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Advancing Inclusion for Blood Donation Systems for Marginalized Groups With Warren Fingrut, MD

At the recent American Society of Hematology (ASH) Annual Meeting, Warren Fingrut, MD, a Transplant and Cell Therapy Physician at MD Anderson Cancer Center and Founder and Director of Stem Cell Club, a donor recruitment organization based in Canada, sat down with Oncology Data Advisor to discuss his team's research and presentation addressing disparities experienced by marginalized and underserved groups in blood donation systems, as well as developing a more inclusive environment in this setting.  

Oncology Data Advisor: Welcome to Oncology Data Advisor. Thank you so much for your time today and meeting with me. Would you like to begin with introducing yourself and your research interest?

Warren Fingrut, MD: Absolutely. My name is Dr. Warren Fingrut. I'm a Transplant and Cell Therapy Physician working at MD Anderson Cancer Center. I'm a Master's in Public Health (MPH) Student with the Harvard T.H. Chan School of Public Health, and I'm also Director of Stem Cell Club, which is a donor recruitment organization I lead in Canada, that works to address racial disparities in access to donors. My research interest is in characterizing and addressing disparities in care delivery impacting patients and donors from marginalized and underserved groups.

Oncology Data Advisor: If you would like, could you start with giving us an overview about your presentation and abstract?

Dr. Fingrut: My abstract that you were asking about is titled, "Advancing a More Inclusive Blood and Transplant System for Marginalized Groups: Development and Evaluation of a Transfusion Medicine Health Equity and Advocacy Curriculum." So, for this project, we know in terms of the background that health advocacy and equity skills are important skills for physicians to know and to practice but challenging to teach. In fact, there have been increasing calls for development of curricula to teach these important skills to health care providers. With this project, we developed a curriculum to teach health care practitioners and students about advancing health equity for donors from marginalized groups. Specifically, our curriculum includes two workshops, one called, "Advancing a More Inclusive Blood and Transplant System for LGBTQIA+ Peoples," and the second module is about addressing racial disparities in blood stem cell and organ and tissue donor pools.

These modules outline historic policies related to the exclusion of donors or potential donors from these groups, current policies and future policies, the aftermath or consequences of historic exclusion even when policies have changed, and how the history of such policies continues to play a role in serving as barriers to or preventing peoples from these underserved or historically excluded groups from participating as donors. Also, the modules sought to identify unique challenges that are ongoing that individuals from these groups face today and potential solutions in terms of how members of the health care communities can partner with diverse advocates to address some of these disparities and overcome challenges to inclusion.

Oncology Data Advisor: Thank you so much for your passion and research on this topic. I was wondering what results were you able to present?

Dr. Fingrut: Absolutely. So, we evaluated this curriculum, we piloted it with a cohort of over 140 medical students in Canada, and we did both quantitative and qualitative analysis of their perspectives on their growth and development as health advocates. We found that from a quantitative perspective, the medical students agreed or strongly agreed that participating in this curriculum supported them to develop skills in health equity and advocacy, including the ability to advocate with the population to advocate for change—including being better at recognizing and addressing systemic barriers or issues for populations that they care for and communities that they interact with and are living among.

From a qualitative perspective, we developed key insights and rich examples through our qualitative analysis of examples of medical students' development in terms of their ability to highlight the need to prioritize inclusion, to recognize examples of discrimination in policy and practice, to understand barriers to change, to partner with advocates from diverse communities to address disparities, and to advance a culture which supports inclusion. Really phenomenal discussions were had, demonstrating the growth of the medical students across these areas.

Oncology Data Advisor: Going into the inclusivity, do you have advice for clinicians listening on how they could create a more inclusive atmosphere in the blood and transplant system for the marginalized groups that you studied?

