Fellow Travelers in a Mighty Small Boat: Dispatches from the Highs Seas of DEI

Gary Cramer headshot

Clinical Researcher—August 2022 (Volume 36, Issue 4)


Edited by Gary W. Cramer


“Now, now, now, we’re all sort of fellow travelers in a mighty small boat, in a mighty big ocean. And the more we quarrel, criticize, and misunderstand each other, the bigger the ocean gets and the smaller the boat.”
Henry Hull, playing Charles J. “Ritt” Rittenhouse Jr. in “Lifeboat” (1944)

Fostering Diversity and Inclusion in the Healthcare Workforce

For U.S. health systems, valuing diversity and inclusion in the workforce is vital to serving the emerging needs of a diverse patient population. The much-aspired patient-centered care is feasible when the approach and focus are shifted to enable health systems to improve care quality and the patient experience of diverse patients.

Published in JMIR Formative Research, a study titled “Valuing Diversity and Inclusion in Health Care to Equip the Workforce: Survey Study and Pathway Analysis” asks the following questions:

  • Can the healthcare workforce leverage the educational pipeline to fulfill diversity needs and address workforce shortages?
  • How do the alternative pathways of improving, recruiting, and collaborating compare in this process?

The study finds that improving the current workforce through upskilling or returnships around diversity and inclusion needs is more effective than recruiting or collaborating with universities to find fresh talent. The findings suggest that health systems that value only a diversity and inclusion strategy may not rely on collaboration with universities to equip their workforces.

However, health systems that adopt a recruiting strategy will look externally to find new workers and seek collaboration with universities. Moreover, these pathway effects go hand in hand with a talent-improvement strategy, indicating that talent and diversity strategies must be aligned to achieve the best results for a health system.

Giving voice and committing resources to diversity and inclusion initiatives will fail unless leaders instill a process inside their organizations through education and training. Good intentions will not be enough. Just recognizing or appreciating the concept of diversity is not enough. Leaders need to implement actionable plans within their systems to improve inclusiveness.

Spanish-Speaking Patients Show Strong Interest in Trial Participation in the U.S.

Writing for SubjectWell in June, Ivor Clarke noted how language barriers faced during the clinical trial process can often result in lower participation rates of non-English speakers, an unsatisfactory patient experience and, ultimately, imprecise data.

When SubjectWell fielded a U.S. survey from March to April 2022 of 438 primary English- or Spanish-speaking patients (224 and 214 people, respectively), Spanish-speaking respondents were more likely to show interest in trial participation. However, more Spanish speakers reported being “somewhat likely” to consider participation compared to English speakers, meaning interest is more prevalent, but enthusiasm is lower. Spanish-speaking respondents were also more likely to participate in a trial with bilingual staff.

Compensation motivated both groups, but was stronger for English-speaking respondents. Additionally, respondents without health insurance were more likely to be only somewhat interested (54%) and less likely to be extremely interested (12%) than those with health insurance, suggesting they may need more factors to motivate them to participate.

Despite Spanish speakers’ interest in participation, Hispanics represent only 11% of trial participants, but make up 18.5% of the general population. To make up this deficit, this survey found that an inclusive study design for Spanish speakers includes both a bilingual staff and financial compensation. However, Clarke explains, the industry is still exploring the best accommodations to provide improvements in patient diversity and remove barriers to patient recruitment. Financial compensation is just one simple, but proven, way to increase interest in both Spanish- and English-speaking populations and should be considered during study design.

ASCO, ACCC Release Recommendations to Increase DEI in Clinical Trials

The American Society of Clinical Oncology (ASCO) and the Association of Community Cancer Centers (ACCC) in June jointly released recommendations that address the lack of diversity, equity, and inclusion (DEI) in cancer clinical trials. Published in the Journal of Clinical Oncology, their recommendations detail specific actions to engage the entire cancer clinical trial ecosystem in expanding the participation of underrepresented individuals in research that advances progress against cancer.

The research statement underscores that inclusive participation in clinical trials is necessary to understand potential differences in efficacy and safety across diverse populations, mitigate racial and ethnic disparities in health outcomes, and promote equity and justice. The recommendations focus on the following key areas that address barriers to cancer clinical trials:

  • Access to Clinical Trials
  • Equity-Focused Design
  • Partnerships Among Stakeholder Groups
  • Continuous Education and Training
  • Investment in Equity, Diversity, and Inclusion
  • Sharing Data and Strategies

The full ASCO-ACCC Research Statement clarifies which clinical trial stakeholders would be instrumental in implementing specific recommendations, while encouraging all research stakeholders to help achieve the goal of ensuring cancer clinical trials reflect the racial and ethnic diversity of people with cancer.

Gary W. Cramer (gcramer@acrpnet) is Managing Editor for ACRP.