The Clinical Research Trials: Ethnic and Racial Representation Essay

The purpose of the suggested paper is to investigate an intervention opportunity in enhancing a balanced ethnic and racial representation in clinical research trials. Hence, the research question is: Does the lack of diversity, i.e., minority groups or low representation thereof, in the clinical research (CR) workforce impact diversity in clinical trial participation?

In the PICO(T) form, it is formulated as follows: (P) population or problem – minority groups’ low representation in CR workforce; (I) intervention – inclusion of racial or ethnic minorities in CR workforce; (C) comparison – white population in CR workforce or trials; (O) outcomes of interest – improve minority participation in CR trials.

The search began with querying “minority professionals in clinical research workforce” in the PubMed database, which yielded 35 results; however, the subsequent MeSH database search yielded none. The same approach was applied to every query, filtered as scholarly resources published with a full text within the last five years. The most significant resources were then listed and grouped into the subheadings below, each subheading titled after the query. While ample research is still available, the selected 33 articles sufficiently encompass the problem.

Minority Professionals in Clinical Research Workforce

Out of the 35 results from the query, the following seven articles were selected for this review. The overall sentiment of the research was that the healthcare research workforce continues to lack diversity, with the biomedical workforce demographic profile not reflecting the general population (Rubio et al.; Thompson et al.). Hall et al. begin by drawing attention to many unique challenges in required clinical training and stress that women and non-white ethnic groups are largely underrepresented.

Further, the review of the present disparity is elaborated by Shipman et al., who address the issue of underrepresented ethnic minority groups in rural medicine and discuss the medical institutions’ efforts to recognize and value rural background, especially in minority groups. Lastly, a crucial piece of research by Silver et al. examines CR workforce disparities and their effects on patient care. These articles portray a comprehensive picture of contemporary challenges facing healthcare research workers and their effects on health outcomes.

Next, the research identifies the need for diversity and inclusion programs. Hall et al. summarize the major points on training clinical researchers and identify key priorities for future programs. The priorities included residency research support, new research programs for health professionals at different stages of their careers, and national networks to diversify and sustain the clinical research faculty (Hall et al.).

Lanzi et al. support this call, stating that effective mentoring of underrepresented researchers in health sciences is vital to the future of clinical research and public health. Lanzi et al. investigate mentor support strategies, discuss individualized approaches, and develop an inclusive developmental network that integrates all discussed aspects. Overall, the research indicates that diversity and inclusion support is important, whether national or individual.

Moreover, several projects and solutions have already been proposed and implemented. For instance, Rubio et al. present sister programs of Career Education and Enhancement for Health Care Research Diversity (CEED), which target medical students and intend to build a local and diverse research community. Hemming et al. evaluate a partnership network whose goals include remedying documented racial and ethnic disparities by issuing stimulating research grants.

Additionally, Thompson et al. present a series of training activities focused on recruiting and training primarily Hispanic researchers on treating cancer and report successful initial implementation. This research reports some of the results of extant diversity and inclusion programs.

Hiring Minority Professionals in Clinical Research

Out of 11 query results, the following four articles were selected, including the one by Hall et al., already mentioned in the previous subheading. Andriole and Wolfson state that supporting the CR workforce is critical to the continued development of health care in the US and introducing a clinician-researchers’ role. Andriole and Wolfson’s work is vital for showing the importance of inclusive programs for early-career researchers since they find that a well-informed initiative can sustain long-term interest and foster subsequent career development among minority groups. Hiring minority professionals can thus be effectively supported by appropriate programs.

Moreover, the focus of this query was on ways to enhance recruitment and evaluate employment prospects for ethnic minorities. For instance, Gotian et al. evaluate the results of the “Gateways to the Laboratory” program, which provided summer CR training for racial and ethnic minorities, mirroring the life of a clinician-scientist.

Gotian et al. find hopeful outcomes, with high rates of program graduates attaining graduate degrees. Further, Kaljo et al. discuss another pipeline program that focuses on helping minority students transition into the CR workforce quickly and efficiently. The reviewed programs demonstrate the importance of targeted real-life-emulating training programs for creating more professionals from minority populations.

