The official adaptation of "Just ASK: Increasing Diversity in Clinical Research Participation" — a course developed and piloted at Duke Cancer Institute (DCI) five years ago by Nadine Barrett, PhD — has rolled out nationally.

Now trademarked by the American Society of Clinical Oncology (ASCO) and the Association of Community Cancer Centers (ACCC), the Just ASK™ Increasing Diversity in Cancer Clinical Research: An ACCC-ASCO Training Program is being offered as "an online implicit bias training program intended for all members of the research team." The training, which provides a health equity framing and lens, consists of five interactive modules that can be completed independently in about 60-90 minutes, and focuses on the broader context of structural and systemic racism.

"Structural and systemic racism manifests in many ways, one being implicit biases that limit access to quality care and research for historically marginalized populations," said Barrett, founding director (in 2012) of DCI’s Office of Health Equity, current director of Equity, Community and Stakeholder Strategy within DCI’s Community Outreach, Engagement, and Equity program (COEE), as well as director of the Center for Equity and Research at the Duke Clinical and Translational Science Institute (Duke CTSI). "This training is one resource that helps chip away at these pervasive and longstanding inequities, locally and nationally."

Created in 2017 and expanded in 2020, the Just Ask training, was adapted and tested by ASCO-ACCC as a result of Barrett's work and collaborations with DCI, Duke CTSI, her Center for Equity in Research, and the Duke Office of Clinical Research (DOCR). The DOCR, under the leadership of associate dean for Clinical Research Denise Snyder, MS, RD, and leveraging the office’s research infrastructure, first rolled out Just Ask with the DCI clinical research teams, then expanded access to all clinical research teams across Duke through the Duke Engagement, Recruitment, and Retention Certification Program (manuscript in press). The training has also been utilized by other national research institutions and organizations.

Snyder said that Just ASK has changed the way research faculty and staff design and approach their research. “Just ASK raises awareness about our own internal biases, but also provides us the strategies and tools to move forward. Our research will become stronger as our staffing pool becomes more inclusive and diverse.”

The Just ASK™ Training Program is one of two new ASCO-ACCC resources for research sites to help improve equity, diversity, and inclusion in cancer clinical trials. The other is the ASCO-ACCC Equity, Diversity, and Inclusion Research Site Self-Assessment, an online tool that helps research teams identify potential opportunities to improve equity, diversity, and inclusion in clinical trials while doing an internal review of existing policies, programs, and procedures.

The recent release of these new free-of-charge resources followed the publication, in May, of ASCO-ACCC recommendations addressing “the lack of equity, diversity, and inclusion in cancer clinical trials" and detailing "specific actions to engage the entire cancer clinical trial ecosystem in expanding the participation of underrepresented individuals in research."

Barrett served on the ASCO-ACCC task force, which conducted assessments across 75 research sites nationwide. The recommendations covered access to clinical trials, equity-focused design, partnerships among stakeholder groups, continuous education and training, EDI (equity, diversity, and inclusion) investment, and the sharing of data and strategies.

On August 18, upon learning that the Just ASK™ Training Program had officially gone national, Barrett thanked her colleagues across campus who'd been "instrumental in the development of this program" and encouraged them to share the news and ASCO-ACCC program web links with their colleagues, teams, and peer institutions.

"So proud! Local impact, national impact, societal impact…" wrote Michael B. Kastan, MD, PhD, executive director of Duke Cancer Institute and William and Jane Shingleton Professor, Pharmacology and Cancer Biology, in an email.

"I am so thrilled for you. You have changed the world!" wrote Angeles Alvarez Secord, MD, MHSc, associate director of Clinical Research in the DCI Gynecologic Cancer Disease Group, professor in the Duke Department of Obstetrics and Gynecology, Division of Gynecologic Oncology.