Improving Ethnic Diversity in Cancer Trials Through Healthcare Interpreter Training

People with cancer from culturally and linguistically diverse (CALD) backgrounds who are not proficient in English face many challenges in accessing clinical trials. Clinical trials offer opportunities to access cutting-edge therapies for cancer management, with opportunities for longer survival and/or better quality of life. Inequitable access to these clinical trials not only reduces the validity of research findings, but also exacerbates the known disparities in cancer outcomes for these populations. Australia is a migrant majority country, with certain areas having large proportions of people who do not speak English-research has shown that this group has a lower rate of trial participation than those who can speak English. There is no available specific training in cancer clinical trials or research terminology for healthcare interpreters (HCIs). Research has shown that inadequately trained interpreters are a recognized barrier to clinical trial access for patients who are not proficient in English. This two-phase quality improvement project, including a baseline knowledge survey and subsequent training modules, was undertaken to build workforce capacity for interpreters in cancer clinical trials.

Phase 1: Subject matter experts and NSW Healthcare Interpreting Services managers codeveloped a survey to identify knowledge and skill gaps. HCIs across NSW (approx. 700) were invited to participate in a survey via an anonymous link (Qualtrics). Phase 2: Training was developed comprising five sections (basic concepts of clinical trials, governance and ethics, phases, informed consent and role of interpreters) using a blend of videos and presentations, interactive polls, and discussions. Pretraining and post-training surveys were conducted to assess learnings. Statistical analysis used descriptive statistics and t-tests.

In Phase 1, 133 interpreters responded to an initial online survey (response rate of 19%). The majority (71%) had been working as interpreters for more than 10 years. Clinical trial interpreting experience was limited; 34% had never interpreted for a clinical trial. Mean knowledge accuracy for clinical trial concepts was 68%, with uncertainty/lack of knowledge around randomization, clinical trial phases, and uncertainty around governance/ethics and clinical trial sponsors. In Phase 2, 92 interpreters attended in-person or online training. Training increased mean accuracy in knowledge items about cancer clinical trials from 74% prior to training to 91% after the training. Confidence in understanding clinical trial terminology increased from 20% to 62% after training.

Training for HCIs improved knowledge and confidence in understanding cancer clinical trial principles and terminology, building competency to provide better service to people from CALD backgrounds. The training modules developed will be made available online for statewide interpreter access. Future evaluation should track the impact on CALD trial participation to assess long-term outcomes.