Assessing barriers to prostate cancer clinical trial participation among Black and African Americans: A multi-perspective qualitative study.
Authors: Leger Paul Denis , Frencher Stanley K , Nauseef Jones T. , Jones Brian , Scriven Lansing , Tsao Che-Kai , Bilen Mehmet Asim , Brown Alan , Pereira-Rico Alvaro , Ullah Aminha , McDevitt Shane 
Published: May 2024

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Background: Prostate cancer affects non-Hispanic Black people at a higher rate than other groups, including non-Hispanic White people and Hispanic people. However, Black and African American patients are historically underrepresented in prostate cancer clinical trials. Using a multi-perspective qualitative approach (physicians, advocates, and patients), we aimed to better understand the barriers to Black and African American participation in prostate cancer clinical trials. Methods: Three advisory boards were conducted with each advisory board consisting of a unique stakeholder: (1) physicians, (2) patient advocates, and (3) patients. The physician advisory board included 5 medical oncologists, 1 radiation oncologist, and 1 urologist. The patient advocate advisory board included 7 patient advocates focused on increasing healthcare equity in prostate cancer. The patient advisory board included 7 Black and African Americans with prostate cancer. The median patient age was 65 years (range: 60-73). Each advisory board was a 2-hour virtual meeting, with a moderated discussion to deepen the understanding of enrollment obstacles and identify strategies to increase diverse enrollment in prostate cancer clinical trials. All participants were compensated for their time. Results: We identified five key themes describing barriers to diverse prostate cancer clinical trial enrollment: (1) systemic healthcare system barriers including lack of insurance or underinsurance, difficult to navigate healthcare systems, and lack of caregiver support structures; (2) the lack of trust in clinical research due to historical injustices; (3) stigma and lack of education around prostate cancer; (4) the importance of female caregivers; and (5) lack of time, incentive, and funding from trial sponsors for institutions to develop and execute strategies to enroll diverse patients. We also identified opportunities for improving diversity in prostate cancer clinical trials. These include allowing additional start-up time and sponsor funding for sites to develop unique diversity-focused enrollment strategies, sponsors encouraging diverse enrollment by considering steering committee appointments that can provide expertise in enrolling diverse patients, and building trust by engaging Black and African American community organizations, such as churches and fraternities/sororities, including female caregivers. Conclusions: Shared themes emerged from the 3 advisory boards that both validated prior knowledge and identified new areas of emphasis for reducing health inequities and low enrollment among Black and African Americans in prostate cancer clinical trials. In addition, the multiple perspectives represented by the advisory boards led to specific ideas and strategies for institutions to consider implementing for future trials.