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The theory of social determinants of health (SDH) posits that the health of people and communities is affected by social and economic factors (i.e., economic stability, education, neighborhood and built environment, health and health care, and social and community context). These interrelated constructs may negatively affect minority patients' ability to participate in cancer research. Understanding SDH can help nurse researchers assess and address barriers to research participation, as well as design trials to improve minority patients' cancerrelated health.
Keywords: care of the medically underserved; clinical trials; cultural competence; informed consent issues
ONF, 44(1), 20-23.
doi: 10.1188/17.ONF.20-23
Oncology nurses confront health disparity issues in numerous settings and across many roles in their work lives. These health disparity issues are often complex, challenging, and recurrent. Cancer health disparities are defined by the National Cancer Institute (2008) as "adverse differences in cancer incidence (new cases), cancer prevalence (all existing cases), cancer death (mortality), cancer survivorship, and burden of cancer or related health conditions that exist among specific population groups in the United States" (para. 1). Groups affected by health disparities may differ in race, ethnicity, age, sexual orientation, disability, education, income, or geographic location, and they may experience disparities not only in cancer-related health factors but also in representation in cancer-related research.
Background
Individuals from diverse racial and ethnic backgrounds are underrepresented in clinical trials and in cancer research studies (Siegel, Miller, & Jemal, 2015). With the need to provide evidence-based care and to conduct research that is generalizable, the underrepresentation of diverse groups in research compounds the difficulty of adequately understanding, addressing, and reversing health disparities. Data from 2015 indicate that the U.S. population is about 77% Caucasian alone, 13% African American alone, and 18% Hispanic or Latino (US. Census Bureau, n.d.). Therefore, a cancer research study reflecting population-based statistics would include at least 23% nonCaucasian participants. This percentage is rarely achieved.
An organizing framework or theoretical model can be particularly useful for framing, understanding, and addressing the complex issues involved in low research participation rates. The Office of Disease Prevention and Health Promotion (ODPHP) maintains a website, www .healthypeople.gov, which outlines broad health goals and objectives that are part of the federal Healthy People 2020 initiative. The elimination of health disparities is an overarching goal...