Lastly, the research highlights the disparities in recruitment to cancer CR trials. Niranjan et al.’s research is crucial for answering the stated PICOT question since it raises the issue of factors that influence minority participation in CR trials, focusing specifically on minority recruitment training for CR recruiters. They identify the lack of proper and systematic training and suggest ways to enhance CR recruitment. This article is identified as one of the major guidance for the proposed paper.

Diversity and Inclusion in Clinical Research Workforce

With 69 total query results, the following four articles were selected for this review. Kronenfeld et al. discuss the critical disparity in available treatment options for Hispanic and Latino cancer patients compared with white patients. Kronenfeld et al. further argue that such disparity is commonly rooted in inequalities in the socio-economic determinants of health and that, among other solutions for such barriers, there should be more CR trials inclusive of Hispanic and Latino patients.

In their turn, Levites Strekalova et al. focus on the underrepresentation of black biomedical researchers and outlines the program curriculum with instructional content on CR research and storytelling components. Overall, appropriate racial and ethnic representation in CR is highlighted.

This sentiment is further supported by drawing connections between diversity in staff and inpatient populations. Another crucial article by Villanueva et al. conveys that the healthcare workforce has to be appropriately representative (diverse) to provide quality service to diverse patients. Hence, Villanueva et al. call for achieving diversity in the trainees’ pool to improve treatment processes.

Lastly, Cory discusses the white privilege in healthcare, its potential for perpetuating CR disparities, and the current insufficient systemic response to this issue. Hence, the researchers call for enhancing diversity and inclusion in the workforce to ensure the future clinical utility of the CR.

White Representation in Clinical Research Workforce and Trials

Out of 83 total results, the following six articles were fitting. These queries continued exploring the question of representation in CR. Esdaille et al. evaluate the history of prostate cancer occurrence and find it to have an earlier onset, more advanced stages, and worse survival rates in black than white males.

Further, Javier‐DesLoges et al. find disparity in the representation of black and Hispanic patients in CR trials on cancer. Charlot et al. add data on black individuals being underrepresented in cancer CR trials compared to white individuals, advising to establish a patient advisory council to address the issue. Hence, all the aforementioned articles argue for the increased inclusion of underrepresented individuals in CR trials.

Nevertheless, ethnic representation in trials and recruitment efforts is compared across fields and ethnicities. Lee et al. contemplate representation in the context of various CR recruitment flyers, pointing out that flyers with white clinicians and patients were commonly more effective for representatives of all races.

Cwalina et al. continue to review ethnic representation in orthopedic CR trials, ultimately finding that race reporting itself is quite low in this field. Lastly, Logic et al. conduct an overarching overview of various CR trials and demonstrate highly variable representation rates depending on the field and ethnicity. The researchers demonstrate various data from different healthcare fields to showcase the effect of white overrepresentation.

Racial Diversity Leadership and Clinical Research Workforce

Out of all results, only one recent article was found. Bignall and Crews discuss the health implication of racial disparities in kidney diseases CR. Bignall and Crews subsequently stress the importance of prioritizing CR workforce diversity and inclusion to alleviate those implications. Racially diverse leadership thus may result in better health outcomes, at least in some fields.

Improve Minority Participation and Clinical Trials

Only one result was found for this search query and is represented below. Dangerfield II and Wylie discuss the persistent mistrust in research among black sexual minority men and offer appropriate strategies to improve their participation in pre-exposure prophylaxis telehealth CR trials. Ethical and culturally responsible activities were identified as key in attracting minority participation.

Increasing Minority Participation and Clinical Trials

Over 770 results of this search were narrowed down to the only recent article on the topic by citation-matching. Lee discusses how the COVID-19 pandemic reinforced existing racial and socio-economic disparities in health care and then calls for increased minority participation in CR trials to find effective coronavirus treatment strategies. Hence, the importance of racially diverse CR trials is highlighted.

Does Increasing Minority in Workforce Improve Participation in Clinical Trials?

Out of five found results, only one article was sufficiently fitting and recent. Hofstädter-Thalmann et al. discuss the comparatively lower role of women in higher management positions and its effect on female representation in conferences. While the paper does not specifically study ethnic minorities, Hofstädter-Thalmann et al. draw on examples of both female and minority participation in leadership roles and their effect on underrepresentation in CR. This research is another important link between the CR workforce and CR trials representation dynamics.

