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Dr Chesahna Kindred Addresses Diversity Barriers in Clinical Trials

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Chesahna Kindred, MD, MBA, FAAD, board-certified dermatologist, Kindred Hair & Skin Center, discusses ways to overcome barriers in clinical trials for diverse patients with psoriasis.

Having principal investigators (PIs) within a community who can relate and best communicate with their patients from diverse backgrounds is one way to ensure different patient populations are being included in clinical trials, says Chesahna Kindred, MD, MBA, FAAD, board-certified dermatologist, Kindred Hair & Skin Center.

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What are some common barriers of diverse patient inclusion in clinical trials for psoriasis?

One of the big things, particularly in the Black community, is that we have to make sure that we address that well-deserved mistrust. I know a lot of people bring up Tuskegee, but there's things happening today. There was a study not that long ago showing that women surgeons tend to have fewer complications than male surgeons. There are studies showing that Back patients who have a Black physician live longer, because there's this mistrust that we have to overcome.

And so, one of those things is making sure that those that are running the clinical trials, the PIs, the coordinators, etc., that these are people who strongly believe in fairness for everyone, in diversity, equity, and inclusion. And that way, we get biases out of the clinical trials. That way, we have the trust. We can't just say, “Hey, come to me. I'm a nice person.” We have to unravel some of those layers, and part of it is the PIs being diverse.

Have you seen any notable successes or challenges in recruiting diverse populations for psoriasis clinical trials?

One of the things about psoriasis, particularly in Blacks, [is] it can look different. Well, it does. The more melanin-rich the skin, the psoriasis can look vastly different from those with fair skin. It can be mistaken for prurigo nodularis, sometimes lichen planus, etc, so the clinician needs to be able to really achieve an accurate diagnosis. That's one.

Secondly, being able to explain the research in a way that everyone understands. Our patients are smart, they're brilliant, but they're not medical. If we approach the patient saying, “scaling plaques,” well, that sounds pretty scary, right? We just want to say, "thick, flaky bumps." It's such a simple way that we can make sure that someone, let's say with an English barrier, is able to understand a little bit better. And that's our job as physicians, not to show that we know medicalese, but to explain it to the patient.

Another [way] is to really make sure that we're going to the patient. So, if there's a particular area that has a large area of Black patients, and these Black patients tend to go to this physician, it’s smarter to train that physician to be a PI, so that they can run the clinical trials, opposed to going where the patients are not and spending a lot of energy trying to recruit [them]. We shouldn't do an “if you build it, they will come” approach. Go to the patient, and that will really help to make sure that there's a diverse population in clinical trials.

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