NHS8051Unit7Assignment.docx

9

Synthesis of Evidence Substantiating Potential Interventions

Kayla T. Stephens
School Of Nursing and Health Sciences, Capella University
NHS 8051: Preparing for the Professional Doctorate in Public Health and Health Administration
Dr. Abida Solomon
May 2021

Abstract

Objective: The paper seeks to identify and synthesis evidence for potential interventions which can be used in the organizational challenge that barriers that minorities face when participating in oncology clinical research. The evidence will enable the organization to make effective improvements in mitigating the barriers to reduce negative impacts of the challenge.

Methods: The study follows a systematic review of journals and articles regarding barriers to clinical trial enrolment of the minority population in oncology clinical trials.

Results: Barriers to enrolling the minority population can be effectively mitigated by addressing the barriers from a multilevel framework.

Conclusions: To increase the enrollment of minority populations in oncology clinical trials, the organization should address the barriers from an organizational and individual level.
Keywords- barriers in inclusion, presentation of interventions leading to inclusion, and applicability of the interventions

Introduction

Minority groups around the continent face a lot of challenges in health care as well as inclusion in health research. This has facilitated disparities in health care opportunities as well as in clinical trials. Limited or lack of inclusion to such research reduces the generalizability of findings. Also, it increases population disparity to access quality health care. Over the years, cancer has become a persistent killer disease requiring advancements in cancer care and treatment. The organizational challenge presented considers the barriers that minorities face when participating in oncology clinical research. Overcoming the population barriers will require stakeholders to address barriers experienced by the population in participating in oncology research. The paper will synthesize evidence that supports potential interventions to mitigate negative impacts of the organizational challenge. Evidence-based interventions will be evaluated to align with organization goals and mission.

Search Strategy

Significance of Challenge and Need for Improvements

Racial and ethnic differences create considerable barriers for populations to be included in health research studies. Some of the barriers involve linguistic differences, lack of information on enrolment, beliefs and values, lack of support, financial barriers, and lack of resources (Nipp et al., 2019). Enrollment to cancer clinical research is perceived to only involve certain population in the society. The challenge results in ineffectiveness of treatments, untested safety, and reduced advancements in cancer care (Hamel et al., 2016). To increase population participation, improvements on the enrollment and retention of minorities must be facilitated. This would result in effectiveness of cancer treatment and care across all social populations around the globe with less generalization.

Search Strategy and Methods

The search strategy was enabled through a systematic review of existing literature, especially articles on barriers and to minority population inclusion in oncology research. The search was carried out on various nursing journals. Key words included minority populations, oncology research, improvements, barriers, and interventions leading to inclusion of minorities. The exclusion criteria considered articles regarding inclusion and enrolment of minorities in oncology research without interventions. Around ten articles had been chosen before elimination of seven. The inclusion criteria were based on the search words, ability to present barriers in inclusion, presentation of interventions leading to inclusion, and applicability of the interventions in organizations. In addition, the interventions provided had to create parity of the minority population in assessing quality care.

Research Synthesis

Evidence Application

The studies provide and support claims and interventions regarding the organizational challenge. This is from an organizational level, individual level, to an interpersonal level. Application of the evidence in an organizational level would result to changes mitigating system barriers such as financial costs and resources limitations. Also, community engagement from the individual level would increase participation and ownership of the research. Meanwhile, the individual level evidence reduces individual barriers like population support reducing agreements to enrollment. Interpersonal level evidence addresses barriers related to biasness, communication, and understanding of the trials. The outcomes will be reflected in increased clinical trials with increased numbers of minority population members. This is imperative as the evidence supports interventions and their applicability.

Comparison of Evidence

The provision of a multilevel framework in interventions is used in Hamel et al. (2016) article. The second article regards national and community facilitators to reduce the barriers. The participation would encompass cultural-sensitive participatory approaches, awareness, and community-based approaches in the enrolment and retention of participants (George et al., 2014). The third article’s evidence is based on interpersonal and financial factors as interventions to increase participation in cancer clinical trials. Shared decision-making, communication, and mutual understanding facilitate encouragement and discussion about participation concerns (Nipp et al., 2019). The evidence synthesis and comparison can be observed to involve at least two levels of the first article’s interventions framework.