Minority Leadership in Clinical Research Workforce

This search yielded 22 results total, among which were six articles previously mentioned in the sections above and the following two. Banister et al. discuss the ethnic makeup of the nursing workforce and point out the underrepresentation of minorities within. They further discuss the role of academic-practice leadership programs on future leadership engagement in the work environment.

Banister et al. conclude that such programs are effective stimulants for promoting minority leadership. Furthermore, Herrin et al. elaborate on the degree of racial and ethnic representation among hospital executives and how it affects health equity. They find that hospitals with more ethnically diverse leaders committed more to diversity initiatives, while hospitals led by white women committed less. Overall, the importance of minority leaders for the subsequent greater inclusion is highlighted, potentially extending its relevance to CR trials participation as well.

References

Hall, Alison K., et al. “Clinician–Investigator Training and the Need to Pilot New Approaches to Recruiting and Retaining This Workforce:”Academic Medicine, vol. 92, no. 10, 2017, pp. 1382–1389. DOI.org (Crossref), Web.

Hemming, PhD, Japera, et al. “Exploring Professional Development for New Investigators Underrepresented in the Federally Funded Biomedical Research Workforce.” Ethnicity & Disease, vol. 29, no. Suppl 1, 2019, pp. 123–128. DOI.org (Crossref), Web.

Lanzi, Robin Gaines, et al. “Effective Mentoring of Underrepresented Doctoral Trainees and Early Career Scholars in the Biobehavioral and Health Sciences: A Developmental Framework to Maximize Professional Growth.”American Journal of Orthopsychiatry, vol. 89, no. 3, 2019, pp. 378–89. DOI.org (Crossref), Web.

Rubio, Doris, et al. “A Multi-Pronged Approach to Diversifying the Workforce.”International Journal of Environmental Research and Public Health, vol. 15, no. 10, 2018, p. 2219. DOI.org (Crossref), Web.

Shipman, Scott A., et al. “The Decline in Rural Medical Students: A Growing Gap in Geographic Diversity Threatens the Rural Physician Workforce.”Health Affairs, vol. 38, no. 12, 2019, pp. 2011–2018. DOI.org (Crossref), Web.

Silver, Julie K., et al. “Physician Workforce Disparities and Patient Care: A Narrative Review.”Health Equity, vol. 3, no. 1, 2019, pp. 360–377. DOI.org (Crossref), Web.

Thompson, Beti, et al. “Long-Term Tracking Demonstrates Effectiveness of a Partnership-Led Training Program to Advance the Careers of Biomedical Researchers from Underrepresented Groups.”PLOS ONE, edited by Cesario Bianchi, vol. 14, no. 12, 2019, p. e0225894. DOI.org (Crossref), Web.

Andriole, Dorothy A., and Rachel K. Wolfson. “The Physician–Investigator Workforce: Looking Ahead.”Academic Medicine, vol. 96, no. 4, 2021, pp. 486–489. DOI.org (Crossref), Web.

Gotian, Ruth, et al. “Gateways to the Laboratory: How an MD–PhD Program Increased the Number of Minority Physician–Scientists.”Academic Medicine, vol. 92, no. 5, 2017, pp. 628–634. DOI.org (Crossref), Web.

Kaljo, Kristina, et al. “Student-Centered Pipeline to Advance Research in Cancer Careers (SPARCC): Diversifying the Clinical Cancer Research Workforce.”Journal of Cancer Education, 2022. DOI.org (Crossref), Web.

Niranjan, Soumya J., et al. “Training Needs of Clinical and Research Professionals to Optimize Minority Recruitment and Retention in Cancer Clinical Trials.”Journal of Cancer Education, vol. 34, no. 1, 2019, pp. 26–34. DOI.org (Crossref), Web.

Cory, Jeffrey M. “White Privilege in Neuropsychology: An ‘Invisible Knapsack’ in Need of Unpacking?”The Clinical Neuropsychologist, vol. 35, no. 2, 2021, pp. 206–218. DOI.org (Crossref), Web.

