University of Alabama at Birmingham, Birmingham, AL.
Johns Hopkins University, Baltimore, MD.
JCO Oncol Pract. 2021 May;17(5):e666-e675. doi: 10.1200/OP.20.00970.
PURPOSE: In general, participation rates in cancer clinical trials are very low. However, participation rates are especially low among the socially disadvantaged and racial and ethnic minority groups. These groups have been historically under-represented in cancer clinical trials. Although many patient-related barriers have been studied, institutional factors that are essential for building clinical research infrastructure around the clinical trial enterprise in academic medical centers have been underexplored. MATERIALS AND METHODS: We assessed perspectives of cancer center professional stakeholders on the institutional factors that can potentially influence racial and ethnic minority recruitment for cancer clinical trials. Ninety-one qualitative interviews were conducted at five US cancer centers among four stakeholder groups: cancer center leaders, principal investigators, referring clinicians, and research staff. Qualitative analyses examined response data focused on institutional factors related to minority recruitment for cancer clinical trials. RESULTS: Four prominent themes emerged regarding institutional barriers among clinical and research professionals. (1) There are no existing programs currently being used to recruit or retain minorities to clinical trials. (2) Institutional efforts are needed to increase trial participation and are not specific to potential minority participants. (3) Access to cancer clinical trials and navigation within an Academic Medical Center need to be simplified to better facilitate recruitment of minority patients. (4) Community outreach by cancer centers will increase clinical research awareness in the community. CONCLUSION: Our research highlights the need to address institutional barriers to improve the success of minority recruitment. To increase participation among minority populations, medical centers must address mutable institutional barriers such as setting specific minority recruitment goals for cancer clinical trials, ensuring that cancer clinical trials are accessible, especially to minority patients, and supporting sustained community outreach programs to increase clinical research awareness.
目的:一般来说,癌症临床试验的参与率非常低。然而,社会弱势群体以及少数族裔群体的参与率尤其低。这些群体在癌症临床试验中历来代表性不足。尽管已经研究了许多与患者相关的障碍,但对于学术医疗中心中围绕临床试验企业构建临床研究基础设施至关重要的机构因素仍未得到充分探索。
材料与方法:我们评估了癌症中心专业利益相关者对可能影响癌症临床试验中少数族裔招募的机构因素的看法。在五个美国癌症中心的四个利益相关者群体(癌症中心领导、首席研究员、转诊临床医生和研究人员)中进行了 91 次定性访谈。定性分析检查了针对与癌症临床试验中少数族裔招募相关的机构因素的应答数据。
结果:临床和研究专业人员提出了四个突出的主题,涉及机构障碍。(1)目前没有用于招募或留住少数族裔参加临床试验的现有计划。(2)需要开展机构工作以增加试验参与度,而且不限于潜在的少数族裔参与者。(3)需要简化癌症临床试验的参与途径和在学术医疗中心的导航,以更好地促进少数族裔患者的招募。(4)癌症中心的社区外展将提高社区对临床研究的认识。
结论:我们的研究强调需要解决机构障碍,以提高少数族裔招募的成功率。为了增加少数族裔人群的参与度,医疗中心必须解决可改变的机构障碍,例如为癌症临床试验设定特定的少数族裔招募目标,确保癌症临床试验对少数族裔患者具有可及性,并支持持续的社区外展计划以提高临床研究意识。
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