Qualitative study with health disparities experts (n = 5), community members (n = 9), and seriously ill African American patients and caregivers (n = 11). Using template analysis, interviews were coded to identify intrapersonal, interpersonal, and systems-level themes in accordance with a social ecological framework.ResultParticipants identified seven primary factors that influence ACP for African Americans: religion and spirituality; trust and mistrust; family relationships and experiences; patient-clinician relationships; prognostic communication, care preferences, and preparation and control. These influences echo those described in the existing literature; however, our data highlight consistent differences by group in the degree to which these factors positively or negatively affect ACP. Expert participants reinforced common themes from the literature, for example, that African Americans were not interested in prognostic information because of mistrust and religion. Seriously ill patients were more likely to express trust in their clinicians and to desire prognostic communication; they and community members expressed a desire to prepare for and control the end of life. Religious belief did not appear to negate these desires.Significance of resultsThe literature on ACP in African Americans may not accurately reflect the experience of seriously ill African Americans. What are commonly understood as barriers to ACP may in fact not be. We propose reframing stereotypical barriers to ACP, such as religion and spirituality, or family, as cultural assets that should be engaged to enhance ACP. Although further research can inform best practices for engaging African American patients in ACP, findings suggest that respectful, rapport-building communication may facilitate ACP. Clinicians are encouraged to engage in early ACP using respectful and rapport building communication practices, including open-ended questions.

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The significantly higher breast cancer (BCa) mortality rates of African-American (AA) women compared to non-Hispanic (NHW) white women constitute a major US health disparity. Investigations have primarily focused on biological differences in tumors to explain more aggressive forms of BCa in AA women. The biology of tumors cannot be modified, yet lifestyle changes can mitigate their progression and recurrence. AA communities have higher percentages of obesity than NHWs and exhibit inefficient access to care, low socioeconomic status, and reduced education levels. Such factors are associated with limited healthy food options and sedentary activity. AA women have the highest prevalence of obesity than any other racial/ethnic/gender group in the United States. The social ecological model (SEM) is a conceptual framework on which interventions could be developed to reduce obesity. The SEM includes intrapersonal factors, interpersonal factors, organizational relationships, and community/institutional policies that are more effective in behavior modification than isolation from the participants' environmental context. Implementation of SEM-based interventions in AA communities could positively modify lifestyle behaviors, which could also serve as a powerful tool in reducing risk of BCa, BCa progression, and BCa recurrence in populations of AA women.

The US is experiencing a severe shortage of underrepresented biomedical researchers. The purpose of this paper is to present two case examples of cancer research mentoring programs for underrepresented biomedical sciences students. The first case example is a National Institutes of Health/National Cancer Institute (NIH/NCI) P20 grant titled "South Carolina Cancer Disparities Research Center (SC CaDRe)" Training Program, contributing to an increase in the number of underrepresented students applying to graduate school by employing a triple-level mentoring strategy. Since 2011, three undergraduate and four graduate students have participated in the P20 SC CaDRe program. One graduate student published a peer-reviewed scientific paper. Two graduate students (50 %) have completed their master's degrees, and the other two graduate students will receive their degrees in spring 2015. Two undergraduate students (67 %) are enrolled in graduate or professional school (grad./prof. school), and the other graduate student is completing her final year of college. The second case example is a prostate cancer-focused Department of Defense grant titled "The SC Collaborative Undergraduate HBCU Student Summer Training Program," providing 24 students training since 2009. Additionally, 47 students made scientific presentations, and two students have published peer-reviewed scientific papers. All 24 students took a GRE test preparation course; 15 (63 %) have applied to graduate school, and 11 of them (73 %) are enrolled in grad./prof. school. Thirteen remaining students (54 %) are applying to grad./prof. school. Leveraged funding provided research-training opportunities to an additional 201 National Conference on Health Disparities Student Forum participants and to 937 Ernest E. Just Research Symposium participants at the Medical University of South Carolina.

Objectives Serious illness conversations (SICs) can improve the experience and well-being of patients with advanced cancer. A structured Serious Illness Conversation Guide (SICG) has been shown to improve oncology patient outcomes but was developed and tested in a predominantly White population. To help address disparities in advanced cancer care, we aimed to assess the acceptability of the SICG among African Americans with advanced cancer and their clinicians. Methods A two-phase study conducted in Charleston, SC, included focus groups to gather perspectives on the SICG in Black Americans and a single-arm pilot study of a revised SICG with surveys and qualitative exit interviews to evaluate patient and clinician perspectives. We used descriptive analysis of survey results and thematic analysis of qualitative data. Results Community-based and patient focus group participants (N = 20) reported that a simulated conversation using an adapted SICG built connection, promoted control, and fostered consideration of religious faith and family. Black patients with advanced cancer (N = 23) reported that SICG-guided conversations were acceptable, helpful, and promoted conversations with loved ones. Oncologists found conversations feasible to implement and skill-building, and also identified opportunities for training and implementation that could support meeting the needs of their patients with low health literacy. An adapted SICG includes language to assess the strength and affirm the clinician–patient relationship. Significance of results An adapted structured communication tool to facilitate SIC, the SICG, appears acceptable to Black Americans with advanced cancer and seems feasible for use by oncology clinicians working with this population. Further testing in other marginalized populations may address disparities in advanced cancer care.

