‘Intentional’ efforts needed to address DEI challenges in cancer care
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When Danielle Mitchell told an acquaintance about her mission to better represent Black women in the clinical workforce, the woman responded with a personal story.
She told Mitchell about her mother’s previous breast cancer diagnosis and surgical treatment. On the day of the surgery, both mother and daughter were nervous.
Then the physician entered the room to greet them.
She was a Black woman.
“She told me she immediately felt overcome with emotion, and asked the doctor if she could hug her,” Mitchell, CEO and founder of Black Women in Clinical Research, said during her presentation at National Comprehensive Cancer Network’s Oncology Policy Summit: Advancing diversity, equity and inclusion in the cancer workforce. “She told me that when she saw another Black woman who was taking care of her mother, she felt a sense of ease. She finally knew her mother was going to be OK.”
Mitchell, whose organization strives to empower and support Black women who are interested in clinical research careers, said this woman’s story reminded her why diversity in the cancer workforce is so important.
“When I think about the cancer workforce, I think of these stories that a lot of people share with me,” she said. “I also think about my own grandmother, who had breast cancer. So, when it comes to the challenges we face in DEI, we really need to be intentional.”
‘We really have to be that voice’
The oncology field continues to face a substantial underrepresentation of professionals from many racial or ethnic backgrounds, Mitchell said, adding that improvements in DEI are crucial to ensuring equitable representation.
“We have to make sure that when it comes to middle school, high school or college students, we are aware of the different opportunities that are available,” she said. “Oftentimes, there are not any clinical research programs at the colleges or universities. So, we really have to be that voice and tell people about these opportunities.”
Mitchell, who happened to learn about careers in clinical research at a pool party, said her group offers networking and mentorship opportunities to Black women interested in clinical research.
Black Women in Clinical Research also partners with universities — particularly historically Black universities and colleges—– and other organizations to recruit diverse talent. The organization provides financial support through scholarships or fellowships for Black women entering clinical research, and also pairs financial aid with mentoring and networking opportunities.
“We’ve been able to help over 1,000 members receive jobs in the industry,” Mitchell said. “People have told me it was difficult to get in but, once we gave them the tools that were needed, they were successful. There are so many different jobs in the clinical research industry, and a lot of people don’t know where they fit in.”
Value of concordance
The lack of diversity in the cancer workforce led NCCN to establish its DEI Directors Forum in October 2022.
Its mission is to improve diversity and share best practices for staff and faculty across institutions.
When the percentages of underrepresented groups are added together, they equate to 12.1%, according to Carmen E. Guerra, MD, professor of medicine at Abramson Cancer Center at University of Pennsylvania and an NCNN DEI Directors Forum representative.
“This entire subset of populations is very underrepresented in medicine — and in cancer,” she said.
Guerra discussed ways in which a more racially concordant workforce could improve the patient experience and possibly even cancer outcomes.
She cited a study that showed race concordance in the cancer care setting resulted in higher scores on Press Ganey surveys, which measure how patients feel about their experiences with their physicians.
Additionally, a systematic review of the 12 published studies in the literature addressing patient satisfaction showed racial concordance results in better communication. A study of patient encounters in which clinicians discussed prostate cancer results showed that Black patients had more trust when the presenter of this information also was Black.
Guerra also noted that racially concordant medical visits yielded increased patient satisfaction among Latino patients.
“In addition, it appears that racially concordant care reduces ER visits and medical expenditures, and that greater Black representation in primary care also results in greater life expectancy,” Guerra said. “So, our DEI forum wants to develop recommendations and best practices for all stakeholders, which we’re going to develop and finalize in the coming months.”
Multifaceted approaches
Shiva Bidar-Sielaff, MA, CDM, vice president/chief diversity officer and associate dean for Diversity Equity Transformation at the University of Wisconsin Health and UW Carbone Cancer Center, once served as the institution’s first Spanish interpreter.
“As we talk about the work of diversity, equity and inclusion, I always want to go back to the fact that language does matter very deeply in our communication,” Bidar-Sielaff said.
In her current role, Bidar-Sielaff seeks to improve patient communication by increasing racial/ethnic concordance at Carbone Cancer Center. She discussed the work UW Health has done in increasing the number of MD students who are categorized as underrepresented in medicine.
“Trying to ensure that we have racial and ethnic diversity in our MD students is work that is longitudinal, but we have had great success with our highest numbers,” she said. “In 2022, a third of our students were [underrepresented in medicine].”
Bidar-Sielaff also discussed UW School of Medicine and Public Health’s Native American Center for Health Professions, which seeks to support the recruitment, retention and graduation of Native American students in the health professions. The center engages this population through events, mentoring and educational opportunities. It also interacts with local tribal communities through clinic work and outreach.
“This is one of a few Native American centers for health professions that’s being funded by the Indians Into Medicine grant, and it’s an incredible center led by my colleague Danielle Yancey, MS,” Bidar-Sielaff said. “It really shows the success of having focused work that is based on and done by the communities we’re trying to serve.”
The program has resulted in a 600% increase in Native American MD student enrollment since 2013.
Bidar-Sielaff emphasized the importance of reaching underrepresented students with an interest in medicine as early as possible.
“Yes, it does start in middle school,” she said. “We have individuals who are focused on going into the middle schools — they are not a one-off; they’re longitudinal programs.”
She discussed Carbone Cancer Center’s ARISE program, which allows high school students to spend summer internships in laboratories. For working adults, the institution offers mentorship and apprenticeship programs, including a new RN apprenticeship.
“We have many ways in which we’ve started to implement our plan to enhance diversity,” Bidar-Sielaff said. “There are internal action groups working on it, but also a lot of collaboration across our systems to create workforce diversity.”
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Best Practices Presentations. Presented at: NCCN Oncology Policy Summit: Advancing diversity, equity and inclusion in the cancer workforce. Sept. 10, 2024; Washington, D.C.
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