Significance and Relevance of the Evidence

Specific aspects of the evidence include the interventions been embedded in a particular level. This not only increases the significance of the intervention but also the ability to address the challenge from different levels. For instance, the potential interventions would be addressed from a general aspect before been addressed in a specific patient/community member level. Another aspect in the evidence considers the stipulation of cultural and linguistic sensitivities in the application of the potential interventions. The specificity results in effective application of planning strategies enabling acceptance of the trials, adaptation to future trials, and improvements in participation. The aspects are relevant for interventions effectiveness.

Applicability of Interventions

Specific Interventions on the Population

The interventions specifically apply to the population characteristics through exposure to unique barriers. The barriers such as biasness and under-representation in clinical research resonate with the population. The interventions articulated consider equity and cultural sensitivity of the population. In addition, the population experiences a lot of disparities when assessing quality health care. The interventions ensure that their participation in the trials would lead to quality cancer care through reduced generalization of findings and treatments.

Anticipated Outcomes

The first outcome is associated with increased numbers of members from the minority population who participate and enroll in the cancer clinical trial. Secondly, the enrolled members are to accept been retained in the participation programs through education and assistance. The third outcome considers application of effective research strategies which are culture and language sensitive. The outcomes align with the organization’s mission and goals on clinical trials to patients and community members. Equality, fairness, honesty, awareness, assistance, education, and cultural sensitivity are the founding values in the organizational goals and mission. The values would influence inclusion of minority groups through mitigation of different barriers.

Substantiating Interventions Implementation

Considering the multilevel framework of interventions, the organization is likely to facilitate improvements through organizational and individual levels to mitigate the negative impact of the challenge. This can be associated with resources, finance, assistance, support, awareness, community engagement, and positive attitudes towards the trials. The organization would stipulate its contribution of resources and finances since they are challenging factors in the population to reduce under-representation and lack of participation in trials. Assistance, support, awareness, and community engagement would be influenced through application of the resources towards effective organization-community relationships. On the other hand, changes attitudes and perspectives on participation would regard engagement with population members through effective communication and appreciation of cultural differences by the organizational staff.

Evidence-Based Intervention

Evidence Quality and Level

The intervention is supported by all the articles articulating its quality and applicability in reducing the negative impacts of the organizational challenge. Additionally, the articles provide substantial evidence which effectively supports the specific intervention. This is because of its effectiveness and applicability. Considering the level of the intervention, it is appropriate as it directly deals with the organization, the community, and individual population members. To impact changes on inclusion in trials, the community, organization, and members ought to be involved. This is facilitated through education, awareness, support, and assistance. Community and organizational support are significant in enabling the inclusion of minorities in oncology clinical trials.

Support of the Intervention

The multilevel framework intervention would work to facilitate organizational improvements, increased inclusion of the population, and influence participation in trials enrollment and retention. However, this would be highly inclined on the organizational and individual levels. The interpersonal level is unlikely to have effective improvements as it regards frequent and personal level interactions with the population. Effectiveness would be enabled after the population has been included and enrolled in the trials to enable assistance. Thus, the two levels are relevant to both the minority population and the organization resulting in positive outcomes to overcome the challenge.

Conclusion

Minority populations are time and again faced with disparities during inclusion in clinical trials. The population members range from Latinos to African Americans. In particular, minority groups inclusion in oncology clinical trials lead to generalization of findings and treatments. This as a result of various barriers experienced during the enrolment process. Stakeholders ought to adopt different strategies to ensure that fairness is achieved during clinical trials. The interventions considered from the evidence synthesis involve the multilevel framework. The framework regards organization/system level, individual level, and interpersonal level. The organization would benefit from incorporating the organization and individual levels to facilitate improvements and mitigate barriers towards inclusion of minority groups. The intervention is effective as it is culturally sensitive and the ability to address the challenge from specific levels.

References

George, S., Duran, N. & Norris, K. (2014). A systematic review of barriers and facilitators to minority research participation among African Americans, Latinos, Asian Americans, and Pacific Islanders. American journal of public health 104(2). doi:10.2105/AJPH.2013. 301706)
Hamel, L., Penner, L., Albrecht, T., Heath, E., Gwede, C. & Eggly, S. (2016). Barriers to clinical enrollment in racial and ethnic minority patients with cancer. Cancer control 23(4), 327-337.
Nipp, R., Hing, K. & Paskett, E. (2019). Overcoming barriers to clinical trial enrollment. Care delivery and practice management. https://doi.org/ 10.1200/EDBK_ 243729

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