All ETDs from UAB

Advisory Committee Chair

Mieke Beth Thomeer

Advisory Committee Members

Smita Bhatia

Raegan W Durant

Irena Stepanikova

Joseph D Wolfe

Document Type

Dissertation

Date of Award

2018

Degree Name by School

Doctor of Philosophy (PhD) College of Arts and Sciences

Abstract

Introduction: Current rates of participation for racial and ethnic minorities in cancer clinical trials are significantly lower when compared to non-Hispanic whites. The patients’ perspective on reasons for low participation is abundant. Yet, very little is known from the perspective of clinical and research professionals who are actively involved in patient recruitment. This study seeks to understand their perspective on how the external environment associated with the health care system contributes to limited participation of racial and ethnic minority groups in cancer clinical trials. To that effect, the health services utilization framework was utilized. Data/Methods: EMPaCT data with 91 qualitative interviews conducted at 5 NCI designated cancer centers with 4 stakeholder groups: cancer center leaders (N=8), principal investigators (N=34), research staff (N=33), and referring clinicians (N=16) was used. Interview transcripts were first read for global understanding, then for identification of major themes pertaining to structural reasons for minority non-participation, in accordance to health services utilization framework. Results: Key results gathered from the above mentioned respondents include A) Investigator bias is seen amongst clinical and research professionals; B) Color blind racial attitudes are prevalent among clinical and research professionals; C) There is a lack of institutional and leadership commitment towards increasing minority participation in cancer clinical trials; D) There is low research literacy amongst minorities due to a dearth of community outreach and E) There is a paucity of standardized recruiting and retaining practices toward minority participants for clinical trials. Conclusion: Clinical trials represent high quality treatment that must be made available for all sections of society irrespective of race. It is also imperative to recognize than the health of social groups is likely most affected by structural rather that individual phenomena. Thus, perspectives of clinical and research professionals can inform efforts to identify and mitigate health care system factors by implementing institutional policies in order to reduce racial disparities in oncology clinical trial participation.

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