种族和少数民族参与美国临床试验的主要障碍

Ashley S. Bae
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摘要

尽管美国长期以来一直在推动一个由来自不同种族和民族背景的人组成的大熔炉国家,这些人都有能力实现美国梦,但有人认为,美国未能平等地向所有选民提供高质量的医疗保健。少数民族群体普遍存在的健康差异已经延伸到临床研究和临床试验的平行领域。在美国临床试验中,白人临床试验参与者的百分比与种族和民族多样化的少数民族临床试验参与者的百分比之间存在着惊人的差距。少数群体在临床试验中的代表性不足,错失了识别潜在的严重亚组安全性或有效性信号的机会,为获得挽救生命的治疗打开了大门,并最终提高了美国循证医学的标准。目前关于这一问题的文献经常重申少数群体在参与临床试验时面临以下五个主要障碍:不信任、缺乏意识和准入、文化和语言障碍、研究者和提供者偏见以及经济负担。为了解决临床试验人群中种族和民族代表性差的问题,深入了解每个障碍对于实施行动和观点的变化至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Key barriers against racial and ethnic minority participation in U.S. clinical trials
Despite the United States’ (U.S.) longstanding history of promoting a melting pot nation of people from diverse racial and ethnic backgrounds all capable of achieving the American Dream, it is argued that the U.S. is failing to deliver high quality healthcare to all of its constituents equally. The widely seen health disparities of ethnic minority groups endure has extended into the parallel field of clinical research and clinical trials. There is a staggering gap between the percentage of White clinical trial participants compared to clinical trial participants of racially and ethnically diverse minority groups in U.S. clinical trials. Underrepresentation of minority groups in clinical trials dismisses opportunities to identify potential serious sub-group safety or efficacy signals, open doors to access life-saving treatments, and ultimately improve the standard of evidence-based medicine in the United States. Current literature on this issue frequently reiterates the following five key barriers underrepresented minority groups face against clinical trial participation: mistrust, lack of awareness and access, cultural and language barriers, investigator and provider bias, and financial burdens. A deeper dive into understanding each barrier will be critical in implementing changes with actions and in perspectives in order to address the issue of poor racial and ethnic representation in clinical trial populations.
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