Advancing DEI in the Cancer Workforce: Best Practices from Experts and Strategies for Navigating Policy

In recognition of the importance of prioritizing diversity, equity, and inclusion (DEI) in the cancer workforce, the National Comprehensive Cancer Network (NCCN) held a policy summit on September 10, 2024. This event provided an opportunity for a varied group of stakeholders including patients, providers, payers, and patient advocacy organizations to thoughtfully discuss policy and best practice strategies to support these ideals.

Read Part 1 of this blog for the keynote address from Tiffany Wallace, PhD, and the morning panel discussion on establishing and prioritizing a culture of DEI.

Best Practices from Experts

Introduced by Taneal Carter, MS, MPA, manager, Cancer Care Equity Program, NCCN, 5 speakers took the stage for the first session of the afternoon: Shiva Bidar-Sielaff, MA, CDM, vice president/chief diversity and associate dean for diversity and equity transformation, UW Health and UW School of Medicine and Public Health/UW Carbone Cancer Center; Nikia S. Clark Robinson, BS, director, community outreach and engagement, Roswell Park Comprehensive Cancer Center; Kemi Doll, MD, MS, professor, Department of Obstetrics and Gynecology, University of Washington School of Medicine/Fred Hutchinson Cancer Center; Carmen E. Guerra, MD, professor of Medicine, Abramson Cancer Center of the University of Pennsylvania; and Danielle Mitchell, CEO and founder, Black Women in Clinical Research. Allotted 10 minutes each, the presenters spoke to the strategies and initiatives in their respective programs and organizations that led to their success in advancing DEI.

Bidar-Sielaff first discussed the benefit of working with a human resources business partner in the DEI office who can effectively connect the UW Carbone Cancer Center with the UW Health DEI Office. Among the initiatives of the Health DEI Office is the mission to enhance the recruitment, retention, and graduation rates of health professional students of Native American ethnicity and to promote health education, research, and community-academic partnerships with Native communities. Strategies to diversify UW’s workforce include consistent, intentional outreach to individuals in middle school, high school, and post-secondary education, as well as working adults. Through this outreach, staff members explain career pathways into the medical field, in addition to the scholarships, internships, and apprenticeship opportunities available to students.

Equally important are the measurements used to quantify the effectiveness of these outreach programs. Bidar-Sielaff concluded by outlining the 3 key metrics her team employs:

• Retention: turnover rate for employees who are Black, indigenous, or People of Color (BIPOC)
• Recruitment: percentage of BIPOC applicants by level
• Representation: percentage of BIPOC employees by level.

One of the key themes of Robinson’s presentation was genuine community engagement. Unique in its location and catchment area, Roswell Park Comprehensive Cancer Center serves a diverse community of Black, Hispanic, indigenous, immigrant, and refugee patients, and it is important to Roswell’s Community Advisory Board to represent that community. Robinson emphasized the success that arose from being intentional about who they have on their staff, as it led to more diverse recruitment, more diverse patient referrals, and more community members reached with evidence-based education. “Representation does matter. It’s not just the message; it’s the messenger. Be intentional about your staff,” Robinson urged. She went on to list DEI best practices at Roswell that include leveraging a community health worker model, building teams that reflect the population they’re serving, and giving more weight to experience rather than degrees to make job positions and recruitment more equitable.

Dr. Doll spoke to the disparity in incidence of endometrial cancer among White and Black women—an alarming gap that widens each year—and how she worked to “build a community where there wasn’t one before” for these women. To do so, Dr. Doll partnered with an organization that does community work for Black women with breast cancer to learn about their strategies for providing resources for the community. This led her to create the Endometrial Cancer Action Network for African-Americans (ECANA) through which she trained members to be peer educators and sent them back into their communities around the country to reach underserved populations. Dr. Doll emphasized her intention to catalyze resources that not only serve the community, but can eventually be run by them.

The importance of DEI initiatives is backed by the research Dr. Guerra presented—namely, the link between a diverse cancer workforce and cancer disparities. She underscored the poorer quality of care and lower access to care that patients belonging to minority groups experience, as well as the effect a diverse workforce can have. “Historically underrepresented minority physicians see substantially more minority, uninsured, and Medicaid patients,” Dr. Guerra noted. “Minority physicians care for the majority of minority and non-English speaking patients.” The outcomes of numerous studies reveal higher rates of communication, patient satisfaction, trust, and adherence to treatment plans in race-concordant visits for minority patients.

Mitchell closed out the segment by sharing the story of her career in clinical research and her organization Black Women in Clinical Research (BWCR). After experiencing firsthand the challenges that prevent many individuals from breaking into this industry—despite having valuable transferrable skills—Mitchell was inspired to educate, empower, support, and provide a safe space for Black women to thrive in clinical research. She also spoke to the importance of DEI in the cancer workforce, as it facilitates better cultural understanding and patient outcomes from having a variety of perspectives. “People trust people who look like them,” Mitchell said. A diverse workforce improves trust and communication between patients and providers, particularly in underserved communities, and ensures the workforce reflects the patient population. This in turn reduces care disparities and promotes equitable treatment for all. “We are all called to bring in the next generation of clinical research professionals,” urged Mitchell. “We have to shed light on these careers.”

Navigating the DEI Policy Landscape

The summit concluded with a panel discussion moderated by Clifford Goodman, PhD, consultant, health care technology and policy, that examined DEI from a policy lens and ways that the current landscape impacts DEI initiatives. The following speakers were invited to participate: Heather J. Alarcon, JD, senior director, legal services, Association of American Medical Colleges (AAMC); Chyke A. Doubeni, MD, MPH, chief health equity officer, The Ohio State University Comprehensive Cancer Center, James Cancer Hospital and Solove Research Institute; Deborah Grimes, RN, JD, MSHQS, senior vice president, chief diversity officer, Ochsner Health; Christopher I. Li, MD, PhD, vice president, faculty affairs and diversity, Fred Hutchinson Cancer Center; and Eugene Manley Jr., PhD, founder and CEO STEMM & Cancer Health Equity.

Grimes argued for the need to showcase how communities stand to benefit from DEI. “We have to link what we do to helping our communities and to helping patients achieve the best outcomes,” she explained. “[We must] connect DEI to the core belief that we want our communities to be healthier.”

On diversifying the cancer workforce, Dr. Li walked through the steps Fred Hutchinson Cancer Center took to reexamine its recruitment policies and procedures. “There’s a lot of power in looking at what your policies and processes are,” he said. Simple changes like modifying the faculty recruitment language and prioritizing intentional outreach via social media and professional partnerships increased the number of diverse applicants from 3% to 18% in just 1 year. Alarcon added that the AAMC has also historically had a small pool of underrepresented applicants, and eventually noticed that they were only recruiting from the same schools. “Not many minorities are at the elite universities, and even fewer [represent] diverse socioeconomic backgrounds, so they have no path to rise to the top,” she pointed out. In answer, the AAMC examined places in its selection process that may act as barriers for diverse applicants.

At its core, DEI comes down to inherent respect. “It’s all about creating the culture you want,” Grimes commented. “Set the expectation that we treat everyone on a human level. Teach humility from a young age. We need to listen to seek to understand; that’s how you develop trust. Focus on the single patient in front of you.”