I am privileged to share this column with Dr. Nadine Barrett, an ACCC board member and director, Community Engagement and Stakeholder Strategy, Duke Cancer Institute and Duke Clinical Translational Science Institute, and assistant professor, family medicine and community health.
Our country is experiencing an unprecedented and long overdue focus on disparities, inequities, and structural and institutional racism fueled by the deaths of George Floyd, Breonna Taylor, Ahmaud Arbery, and many others who have recently lost their lives due to racism. This, coupled with longstanding health system challenges and barriers that have been brought to light by the disproportionate burden of COVID‐19 incidence and mortality on people of color and marginalized populations, is leading to intentional focus on institutional racism in healthcare systems and facilities.
Now is a critical time to call out where racism and disparities exist in oncology and to examine our personal and professional roles and responsibilities to enact change. Not only is there a moral and ethical imperative to do so, but there is the opportunity for us to enhance and accelerate the impact of our organizations through the strength, perspective, and expertise that a diverse workforce and equitable analyses of our patient services and programs can provide. Looking at cancer care delivery through the lens of equity, diversity, and inclusion will allow us to better understand and authentically value the diverse perspectives of our patients and the communities we serve, tailoring care to better meet the needs and remove the barriers that lead to gaps in outcomes.
This work can feel overwhelming, and it can be difficult to know where to concentrate our efforts. Here are some ideas to consider and customize to your own cancer program and community’s needs:
| • | Practice self‐reflection and self‐education to understand the current climate and how it impacts our work. | ||||
| • | Promote and enable dialogue about racism and disparities within your program. | ||||
| • | Establish a diversity, equity, and inclusion council. Look for participants who bring a diversity of skills and backgrounds as well as gender, race, and sexual orientation. Empower the council to share recommendations and have access to senior leadership. | ||||
| • | Ensure that members of your patient advisory council reflect your patient population and the communities you serve. | ||||
| • | Evaluate policies and procedures for implicit and unconscious bias. | ||||
| • | Examine disparity in the context of quality improvement initiatives. Quality improvement must be framed from an equity perspective to have the greatest impact. | ||||
| • | Identify community partners and opportunities to collaborate to improve cancer awareness, education, access to screening, treatment, and clinical research and trials. | ||||
| • | Make intentional and focused efforts to increase participation of racial and ethnic minorities and underserved patient populations, including the elderly, in clinical research and trials. | ||||
| • | Start mentoring programs and evaluate how you employ, promote, and integrate diverse individuals in all levels of your organization, including senior leadership. | ||||
| • | Identify and disseminate resources to support this important work, such as Project Implicit (implicit.harvard.edu), anti‐racism calendars like the one developed by the Duke Office of Diversity and Inclusion (drive.google.com/file/d/1fUoJWdabhCulMR‐AksHjCOSawYaQRn1T/view), How to Be an Antiracist by Ibram X. Kendi, and White Fragility by Robin DiAngelo. | ||||
Most important, we should focus not on fixing individuals but rather on fixing programs, structures, and practices within our health systems to effectively address racism and equity and improve outcomes for all of our patients with cancer.