Medical School Clinical Trials Educational Intervention: Impact on Knowledge and Attitudes.

Medical student knowledge and opinions of clinical research have important ramifications for how likely they will be to refer patients into clinical trials as practicing physicians. This study examined students understanding, knowledge, and attitudes about clinical trials at the start of medical school and after completion of a multi-faceted intervention designed to increase medical students' confidence in understanding and explaining clinical trials during the pre-clinical and clinical years. Medical students were surveyed about their knowledge of and attitudes toward clinical trials in their first (N = 724) and third (N = 191) years of medical school. During the intervening years, students attend a lecture delivered by University of Hawai 'i Cancer Center faculty, were provided a resource manual from National Cancer Institute, participated in two problem-based learning clinical scenarios, and completed an optional practicum. After completing the comprehensive clinical trials education, there were significant increases in student understanding and knowledge and a decrease in student perception that clinical trials exploit participants. Most students agreed or strongly agreed that inclusion of clinical trials in the curriculum was important and would influence their future practice. Integration of clinical trials education into the medical school curriculum improved students' understanding of clinical research, their ability to communicate the clinical trials process, and confidence in conducting, referring to, and locating clinical trials. Medical students appreciate the importance of clinical trials in advancing medicine and medical education. Further integration of clinical trials education and opportunities to engage in research during medical school are warranted to address students' uncertainty about the benefits of participation for patients.

No Ke Ola Pono o Na Kane: A Culturally Grounded Approach to Promote Health Improvement in Native Hawaiian Men.

In Hawai'i, Native Hawaiian men (kane) have the highest death rate from colon cancer among all ethnic groups. While screening can prevent 90% of these cancers, data show that >58% of kane over age 50 have never been screened. Prior research has demonstrated that community-based social networks may help kane adopt healthy behaviors such as cancer screening, however, few studies have activated such an approach. A cross-sectional study entitled No Ke Ola Pono o Na Kane (for the good health of men) was conducted statewide in Hawai'i from 2014 to 2018. The study strived to perpetuate the Native Hawaiian traditional practice of "hale mua" (men's house) to promote healthy behaviors among kane including the adoption of colon cancer prevention strategies such as fecal immunochemical testing (FIT). The study applied a peer-led intervention model using kane volunteers to deliver the program's educational components, including standardized materials to help the volunteers confidently conduct the sessions. Of the 378 kane who were recruited into the study, 232 participated in the colorectal session of which 64% (n = 149) were over age 50. Survey data from the 149 kane indicated that 31% had not discussed colon health or screening with their doctors but 92% had improved their knowledge about colon health from the session. In addition, 76% (n = 113) agreed to complete a FIT. Session evaluations indicated that >91% of kane liked the hale mua approach and benefited from talking with other kane about their health.

Listening to the voices of native Hawaiian elders and 'ohana caregivers: discussions on aging, health, and care preferences.

Native Hawaiians, the indigenous people of Hawai'i, are affected by varying social and health disparities that result in high prevalence of chronic disease, early onset of disability, and shorter life expectancy compared to other ethnic groups in Hawai'i. Six listening meetings were conducted, involving 41 community-dwelling kupuna (Native Hawaiian elders) and 'ohana (family) caregivers to investigate health and care preferences that offer the potential for improving well-being in later life for Native Hawaiian elders. As background, we provide three explanatory perspectives and theories­life course perspective, minority stress theory, and historical trauma­that guided the design of this study and provided the study's context. A number of overarching themes and subthemes were identified, some of which point to universal concerns with age and caregiving (such as challenges and costs associated with growing old and caregiving) and others that are culturally specific (such as influence of culture and social stressors, including discrimination, on health needs and care preferences). Results give further support to the urgency of affordable, accessible, and acceptable programs and policies that can respond to the growing health and care needs of native elders and family caregivers.

Development of a family intervention for Native Hawaiian women with cancer: a pilot study.

