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ASH 2022 Preview: Perspectives of Black Patients and Hematologists About Increasing Enrollment of Black Americans in Clinical Trials

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During this year's annual meeting, I will present two oral abstracts in the Patient Representation and Equity in Hematologic Malignancies session to be held on Saturday, December 10th. The first is abstract, number 380: "If You Don't Trust Your Doctor That Much... You'd Feel Less Confident Doing a Research Study": Factors Influencing Black Patient Participation in Hematology Trials; the second is 383: "You Have Your Knowledge, but I Have My Knowledge of My Body": The Hematologist-Patient Relationship and Enrollment of Black Participants in Clinical Trials. 

These data originated from a qualitative study performed at the University of North Carolina at Chapel Hill, where we examined factors influencing the underrepresentation of Black Americans in clinical trials. We conducted focus groups with Black patients with multiple myeloma and 1:1 interviews with academic hematologists to elicit their perspectives on the enrollment of Black Americans in clinical trials.

What should attendees be listening for in your presentations?

In these presentations, attendees will learn directly from study participants through direct sample quotations. These quotations will provide verbatim reflections on how medical mistrust, bias, stereotyping, socioeconomic factors, and the patient-provider relationship influence whether Black Americans are offered the opportunity to participate in a clinical trial.

What is the most important takeaway message from these studies? 

The patient-hematologist relationship is one of the most influential determinants of whether Black patients are presented with the opportunity to participate in clinical trials. Additional contributing factors include 1) race and socioeconomic status-based bias and stereotyping on the part of hematologists, 2) the legacy of medical mistrust among Black persons, 3) geographic barriers, and 4) the use of stigmatizing languages such as the word "trial," which invokes ideas of being a guinea pig." 

What are the implications of this study?

These data suggest that reducing the racial gap in enrollment of Black participants in clinical trials requires multilevel (i.e., individual, interpersonal, community, and healthcare system level) interventions. Furthermore, the finding of bias and stereotyping on the part of hematologists highlights a future target for intervention efforts. Physician awareness of their bias toward Black and other socioeconomically disadvantaged patients is an essential first step. However, individual awareness must be paired with strategies encouraging physicians to look beyond patient characteristics such as race and socioeconomic status and focus on specific disease characteristics that can influence patient suitability/eligibility for various trials. Together, multilevel intervention efforts can drive more equitable access to clinical trials for socially disadvantaged populations.

Dr. Grant has recieved a grant from Jimmy V Foundation for Cancer Research Grant No, (A21-0961-00; PI: Sascha Tuchman) to support this research. She is employed by The University of North Carolina at Chapel Hill.

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