Dr. Lovoria Williams, associate director for cancer health equity at Markey Cancer Center, discusses her inspirations and initiatives to foster inclusion.
What is your role at the University of Kentucky?
My primary role is associate professor in the College of Nursing. The majority of my faculty appointment is devoted to research focused on advancing health equity among communities of color and the medically underserved.
I am also associate director for cancer health equity at Markey Cancer Center. This position is part of the Markey Community Impact Office. A major initiative of this office will be the organization and expansion of Markey’s research and outreach portfolio that is focused on reducing health disparities based on race/ethnicity, socioeconomic status, disability, gender identity, sexual orientation and other factors.
Lastly, I’m associate director in the Center for Clinical and Translational Science (CCTS) and co-director of Integrated Special Populations. I work to ensure that the CCTS meets the needs of diverse trainees and faculty and that the CCTS research portfolio is inclusive of people of color (POC), LGBTQIA+ populations and rural communities. I also direct the DREAM Scholars, a career development program for health equity-focused scholars of color, pre-docs and junior scientists, as well as LGBTQIA+ scientists.
I’ve always wanted to be a nurse, and I was definitely influenced by my mother. She was a community caregiver – always striving to assist anyone in need.
I was influenced to continue my education by an advanced practice nurse who was my health care provider. She took such a holistic approach to patient care that I was inspired to become a nurse practitioner.
I practiced in the primary care clinic at the VA Medical Center for about 11 years and really just became frustrated in the role, mainly because I didn’t feel that I was effective in helping my patients improve their preventive behaviors. Over time my patients’ health progressively worsened from preventable conditions such as obesity and type 2 diabetes. I wanted to learn how I could affect behavior change in my patient population. So that’s what inspired me to go back for a doctorate.
Growing up I saw the POC around me have worse health than other groups. At the time, I didn’t understand all the factors that affected health outcomes, such as social determinants of health and other structural inequities. But I remember seeing it happen and recall wanting to help change outcomes among POC.
Over the last year, social justice and equity has brought us to a critical juncture. More people now are willing to acknowledge how social determinants have negatively impacted Black and brown people. Social determinants also affect health outcomes. Markey has demonstrated such impactful work in the Appalachian community, so we know that we have a passion for advancing health equity. And now is the time to apply that more broadly across all special populations, such as racial and ethnic minorities, LGBTQIA+ and medically underserved individuals.
Historically, POC largely do not participate in clinical trials as much as others. There are also so many factors that influence an individual’s decision to participate. Research suggests the main limiting factor is that POC are not asked to participate and when asked, they are as willing to participate as others.
To understand and overcome barriers to enrollment among Black and Latino populations, the American Society of Clinical Oncology (ASCO) and the Association of Community Cancer Centers (ACCC) have partnered to develop a pilot study. The aim is to engage over 40 cancer centers nationally to pilot test a research site self-assessment tool and an implicit bias training program. Markey was selected as one of the sites. The tool will provide an objective assessment of our clinical trial processes, and these data will help us determine areas where we can intervene to increase trial enrollment.
Secondly, scientists and clinicians of color are underrepresented in health care, and we all have biases. There are instances where implicit bias plays a role in the patient encounter. Therefore, the second part of the ASCO/ACCC project will assess for implicit biases among a few of our clinicians and clinical trial staff. The same staff will subsequently receive an implicit bias intervention and a reassessment to determine if baseline measures of biases change. If the training is effective, ASCO/ACCC will disseminate the test and the intervention to other cancer centers. We are extremely excited to be a part of this.
Additionally, I recently received funding from the Markey Cancer Foundation. This funding will allow me to explore factors that influence patients and their families to decline or accept an offer to participate in a clinical trial. Secondly, I will survey clinicians and staff members to examine their confidence with engaging POC in clinical trial discussion and will develop an intervention to strengthen their confidence. We are confident these two projects will increase our understanding of barriers to clinical trial enrollment for POC at Markey and allow us to develop specific strategies to address them.