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The "four spheres" model of transformation, as viewed through the lens of the urban mission of California State University, Fresno, is examined through current projects in economic development, infrastructure development, human development, and the fourth sphere, which encompasses the broad vision. Local projects will be highlighted.

The Covid-19 pandemic challenged our department to adapt existing workflows to maintain high quality cancer care and clinical trial compliance. Limited patient access to campus altered the way trial procedures were conducted. Clinical research staff, including Research Nurses, were redeployed to other departments within the institution. Limited hospital bed availability due to Covid-19 proved difficult for our cancer clinical trial patients. The purpose of this project was to evaluate practice alterations in response to the Covid-19 pandemic, including redeployment of research staff, decreasing research activities, utilizing telehealth, shipping oral study agents, and coordinating inpatient admissions for patients actively on trial who require hospitalization. Our department has staff of 25 research nurses and research nurse practitioners who work primarily in assigned disease-based teams and assume all clinical care for patients on study. One-third of the nursing staff were redeployed to other clinical departments. In response, remaining nurses filled these gaps in coverage. This was possible because of standardization of policies and procedures throughout our department. Many of our patients travel from out of state for clinical trial and had difficulties coming to New York. For these patients, we performed remote telehealth visits where feasible. If possible, we performed laboratory and other assessments locally and shipped oral study drugs directly to patients. This involved careful coordination to ensure investigational product stability and maintain patient safety. Cancer Center leadership recognized the continued need to provide excellent cancer care and access to clinical trials during the pandemic while mitigating risk. To reconcile these competing needs, we carefully decreased our study activities while maintaining care of active patients and still offering patients access to trials with potential therapeutic benefit. Enrollment to trials was paused with a review process implemented to request exceptions for accrual of new patients to existing studies. No exception requests were denied. The pandemic experience demonstrated that Clinical Trials Offices must remain nimble to adapt to large-scale disruptions. Standardized workflows, training, and competencies allowed the continued conduct of clinical trials while many staff members were redeployed to other departments. The use of telehealth and local assessments was beneficial and can be applied more widely to allow patient-centered care closer to their home. [ABSTRACT FROM AUTHOR]

Clinical trial enrollment of minorities, particularly Latinx and Black patients, lags behind that of the general population. Our Cancer Center is an NCI Community Oncology Research Program for Minority and Underserved populations (MU-NCORP) with 48% enrollment to interventional clinical trials from underrepresented minority populations. While above the national average, interventions are needed to address these gaps. The COVID-19 crisis highlighted inequities in health care for communities of color. In response to this, our department created a task force comprised of nurses, nurse practitioners, and research staff with the goal of addressing barriers that prevent underrepresented minorities from enrolling in clinical trials as well as compounding factors that contribute to poor health outcomes. In regards to clinical trial representation, additional efforts are needed to ensure underrepresented minorities are included in studies. Following major events in 2020, our staff expressed the need to contribute in a meaningful way by examining the gaps within our department and the cancer center as a whole. Our goals are to reduce implicit bias particularly when approaching patients about clinical trials, address socio-economic barriers impacting enrollment of diverse patients, and increase visibility of clinical trials. The task force developed a survey to assess the experience of patients and clinical trial discussions. Questions ask about logistical barriers, interpersonal provider relationships, and patient perceptions of discrimination. The data from these surveys will inform tailored patient education regarding clinical trials and guide clinicians in the best way to communicate clinical trial information. The team meets regularly to tackle adjacent issues associated with lack of inclusion. Strategies include enhanced racial and ethnic minority leadership recruitment, transparency in research findings, creating tools for the retention of clinical trial participants, and using social media to address misconceptions. Establishing a diversity, equity, and inclusion initiative empowered our staff to make concrete steps towards increased health equity. Our team has formed relationships with patient advocates and collaborated the community engagement office to continue working on changing the stigma of clinical trials through public education. Future projects include cultural competency training for staff, social media campaign for clinical trials awareness, and interpreting data from patient surveys to implement changes in clinical practice. [ABSTRACT FROM AUTHOR]