Abstract A087: "Trust is built in teaspoons and it's lost in buckets": Clinical trial recruitment of Black individuals with lung cancer
Authors: Stallings Sarah C. , Ciupek Andrew , Bonnet Kemberlee , Schlundt David G. , Opoku-Agyeman William , King Jennifer C. , Karim Nagla Abdel , Lovly Christine M. , Aldrich Melinda C. , Niranjan Soumya J. 
Published: December 2023

Abstract
Black individuals with cancer are underrepresented in clinical trials, which has implications for understanding how therapies work in all patient populations. To achieve representative trial enrollment of Black persons with cancer, it is critical to understand the barriers to participation in this population. Due to stigma from perceptions around lung cancer’s association with smoking behavior, the barriers in this population may be complex compared to other cancer types. This study utilized a mixed-methods approach to decipher provider-reported barriers and facilitators to trial participation specificly among Black lung cancer patients. Providers across three institutions in the Southeastern US were interviewed using a semi-structured interview guide. Recorded and transcribed interviews and free text responses were analyzed by an independent coder using NVivo. Themes were generated using a content analysis approach. Data triangulation was achieved via anonymous surveys which were administered via REDCap. Across three institutions, 38 total, eligible, providers were recruited, having an average of 8.8 years of clinical practice. Nearly half (n=17, 44.7%) self-identified as Medical Oncologists. In the survey data barriers to clinical trial participation noted by the providers as expressed most often by black people with lung cancer were “being worried about the ’experimental nature’ of clinical trial treatments” and “not wanting to be a ’research subject’. The barrier least reported was “being worried about having to see another provider for the trial”. Provider perception of the reason that most contributes to lower trial participation of black people with lung cancer was “lack of trust in the medical system” (n = 18). Interestingly, when asked about perceptions of operational or system level barriers that contributed to lower clinical trial participation among lung cancer patients that identify as Black, providers reported “lack of appropriate trials” and “low numbers of Black patients seen”. Three overarching themes emerged from the qualitative interview data (i) Barriers to recruitment were seen at individual, institutional and structural levels. (ii) Facilitators were seen mostly at the individual provider level and were predominantly based on engendering trust between the patient and provider. (iii) Solutions were largely related to increasing awareness around clinical trials using community engagement. Providers in our study reported patient centric barriers to recruitment such as lack of trust and systems barriers such as not having appropriate trials available locally. Providers reported facilitators to increasing recruitment of Black individuals with lung cancer via community outreach and building provider/patient trust. Institutions should develop culturally appropriate outreach programs to enroll racially diverse patients to lung cancer trials and trialists should explore strategies to increase trial offering and access in key communities.
Citation Format: Sarah C. Stallings, Andrew Ciupek, Kemberlee Bonnet, David G. Schlundt, William Opoku-Agyeman, Jennifer C. King, Nagla Abdel Karim, Christine M. Lovly, Melinda C. Aldrich, Soumya J. Niranjan. "Trust is built in teaspoons and it's lost in buckets": Clinical trial recruitment of Black individuals with lung cancer [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A087.