221183 Role of minority physicians in community practice as gatekeepers for clinical research

Monday, November 8, 2010 : 8:48 AM - 9:06 AM

Helen D. Newton, MD , Research Development and Grants Administration, Saint Francis Hospital and Medical Center, Hartford, CT
Bernice Lubin, PhD , Research Development and Grants Administration, St Francis Hospital and Medical Center, Hartford, CT
Bruce Bernstein, PhD , Pediatrics and Surgery, St Francis Hospital and Medical Center, Hartford, CT
Gregory Makoul, PhD , Chief Academic Officer, Saint Francis Hospital and Medical Center, Hartford, CT
METHODS: We conducted qualitative interviews in Winter 2009-2010 to explore African American physicians' attitude toward and experience with clinical research. “Research” included a range from clinical trials to health services research. Inclusion criteria: AA provider of clinical care in minority communities in greater Hartford, CT. Exclusion criteria: not a minority; not in active practice. Interview results were hand tabulated by the interviewer (HN). The interview assessed the role of providers as gatekeepers to clinical research; their experience as referees of research; the access that their patients have to clinical research; their attitudes toward research; the barriers and gaps to access for themselves and their patients; and their ideas about solving the needs, gaps and barriers. RESULTS: We interviewed 11 African American physicians, seven females and four males, age from 30 to 56, averaging 40.6 y/o, with an average of 12.6 years experience. Four were in primary care and seven were specialists. All had some training in clinical research during post-MD education; two were principal investigators in the past. Eight had referred patients to research protocols at some point during practice. All indicated that participating in clinical research was positive; no physician thought that referral to a trial would disrupt relationships with patients. The expressed barriers to research participation among the community of minority physicians interviewed were diffuse: time, money, staff, availability of appropriate studies, record keeping, and exclusion from the process. Their discussion of patients' barriers was tightly focused: money, trust/distrust, transportation, and lack of education. Six did not think that their patient's access to research would be improved if the providers participated in educational programs about clinical research. CONCLUSION: In overviews of access to research, minority participation is almost universally described as underrepresented. However, few people are looking at the role of community-based providers as gatekeepers. Our results indicate that the major barriers to access are structural, not a matter of provider education. To ameliorate the barriers will require greater effort to solve the problems of time, access, direct funding and paperwork. Improved community-based minority provider/patient inclusionary strategies could ultimately strengthen the development of research questions, process and interpretation.

Learning Areas:
Clinical medicine applied in public health
Conduct evaluation related to programs, research, and other areas of practice
Diversity and culture
Public health or related public policy
Public health or related research

Learning Objectives:
1. Understand the role of African American providers as gatekeepers to research for their patients. 2. Identify what providers believe are the barriers to African American patient participation in clinical research. 3. Analyze the attitudes of African American providers toward clinical research 4. Describe the gaps, barriers, needs and strengths of the African American provider community as gatekeepers to clinical trials for their patients 5. Assess the methods of overcoming the gaps and barriers in both the provider and the patient communities in order to increase African American patient and provider participation in clinical research.

Keywords: African American, Research Agenda

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to be the author of this abstract because I participated in developing the interview framework and conducted all the qualitative interviews personally.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.