Native Hawaiian women have high cancer rates and low survival rates. As with other women, a major source of support for Native Hawaiian women is their families. This pilot study reports on the feasibility of providing and measuring a culturally appropriate intervention designed to help Native Hawaiian women and their families deal with cancer. The feasibility evaluation indicated that a major strength of the intervention was its incorporation of Hawaiian values and practices, and a major limitation reflected the difficulties in recruiting Native Hawaiians for research studies. Despite the small sample size, the six Native Hawaiian women and their 10 family members in the intervention group showed improved self-efficacy and coping when compared with the four Native Hawaiian women and their eight family members in the control group. Pilot study data established the feasibility and potential effectiveness of this culturally tailored intervention for Native Hawaiians, and feasibility findings will be useful in designing follow-up studies. Steps taken to incorporate cultural values into an intervention also provide a model for other social workers in developing culturally appropriate interventions for minority populations.

Empowering natural clinical trial advocates: nurses and outreach workers.

Cancer clinical trials are essential to advancing the prevention and treatment of cancer, yet adult participation rates in clinical trials remain abysmal. Despite the essential contributions of clinical trials to science and medicine, adult participation in clinical trials remains exceedingly low, with only 2%-4% of all adult patients with cancer in the U.S. participating in clinical trials. Clinical trials accrual rates in Hawai'i follow this national trend of less than 3% of eligible patients participating in trials. Recognizing the need to increase awareness about clinical trials, the National Cancer Institute's Cancer Information Service-Pacific Region, through the Hawai'i Clinical Trials Education Coalition, has employed strategic dissemination plans to train and educate key target audiences, including registered nurses, nursing students, and community outreach workers about the availability of over 90 cancer clinical trials in Hawai'i. Previous research suggests that nurses often play a vital role in increasing a patient's understanding of clinical trials and may also act as a patient advocate in regards to participation in a clinical trial. A train-the-trainer model curriculum was developed using the Clinical Trials Education Series (CTES), a collection of multi-level resources designed by the National Cancer Institute, to educate various constituents about clinical trials. The training curriculum and workshop format is adapted based on both formal and informal needs assessments conducted with audiences prior to the planned training, yet key elements remain central to the training model. In addition, an interactive, internet-based case study was developed using local place names and cultural cues to allow training participants to engage in realistic and practical methods for locating and sharing information about clinical trials with patients and the public. This training model has been implemented in a variety of settings including three statewide nursing conferences, two college campuses, and a community-based workshop. Evaluation results consistently indicate statistically significant increases in participants' knowledge and awareness related to clinical trials, and a cadre of trained clinical trials advocates is developing. Health professional advocacy towards adult participation in clinical trials is gaining momentum, with plans to expand the training model throughout the Pacific region.

Ka Lokahi Wahine: a culturally based training for health professionals.

Native Hawaiian women in Hawai'i suffer the highest breast cancer incidence and death rates among women from Hawai'i's five major ethnic groups. Native Hawaiian women have the third highest breast cancer mortality rate in the nation, following African American and Native American/Alaska Native women. While overall cancer mortality rates in other U.S. populations have improved, epidemiological research shows mortality rates among Native Hawaiians has dramatically increased since 1976. Several barriers prevent Native Hawaiian entry into health care. Frequently cited barriers are: a history of oppression; high prevalence of behavioral risk factors; ineffective screening, prevention and treatment efforts; poor utilization of existing services; poor financial and geographical access to care; an absence of culturally appropriate programs, and few Native Hawaiian health professionals. To address poor health service utilization and to sensitize the health care system in Hawai'i, the Native Hawaiian Breast Cancer Sub-Committee (NHBCSC) of the American Cancer Society Hawai'i Pacific, developed and implemented a culturally based training for health professionals. The training is designed to meet continuing medical and professional education requirements. Professional in-service training began in 2001, with over 300 of Hawai'i's health care professionals participating, to date (March 2004). This training provides a model for other cultural and ethnic groups.