, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033, USA
| | - Gilberto Lopes
- Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Gail D Betz
- University of Maryland Health Sciences and Human Services Library, Baltimore, MD 21201, USA
| | - Thuli Katerere-Virima
- University of Maryland Health Sciences and Human Services Library, Baltimore, MD 21201, USA
| | - Laura E Helbling
- University of Maryland Health Sciences and Human Services Library, Baltimore, MD 21201, USA
| | - Bria N Thomas
- Loyola University Maryland, Baltimore, MD 21210, USA
| | - Mark A Lewis
- Department of Gastrointestinal Oncology, Intermountain Healthcare, Murray, UT 84107, USA
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Cheung CK, Nishimoto PW, Katerere-Virima T, Helbling LE, Thomas BN, Tucker-Seeley R. Capturing the financial hardship of cancer in military adolescent and young adult patients: A conceptual framework. J Psychosoc Oncol 2021; 40:473-490. [PMID: 34152263 DOI: 10.1080/07347332.2021.1937771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Examine whether an existing conceptual framework for understanding financial hardship following a cancer diagnosis captures experiences among military adolescent and young adult (AYA) patients. METHODOLOGICAL APPROACH Investigators conducted focus groups and key informant interviews (n = 24) with active-duty military AYA cancer patients, their spouses, cancer care providers, and commanders at a military medical center and military post. FINDINGS Content analysis and thematic abstraction revealed that military AYA cancer patients' experiences of financial hardship occur within material, psychosocial, and behavioral domains that are situated within the contextual influences of AYA development and military culture. Subsequently, investigators constructed an expanded conceptual framework for understanding the financial hardship of cancer to capture these contexts. CONCLUSION Differentiating experiences of financial hardship into material, psychosocial, and behavioral domains situated within life course development and occupational culture contexts, may inform development of interventions with aspects of financial hardship most impacted by cancer care.
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Affiliation(s)
| | | | | | - Laura E Helbling
- University of Maryland School of Social Work, Baltimore, MD, USA
| | | | - Reginald Tucker-Seeley
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
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Cheung CK, Katerere-Virima T, Helbling LE, Thomas BN, Tucker-Seeley R. Capturing the financial hardship of cancer in military adolescent and young adult patients: A conceptual framework. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.29_suppl.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
163 Background: Cancer can be a setback for young active-duty military patients, with potential implications for their financial well-being, early career paths, and young families. Despite the assumption of sufficient material support for military patients, cancer and its treatments still result in substantial out-of-pocket expenses and lost-opportunity costs that can lead to financial hardship. Although prior cancer survivorship studies have put forth a material, psychosocial, and behavioral conceptual framework for describing financial hardship following a cancer diagnosis, it is unknown whether this framework adequately depicts the experience of financial hardship among military adolescent and young adult (AYA) patients. The primary aim of the current study was to extend this conceptual model of financial hardship following a cancer diagnosis for application among military AYA patients. Methods: Using Gale and colleagues’ Framework Method for qualitative multi-disciplinary health research, the investigator team conducted focus groups and key informant interviews (n=24) with active-duty AYA cancer patients, cancer care providers, and commanding officers at both a military medical center and a military post in Hawaii. Subsequently, content analysis and thematic abstraction produced results that were sorted to characterize the material, psychosocial, and behavioral domains of financial hardship. Finally, investigators employed health behavioral change theories to construct a conceptual framework. Results: Data analysis revealed that young active-duty military patients’ experiences of financial hardship following a cancer diagnosis occur within material, psychosocial, and behavioral domains that are uniquely situated within the environments of AYA development and military culture. Hence, we elaborated upon an existing conceptual framework of the financial hardship of cancer, by extending it to capture two meso-level contexts that emerged from our findings: (1) life course development and (2) occupational culture. Conclusions: Differentiating individual experiences of financial hardship within the contexts of life course development and occupational culture, may enable the development of interventions that are informed by the aspect of financial hardship most impacted by cancer care for this special population. Future research should further explicate the meso-level contexts in our study, and investigate the associations among and between factors within these social and environmental contexts.
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Affiliation(s)
| | | | | | - Bria N. Thomas
- University of Maryland School of Social Work, Baltimore, MD
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