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      Formative research to design a culturally-appropriate cancer clinical trial education program to increase participation of African American and Latino communities

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          Abstract

          Background

          Addressing knowledge deficiencies about cancer clinical trials and biospecimen donation can potentially improve participation among racial and ethnic minorities. This paper describes the formative research process used to design a culturally-appropriate cancer clinical trials education program for African American and Latino communities. We characterized community member feedback and its integration into the program.

          Methods

          We incorporated three engagement approaches into the formative research process to iteratively develop the program: including community-based organization (CBO) leaders as research team members, conducting focus groups and cognitive interviews with community members as reviewers/consultants, and interacting with two community advisory groups. An iterative-deductive approach was used to analyze focus group data. Qualitative data from advisory groups and community members were compiled and used to finalize the program.

          Results

          Focus group themes were: 1) Community Perspectives on Overall Presentation; 2) Community Opinions and Questions on the Content of the Presentation; 3) Culturally Specific Issues to Participation in Cancer Clinical Trials; 4) Barriers to Clinical Trial Participation; and 5) Perspectives of Community Health Educators. Feedback was documented during reviews by scientific experts and community members with suggestions to ensure cultural appropriateness using peripheral, evidential, linguistic, sociocultural strategies, and constituent-involving. The final program consisted of two versions (English and Spanish) of a culturally-appropriate slide presentation with speaker notes and videos representing community member and researcher testimonials.

          Conclusions

          Incorporating multiple community engagement approaches into formative research processes can facilitate the inclusion of multiple community perspectives and enhance the cultural-appropriateness of the programs designed to promote cancer clinical trial participation among African Americans and Latinos.

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          Most cited references36

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          Barriers to Clinical Trial Enrollment in Racial and Ethnic Minority Patients With Cancer.

          Clinical trials that study cancer are essential for testing the safety and effectiveness of promising treatments, but most people with cancer never enroll in a clinical trial - a challenge exemplified in racial and ethnic minorities. Underenrollment of racial and ethnic minorities reduces the generalizability of research findings and represents a disparity in access to high-quality health care.
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            The Role of Clinical Trial Participation in Cancer Research: Barriers, Evidence, and Strategies

            Fewer than one in 20 adult patients with cancer enroll in cancer clinical trials. Although barriers to trial participation have been the subject of frequent study, the rate of trial participation has not changed substantially over time. Barriers to trial participation are structural, clinical, and attitudinal, and they differ according to demographic and socioeconomic factors. In this article, we characterize the nature of cancer clinical trial barriers, and we consider global and local strategies for reducing barriers. We also consider the specific case of adolescents with cancer and show that the low rate of trial enrollment in this age group strongly correlates with limited improvements in cancer population outcomes compared with other age groups. Our analysis suggests that a clinical trial system that enrolls patients at a higher rate produces treatment advances at a faster rate and corresponding improvements in cancer population outcomes. Viewed in this light, the issue of clinical trial enrollment is foundational, lying at the heart of the cancer clinical trial endeavor. Fewer barriers to trial participation would enable trials to be completed more quickly and would improve the generalizability of trial results. Moreover, increased accrual to trials is important for patients, because trials provide patients the opportunity to receive the newest treatments. In an era of increasing emphasis on a treatment decision-making process that incorporates the patient perspective, the opportunity for patients to choose trial participation for their care is vital.
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              Achieving Cultural Appropriateness in Health Promotion Programs: Targeted and Tailored Approaches

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                Author and article information

                Contributors
                jerves@mmc.edu
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                3 June 2020
                3 June 2020
                2020
                : 20
                : 840
                Affiliations
                [1 ]GRID grid.259870.1, ISNI 0000 0001 0286 752X, Department of Internal Medicine, , Meharry Medical College, ; 1005 Dr. D. B. Todd Jr. Blvd, Nashville, TN 37208 USA
                [2 ]GRID grid.412807.8, ISNI 0000 0004 1936 9916, Vanderbilt Ingram Cancer Center, , Vanderbilt University Medical Center, ; Nashville, TN USA
                [3 ]GRID grid.256302.0, ISNI 0000 0001 0657 525X, Department of Health Policy and Community Health, , Georgia Southern University, ; Statesboro, GA USA
                [4 ]GRID grid.412807.8, ISNI 0000 0004 1936 9916, Division of Epidemiology, Department of Medicine, , Vanderbilt University Medical Center, ; Nashville, TN USA
                [5 ]GRID grid.259870.1, ISNI 0000 0001 0286 752X, Department of Family and Community Medicine, , Meharry Medical College, ; Nashville, TN USA
                [6 ]Progreso Community Center, Nashville, TN USA
                [7 ]GRID grid.259870.1, ISNI 0000 0001 0286 752X, School of Graduate Research Studies, Meharry Medical College, ; Nashville, TN USA
                [8 ]Matthew Walker Community Health Center, Nashville, TN USA
                [9 ]Meharry Vanderbilt Alliance, Nashville, TN USA
                [10 ]GRID grid.412807.8, ISNI 0000 0004 1936 9916, VUMC Office of Health Equity, , Vanderbilt University Medical Center, ; Nashville, TN USA
                Article
                8939
                10.1186/s12889-020-08939-4
                7268329
                32493245
                78b5f4ed-2fc7-44bb-b080-d2e903f863a5
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 5 December 2019
                : 17 May 2020
                Funding
                Funded by: National Institute of Health
                Award ID: P30 CA068485
                Award ID: P30 CA068485-23S5
                Award ID: U54 CA163072
                Award ID: U54 CA163069
                Award ID: U54 CA163066
                Funded by: FundRef http://dx.doi.org/10.13039/100000002, National Institutes of Health;
                Award ID: UL1 RR024975
                Award ID: UL1 TR000445
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2020

                Public health
                cancer,disparities,clinical trials,african americans,latinos,education,recruitment,community health educators (ches)

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