Cancer research sites demonstrated the utility of new resources designed to increase the diversity of participants in cancer clinical trials, although challenges remain, according to two studies published recently in JCO Oncology Practice.1,2
The studies examine the results from a collaborative pilot program of ASCO and the Association of Community Cancer Centers (ACCC); it worked to identify, develop, and disseminate tangible methods to ensure that cancer clinical trials better reflect the diversity of people with cancer. Specifically, the pilot program tested a research site self-assessment and an implicit bias training program among 75 cancer research sites across the United States.
Findings From First Study
The first article, “Increasing Racial and Ethnic Equity, Diversity, and Inclusion in Cancer Treatment Trials: Evaluation of an ASCO-ACCC Site Self-Assessment,”1 focused specifically on the site self-assessment. It was designed as a quality improvement tool to help research sites conduct an internal review to (1) evaluate their policies, programs, and procedures to identify opportunities and strategies to achieve their equity, diversity, and inclusion (EDI) goals, and (2) assess internal data to identify racial and ethnic disparities in screening and enrollment.
Study authors reported that 82% of the 62 participating sites identified opportunities for improvement at their site, and 63% further identified specific strategies they could implement. Additionally, 81% of participants were satisfied with the assessment, and 74% believed it could help their site address EDI issues.
Lori J. Pierce, MD, FASTRO, FASCO
Although many sites (65%) were able to provide some data on the number of patients who consented to participate in a trial, only two sites were able to provide all requested trial screening, offering, and enrollment data by race and ethnicity. This demonstrates one area where additional standardized efforts are needed to enable uniform baseline data collection.
“We are very pleased with the engagement in, and feedback received during, the pilot of the site self-assessment, as it points to current strengths in the clinical trials system and areas needing further attention, namely data collection on the race and ethnicity of patients screened and enrolled,” said ASCO Board Chair Lori J. Pierce, MD, FASTRO, FASCO, who is Co-Chair of the ASCO-ACCC Steering Group. “Documenting and evaluating which patients were offered and ultimately accepted clinical trial participation are key to identifying and mitigating disparities more broadly—and this will be an area of future focus.”
Findings From Second Study
The second article, “An Assessment of the Feasibility and Utility of an ACCC-ASCO Implicit Bias Training Program to Enhance Racial and Ethnic Diversity in Cancer Clinical Trials,”2 examined the utility and feasibility of a customized online implicit bias training program combined with facilitated peer-to-peer discussion. The training is designed to help research teams identify their own implicit biases and develop strategies to mitigate them.
Measured with pre- and post-training surveys, 119 participants from the 49 participating sites experienced a 19% to 45% mean increase in knowledge on the key concepts that define implicit bias, as well as a 10% to 31% increase in knowledge of strategies and actions to address implicit bias and trial diversity concerns immediately after the training. Although a 6-week follow-up test showed a mean decrease of 6% in knowledge of key concepts and 3.6% in strategies and actions, all retest scores remained higher than pretraining levels. With a 98% completion rate, the implicit bias training proved feasible to complete for cancer researchers. Qualitative feedback also showed the importance of peer-to-peer discussion following the training, and it enhanced self-reflection, triggered content recall, strengthened commitment to equity, and stimulated discussions about applying training insights to specific practice settings.
Randall A. Oyer, MD
“While data are limited about the effectiveness of implicit bias training in health settings, the qualitative feedback received from the pilot shows that giving providers the opportunity for personal reflection, a group debrief, and clear action steps is very valuable,” said ACCC Past President Randall A. Oyer, MD, and Co-Chair of the ASCO-ACCC Steering Group. “The implicit bias training program closes a gap in current training offerings and proposes a simple action plan of asking patients about their interest in clinical trials.”
At the conclusion of the pilot program, the ASCO-ACCC Equity, Diversity, and Inclusion Research Site Self-Assessment and the Just ASK™ Increasing Diversity in Cancer Clinical Research Training Program were modified to incorporate participating feedback and made available online at-no cost to the broader cancer research community.
In addition to the Research Site Self-Assessment and Training Program, the results from the pilot program have been added to ASCO and ACCC’s resources for research sites, including a Facilitation Guide for the implicit bias training and a Research Statement with recommendations that engage the entire cancer clinical trial ecosystem.
For More Information
Read both published articles and learn more about the ASCO-ACCC collaboration and all of ASCO’s health equity initiatives at asco.org/equity. Visit accc-cancer.org/equity for resources and education from ACCC.
1. Guerra C, Pressman A, Hurley P, et al: Increasing racial and ethnic equity, diversity, and inclusion in cancer treatment trials: Evaluation of an ASCO-Association of Community Cancer Centers site self-assessment. J Oncol Pract. January 11, 2023 (early release online).
2. Barrett NJ, Boehmer L, Schrag J, et al: An assessment of the feasibility and utility of an ACCC-ASCO implicit bias training program to enhance racial and ethnic diversity in cancer clinical trials. J Oncol Pract. January 11, 2023 (early release online).
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