Dr. Fingrut: Absolutely. I think all five of those key highlights that the medical students took away from the curriculum are relevant not just for medical students, but across the health care continuum for all peoples that are seeking to advance equity for patients and donors and the workforce, including people from the workforce who are from underserved and underrepresented communities and populations. And so, what I'll say is that in this example, we showed that through educational efforts we're able to upskill medical students' abilities to become and serve as advocates for the future. I think such educational efforts can be very meaningfully adopted, not just at the medical student level, but at the conference level and across the field at the organizational level and so on.

Oncology Data Advisor: How would you suggest we begin healing this broken trust or hurt that the LGBTQIA+ community or racialized groups have been experiencing from the stigmas that were created in this setting?

Dr. Fingrut: Absolutely. So, examples of historic discrimination relate to specific questions that were asked on donor eligibility screening questionnaires, et cetera. I mean, changing those screening questionnaires to address that historic exclusion of those populations is really important, but the work must continue following that. It's not sufficient to just change a policy that was historically exclusionary, and that's an important step forward, but work needs to continue to overcome and to address the aftermath, to undo the damage that had been done related to exclusion or the feeling of exclusion among those populations. Educational efforts are needed to make sure that members of marginalized communities and populations know that their donations are not just eligible now but wanted and needed, that they'll be able to donate without fear of stigma or being mistreated by the health care team. And actually, even further than that, donations from members of these communities should be celebrated and recognized as heroic—indeed as lifesaving. The stories of donors from these communities should be shared, and I think that's really important as well.

Oncology Data Advisor: If you don't mind me asking you, how do you feel clinicians or anyone listening can address and combat their unconscious bias?

Dr. Fingrut: This is a great question. I think reflecting carefully on the work that everyone seeks to do to improve care delivery for all groups is really important. I think it can be very helpful and very important to partner with advocates from diverse communities to center you and to ensure that the work that everyone seeks to do is in partnership with and guided by members of those groups. And so, I think there are many steps to take. I think one of the key takeaways for the medical students from this module—part of our analysis—was recognizing discrimination and understanding barriers to change. I think that there are many examples in health care of discrimination, but without sitting and taking a step back and questioning policies and practices that we do now, it may not be something that jumps out at you, but by taking the time to reflect, such examples can become evident, and that's the first step towards advancing efforts to change those policies.

Oncology Data Advisor: The final question I wanted to ask you is if you and your team have a next step planned for further expanding upon or continuing this conversation of health care advocacy?

Dr. Fingrut: Absolutely. So, the module and the curriculum that we developed focuses on advancing health equity for marginalized donor groups, but similar curricula should be developed for advancing health equity for patient populations too—not just in terms of their access to the donation products but more broadly across health care. And I mean, our conversation focuses on donation products in hematology, but such educational curricula have a place, not just even in hematology, but across oncology and even across health care more broadly. I mean advancing health equity for patients who are from a surgical background and have surgical needs or internal medicine patients, etc. I think that there's a need and a gap in the educational curricula that we have to teach such skills across settings, and it would be much needed.

Oncology Data Advisor: Definitely. Well, I wanted to thank you so much for your voice on this topic, the passion, and your research. We look forward to hearing more about it in the near future.

Dr. Fingrut: Thank you so much.

About Dr. Fingrut

Warren Fingrut, MD, is a Hematology, Transplant, and Cell Therapy Physician at MD Anderson Cancer Center and the Founder and Director of Stem Cell Club, a donor recruitment organization based in Canada. Dr. Fingrut's research and passion are found in characterizing and addressing disparities experienced in care delivery that impacts patients and donors from marginalized and underserved groups. As well, he takes part in studies to develop new ways of addressing these issues of disparity in the oncologic, hematologic, and health care settings.

For More Information

Okonofua S, Rosenfeld A, Segall R, et al (2023). Advancing a more inclusive blood and transplant system for marginalized groups: Development and evaluation of a transfusion medicine health equity and advocacy curriculum. Presented at: 2023 American Society of Hematology ASH Annual Meeting. Abstract 5047. Available at: https://ash.confex.com/ash/2023/webprogram/Paper185491.html

Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor. 


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