ABSTRACT
Background: Access to health care including clinical trials (CT) leading to paradigm-changing cancer treatments are critical for high quality cancer care and equity in society. In this report, we highlight methods in accruing to ETCTN wherein underrepresented rural, low-income, and racial minorities comprise >50% of enrollment. Methods: University of Kansas Cancer Center (KUCC) is one of eight National Cancer Institute (NCI) designated cancer centers awarded CATCH-UP.2020 (CATCH-UP), a congressionally mandated P30 supplement to enhance access for minority/underserved populations to ETCTN precision medicine CT. KUCC catchment area is 23% rural by Rural Urban Continuum Codes (RUCC);almost 90 % of counties are designated primary care HPSA's (Health Professional Shortage Areas). KUCC Early Phase and Masonic Cancer Alliance (rural outreach network) partnered to operationalize CATCH-UP. We engaged disease-focused champion investigators in disease working groups and MCA physicians who selected scientifically sound CT that fit catchment area needs. Patient and Investigator Voices Organizing Together, a patient research advocacy group provided practical feedback. MCA navigator coordinated recruitment. Telehealth was used for rural patients that would have a significant distance to travel just to be screened. Results: CATCH-UP was initiated in September 2020. Twenty-eight CT were activated, many in community sites. Average activation time was 81 days. Delays were mainly from CT amendments. KUCC enrolled the first patient in the CATCH-UP program. In 6 months, we met accrual requirements (24/year, 50% minorities). During first year, we enrolled 47 (>50% minorities), an increase of 680% from our average accrual of 6/year (>50% minorities) in ETCTN through Early Drug Development Opportunity Program (2016-2020). To date, we have enrolled 61, 54% from rural, HPSA, race and other minorities. Although the proportion of minorities did not change but remained high, this funding allowed us to substantially increase the number of patients from a catchment area with high proportion of geographically and socioeconomically underserved minorities given access to early phase CT through ETCTN. Conclusions: Amid COVID-19 pandemic, the NCI CATCH-UP program and methods we used allowed access to novel therapies for rural, medically underserved, and other minority groups.
ABSTRACT
Background Observed Structured Clinical Exams (OSCEs) have been used for years to assess learners' clinical competencies. The sudden transition to virtual medical education during the COVID-19 pandemic has necessitated rapid development of innovative teaching strategies, including the creation of virtual OSCEs. Converting OSCEs to a virtual format poses unique technical, communication, and clinical challenges, especially when focused on the older and seriously ill patient population. Our institution has been performing interprofessional in-person OSCEs in geriatrics and palliative care for many years, and has undertaken an analysis to compare the previous in-person format to the new virtual format. Method In September 2020, interprofessional fellows, faculty, and standardized patients participated (SP) in a virtual OSCE. Preparatory didactic sessions included best-practices for telehealth with older adults. The OSCE consisted of 4 stations (falls, delirium, deprescribing, and advance care planning) hosted in zoom breakout rooms that included a fellow, SP, and a faculty observer. Fellows completed post-OSCE evaluations including feedback on perceived usefulness of individual stations (UIS), perceived overall importance (OI) and innovation in teaching methods all rated on a 5-point Likert scale. This was then compared to the in-person OSCE from 2019. Results The 2019 and 2020 OSCEs consisted of 17 and 21 interprofessional fellows respectively. UIS ranged from 4.33-4.91 in 2019 and 3.9 to 4.6 in 2020. OI was rated 4.7±0.46 in 2019, and 4.3±0.59 in 2020 (0.02). Innovation in teaching methods was rated as 4.6±0.5 in 2019 and 4.0±0.8 in 2020 (0.009). Learner comments cited a lack of sufficient preparation to effectively conduct a virtual encounter, and concerns about virtual fall evaluations. Conclusion Compared to the previous year's in-person OSCE, the virtual OSCE was scored lower in usefulness, importance, and surprisingly in innovation;however, overall ratings were still high. Performing a virtual OSCE is feasible, and increased education and practice of virtual visits may improve fellow perceptions. Further methodological refinement will produce an invaluable teaching tool for the physicians of tomorrow who will likely perform virtual visits throughout their careers.