PurposeTo evaluate the reliability of the Attitudes to Randomized Trial Questionnaire (ARTQ) in measuring perceptions of cancer clinical trials in a predominantly African American (AA) sample in South Carolina (SC).MethodsPrincipal Component Analysis (PCA) and Cronbach’s alpha estimates were used to assess the reliability of the ARTQ in a convenience sample of 315 participants (81.4 % AA) who were recruited from 2008 to 2013, and who live in eleven different counties in South Carolina with high rates of racial disparities in cancer mortality rates.ResultsSlightly more than half of the 315 participants had at least a college education (77.9 %), 84.8 % were female, and 53.1 % had an annual income of $40,000 or more. In this study, PCA confirmed that the ARTQ is unidimensional. Cronbach’s alpha for the ARTQ was 0.86.ConclusionThe ARTQ displayed strong evidence of high statistical reliability. This analysis has great implications for future research because it represents the first test of reliability of the ARTQ in a predominantly African American sample and lays the groundwork for use of the ARTQ in future studies in diverse populations.

The South Carolina Cancer Disparities Research Center (SC CaDRe), funded by the NIH/NCI Center to Reduce Cancer Health Disparities (CRCHD) in 2011, is a formal collaboration between the Medical University of South Carolina (MUSC) and South Carolina State University (SCSU, an historically black university). The SC CaDRe focuses on biological mechanisms of disparity in hormone-related cancers (breast and prostate cancer). The Sea Island population plays a prominent role in the three SC CaDRe research projects. The Sea Islanders are an African American ethnic group indigenous to the coastal southeast, with low rates of European American genetic admixture; as such they are ideal for inclusion in biomedical research. Each SC CaDRe research project includes Multiple PIs from MUSC and SCSU. The first research project is titled Biological Implications of DNA Glycation in Prostate Cancer Disparities; the second is titled MicroRNA Mediated Negative Regulation of Caveolin 1 as a Biological Mechanism Driving Breast Cancer Disparities; and the third is titled Feasibility Study of Breast Cancer Candidate Genes in Three Population Groups in South Carolina. The design and results of each project will be presented. The P20 SC CaDRe has led to two funded NIH R21 grants, an R01 grant, an R25E grant, and a DOD research training grant. Three undergraduate students from SCSU and four graduate students from MUSC have participated in SC CaDRe cancer research training, resulting in peer-reviewed publications and presentations at national scientific meetings. As a next step, the SC CaDRe investigators plan to submit an NIH/NCI CRCHD U54 grant application in 2016. Citation Format: Marvella E. Ford, Dennis K. Watson, James Stukes, Mahtabuddin Ahmed, David P. Turner, Ashley Evans Knowell, Victoria J. Findlay, Anita L. Harrison, Kendrea D. Knight, Heidi Varner, Kimberly Cannady, Judith D. Salley. Highlighting the maturation of the MSI/NCI P20 South Carolina Cancer Disparities Research Center Partnership. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B08.

BACKGROUND: Human papilloma virus (HPV) is linked to cervical cancer incidence. The HPV vaccine has been shown to significantly reduce the risk of HPV infection and subsequent cervical cancer diagnosis. Unfortunately, African Americans (AA) show lower uptake of the HPV vaccine than other groups. Underuse of the HPV vaccine has been linked to lack of knowledge of its effectiveness in preventing cervical cancer. OBJECTIVES: The purpose of this study was to evaluate an educational intervention to improve cervical cancer knowledge and HPV vaccine knowledge among predominantly AA communities in South Carolina (SC). METHODS: The study was conducted in a convenience sample of residents of five SC counties with high racial disparities in cervical cancer mortality rates that were recruited by community partners. The intervention consisted of a 4.5-hour educational session with 8 different components including a 30-minute cervical cancer/HPV vaccination knowledge component. Pre-and post- intervention surveys were administered. MEASURES: A 7-item investigator-developed instrument was used to evaluate pre-/post-intervention changes in cervical cancer knowledge and HPV vaccination knowledge. The items were based on the investigators’ review of the contemporary literature on the topics of cervical cancer, HPV infection, and the HPV vaccine. RESULTS: The first sample consisted of 64 participants from last year and this year participants consisted of 28 which make 92 in all (99% AA). Most of the participants who reported age were 50+ years. Among those who reported gender, 90% were female. Among those who reported income, 80% had an annual household income >$40,000. Seventy-two percent of the participants who reported their educational level had received at least some college training. Conclusions: Providing cervical cancer and HPV vaccination information leads to increasing knowledge related to cervical cancer and the HPV vaccine. In the future study, the investigators will evaluate changes in the pre-/post-intervention. HPV vaccination uptake rates in the five counties where the intervention was conducted. Citation Format: Marvella E Ford, Kimberly Cannady, NiAsia Hazelton, Kendrea D Knight, Claudia Lawton, Angela M Malek, Judith D Salley. Assessing an intervention to increase cervical cancer knowledge and HPV vaccination knowledge among predominantly African American communities in South Carolina [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D014.