I’m a clinician and professor at Rush University Hospital working in the up-and-coming field of cardio-oncology. My interest in clinical trial research came from my time as a cardiology fellow at the University of Chicago Medical Center. Now, I carry on a lot of research in my field of cardio-oncology studying heart disease in cancer patients.
As I got involved in research I had to enroll as many patients as I could, whether it was Black, white, Asian—it didn't matter. And when I saw how difficult it could be to enroll certain groups of patients, I started to ask questions. So as a Black doctor, if I didn't see myself represented in a trial, how am I going to translate that trial to my patients that are Black?
One pretty prevalent thing, and the message that you always get consistently from people, is that it's difficult to enroll Black patients. And so the question always comes up—why is that? What are the reasons for this and why are there such disparities? It often starts with doctor-patient rapport.
How Doctors Can Improve Rapport With Black Patients Around Clinical Trials
Building Trust
A few things influence Black people to try clinical trials. One is trust—having someone who looks like them that they can talk to about getting enrolled. When I enter a room and meet a Black patient for the first time, particularly one who has just been referred to my clinic, their eyes light up when I introduce myself as their cardiologist. They feel like they're in safe hands because I look like them Very importantly, they feel if they have concerns, they can voice them to me without judgment I will take their concerns to heart. And I will do my best to try to take care of their concerns.
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So that trust is established and maybe after a few visits or a year or two and there's a trial that comes out and I say to them ”Would you be interested in getting enrolled in the trial?”
Even if I did not look like the patient, a very important part of building trust in talking to someone about getting enrolled in a trial is by taking the time to explain what the risks of the trial might be.
Emphasize the Benefits
Discuss the nuances of the clinical trial you’re looking to get enrollment for. A lot of trials I work with here at Rush are interventional cardiology focused on procedures, like heart valve replacement or coronary interventions. Here at Rush, we have a good population of Black patients who get involved in cardiology clinical trials for treatments.
Let's say a patient has an aortic valve stenosis, or a tight heart valve. One option for that patient is to either go through surgery and get their chest cracked open to get the valve fixed. Or we do this percutaneous procedure where we just thread a catheter through your groin, get to your heart, blow up a balloon, and put in the new heart valve. Patients have the choice to have a recovery time of weeks because their chest was cracked open from surgery and then have a big scar there for the rest of their life—versus doing this minimally invasive trial procedure where you get to go home in the next day or two. So you can start to see that patients, of course, would prefer to not have to do the surgery because we explained the benefits of the trial procedure.
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And so a lot of those patients that have a procedure like the transcatheter aortic valve replacement (TAVR) tend to be happier for that reason. So they come out and they're satisfied and they feel happier because they did not have to have their chest cracked open.
Be Honest With Patients
If a patient ever senses that you're lying to them about the risks of getting into the trial, they're not going to trust you. I don't care what your skin color is. So explaining to them what the risk might be of getting into that clinical trial, as well as the benefits, is key. Tell them certain risks that we as Black folks get concerned about, but also how we're taking care of those risks so that it doesn't apply to the patient as much as possible. Share what they and society can gain down the line as well.
Make sure that whatever consent form you're having them fill out is very explicit in explaining the trial.
Involve Community Advocates and the Church
Other doctors have brainstormed on involving community advocates, whether it's pastors in churches or barber shops or salons—places where Blacks or underrepresented minorities, in general, congregate with people that they trust, with people that they see as part of their community. For all of these people who are advocates, explaining to them exactly what the trial is about, exactly what the risks might be that are involved, exactly what the gains might be, and then listening to them also about ways they may go about it.
Find Black Trial Coordinators
If you're enrolling mostly Black patients, getting Black coordinators is important so they feel like there's a certain rapport, a certain understanding, or a certain connection between them. But making sure it's not just getting somebody who's the same race, but it's making sure that those people understand the trial well. Can they answer questions in such a way that those people they're enrolling feel comfortable? They should fully understand what the trial is about before they agree to enroll.
If possible, make sure that the individuals enrolling participants in the trial are from the same racial or ethnic group as those being enrolled.
Partnering with Black and Black-Adjacent Institutions
If you work with a predominantly white institution, it may be hard to not only engage but also enroll Black patients in a clinical trial. However, if you partner with institutions like the University of Illinois or Rush Hospital, with a larger population of Black patients, they can enroll in that trial. The beauty of partnering with such institutions is that the Black patients trust the physicians in those institutions because they've been going to them for some time, and maybe even their family members go to that institution, and so on. So partnering with institutions where some of our Black patients go to get care is also important.
Dr. Tochukwu Okwuosa is a Professor and Director of the Cardio-Oncology Program at Rush University Medical Center in Chicago, IL. She earned her medical degree from the Philadelphia College of Osteopathic Medicine and completed her Internal Medicine and Cardiology training at the University of Chicago. Dr. Okwuosa's primary research interests lie in the areas of Cardio-Oncology and Cardiovascular Disease Prevention. She actively participates in multiple locoregional and national Cardiology/Cardio-Oncology committees and boards, serves as an Associate Editor for the Journal of the American Heart Association, and is the Immediate Past Chair of the American Heart Association's Cardio-Oncology sub-Committee.
