WHY RACIAL AND GEOGRAPHIC DIVERSITY OF INVESTIGATORS MATTERS
Positive experiences between medical providers and patients build trust, quality of care and ultimately can contribute to positive health outcomes. As we seek to build more diverse clinical trials, we must understand the importance of diversity within study sites and with investigators—the physicians conducting the research.
A 2021 study examined data from more than 50,000 patients to explore the effects of racial concordance of patients and clinicians. It linked patient-physician racial concordance to improved satisfaction, lower healthcare expenditures and better outcomes.
Researchers in another study evaluated the demand for preventative care among African-American men. They found African-American men were more likely to feel comfortable with doctors who look like them, and suggested that Black doctors could actually help reduce the Black-White male gap in cardiovascular mortality by 19%.
Eddilisa Martin, Founder and CEO of 2M Clinical, stresses the importance of diversity among physicians and how that can carry over to increased success in patient care and clinical trials.
“Rather than a didactic approach to caregiving, encounters are often more interactive,” Dr. Martin said. “Minority patients are more comfortable conversing with providers who are racially concordant, and providers in these interactions ask more questions that lead to more specialized and informed care and treatment.”
Clinical trial participants are often referred by their primary care provider, which makes reaching a more diverse group of investigators and referring physicians incredibly important. Racial and ethnic minority physicians are more likely to practice primary care and serve in underserved communities so including these physicians as investigators could lead to increased enrollment of their patients in clinical trials.
Expanding the scope of trials outside of academic medical centers can reach beyond the typical homogenous physician and patient populations in those institutions. “Biopharmaceutical companies tend to go to large university settings for trials, but there’s good infrastructure elsewhere and a lot of community multi-specialty clinics that they could be going to as well,” Dr. Martin said.
Expanding the scope of trials to include community clinics also increases geographic diversity. Patients who live in rural communities or far from academic medical centers can participate at their local clinic or even from home without the burdens of time and expenses to travel. Decentralized trials (DCTs) can strategically add technology to replace the need for in-person visits, bring clinical trials to patients where they are, and ultimately make trials more appealing and accessible to non-traditional patient groups. Clinical trial sponsors should design trials that are more accessible, feasible, and desirable for minority and community physicians and participants.
One way to move the needle in reaching prospective investigators is to tap into minority professional medical societies like the National Medical Association for African-American physicians, National Hispanic Medical Association and National Council of Asian Pacific Islander Physicians. Similarly, a long-range approach involves engaging student chapters of minority-focused associations at various medical schools to plant the seed that physicians can be involved in research from a community perspective and not just in large academic medical centers.
Many sponsors have had trouble recruiting and retaining new investigators and minority providers tend to have lower participation in clinical trials. Dr. Martin and her team believe these issues can be combated with better recruiting and training of more investigators from the community setting. “Often when physicians participate in clinical research, it’s been more of an apprenticeship approach where they learn under the tutelage of somebody else that’s doing it,” Dr. Martin said. “But when you have well-designed study courses and curriculums that physicians can enroll in, there’s greater persistence with investigators enrolling patients and participating in future trials.”
This involves devoting resources to recruiting and training investigators in good clinical trial practices and setting clear expectations for their role as investigators. They should also be informed of the infrastructure their facility will need to conduct trials. Investigators who feel more support and ownership of the study will be more likely to have a positive experience and see the benefits for themselves and their patients. This more structured training approach may be beneficial to overcome lack of mentorship opportunities in the clinical trial space and other barriers that the minority community physician may face.
2M Clinical works to meet these needs with a program developed specifically for better investigator recruiting and training. They developed the new NeighborhoodTrials.com platform to bring new therapies directly to patients and better connect all groups involved. Physicians can also use the customized, interactive, A.I. data-driven platform to learn about new clinical trials and emerging therapies that could benefit their patients and opportunities to become investigators.
Increasing diversity requires us to approach clinical trial development from both a patient and provider mindset. They work hand-in-hand to make sure diverse populations are included and that clinical trials provide answers for all groups of people.