Kronenfeld, Joshua P., et al. “Overcoming Disparities in Cancer: A Need for Meaningful Reform for Hispanic and Latino Cancer Survivors.”The Oncologist, vol. 26, no. 6, 2021, pp. 443–452. DOI.org (Crossref), Web.

Levites Strekalova, Yulia A., et al. “The Black Voices in Research Curriculum to Promote Diversity and Inclusive Excellence in Biomedical Research.”Journal of Clinical and Translational Science, vol. 5, no. 1, 2021, p. e206. DOI.org (Crossref), Web.

Villanueva, Claudia, et al. “‘The Odds Were Stacked Against Me’: A Qualitative Study of Underrepresented Minorities in Surgical Training.”ANZ Journal of Surgery, vol. 91, no. 10, 2021, pp. 2026–2031. DOI.org (Crossref), Web.

Charlot, Marjory, et al. “Patient Powered Research: An Approach to Building Capacity for a Hardly Reached Patient Population to Engage in Cancer Research.”Research Involvement and Engagement, vol. 7, no. 1, 2021, p. 74. DOI.org (Crossref), Web.

Cwalina, Thomas B., et al. “Is Our Science Representative? A Systematic Review of Racial and Ethnic Diversity in Orthopaedic Clinical Trials from 2000 to 2020.”Clinical Orthopaedics & Related Research, vol. E-Publish Ahead of Print, 2021. DOI.org (Crossref), Web.

Esdaille, Ashanda R., et al. “Access and Representation: A Narrative Review of the Disparities in Access to Clinical Trials and Precision Oncology in Black Men with Prostate Cancer.”Urology, 2021, p. S0090429521008931. DOI.org (Crossref), Web.

Javier‐DesLoges, Juan, et al. “Disparities and Trends in the Participation of Minorities, Women, and the Elderly in Breast, Colorectal, Lung, and Prostate Cancer Clinical Trials.”Cancer, vol. 128, no. 4, 2022, pp. 770–777. DOI.org (Crossref), Web.

Lee, Sungkyoung, et al. “Effects of Communication Source and Racial Representation in Clinical Trial Recruitment Flyers.”Health Communication, 2021, pp. 1–13. DOI.org (Crossref), Web.

Lolic, Milena, et al. “U.S. Racial and Ethnic Participation in Global Clinical Trials by Therapeutic Areas.”Journal of Clinical Pharmacy and Therapeutics, vol. 46, no. 6, 2021, pp. 1576–1581. DOI.org (Crossref), Web.

Bignall, O. N. Ray, and Deidra C. Crews. “Stony the Road We Trod: Towards Racial Justice in Kidney Care.”Nature Reviews Nephrology, vol. 17, no. 2, 2021, pp. 79–80. DOI.org (Crossref), Web.

Dangerfield II, Derek T., and Charleen Wylie. “Identifying Ethical and Culturally Responsive Research Activities to Build Trust and Improve Participation of Black Sexual Minority Men in Pre-Exposure Prophylaxis Telehealth Clinical Trials: Qualitative Study.”JMIR Human Factors, vol. 9, no. 1, 2022, p. e28798. DOI.org (Crossref), Web.

Lee, Marshala. “We Must Act Now: Building Trust and Increasing Minority Participation in COVID-19 Clinical Trials.” Delaware Journal of Public Health, vol. 6, no. 5, 2020, pp. 34–35. DOI.org (Crossref), Web.

Hofstädter-Thalmann, Eva, et al. “Report on the Status of Women Occupying Leadership Roles in Oncology.”ESMO Open, vol. 3, no. 6, 2018, p. e000423. DOI.org (Crossref), Web.

Banister, Gaurdia E., et al. “African American Nurses’ Perspectives on a Leadership Development Program.”JONA: The Journal of Nursing Administration, vol. 50, no. 7/8, 2020, pp. 414–418. DOI.org (Crossref), Web.

Herrin, Jeph, et al. “Hospital Leadership Diversity and Strategies to Advance Health Equity.”The Joint Commission Journal on Quality and Patient Safety, vol. 44, no. 9, 2018, pp. 545–551. DOI.org (Crossref), Web.