Brenda Adjei, Ed.D., M.P.A., Associate Director of the Office of Healthcare Delivery and Equity Research
Brenda Adjei, Ed.D., M.P.A., is the new Associate Director of the Office of Healthcare Delivery and Equity Research at CCR. A former program director at the NCI, Dr. Adjei received her Master's in Public Administration from New York University’s Wagner Graduate School of Public Service and her Doctorate of Education from Columbia University’s Teachers College.
In this Q&A, Dr. Adjei discusses her career in healthcare delivery research and the importance of including underserved populations at every level of clinical trials to improve health outcomes.
What is healthcare delivery research, and what sparked your interest in the field?
Healthcare delivery research in the context of cancer care focuses on improving clinical outcomes and patient well-being by understanding and intervening in the multiple factors that influence the delivery of care at the patient, caregiver, family, clinician, institutional and community levels. Because multiple factors can impact the access, availability, utilization, quality, coordination and outcomes of cancer care, healthcare delivery research requires a multidisciplinary approach.
I am a cancer survivor — I was diagnosed when I was 18 months old, and knowing what my parents experienced as new immigrants navigating the United States healthcare system really sparked and motivated me to learn from the lived experiences of patients, families and communities as they navigate the cancer care journey.
Tell us a little bit more about yourself. How has your background prepared you for this role?
I am a mother of a bright and funny 7-year-old. I am originally from Brooklyn, New York, and my family is from Ghana, West Africa.
I have been a program director here at the NCI for the past 13 years and have worked with community-based cancer disparities research programs for the past 20 years. These include programs such as the Partnerships to Advance Cancer Health Equity, the National Outreach Network and the NCI Community Oncology Research Program.
Through these programs, I have been involved in initiatives related to healthcare delivery and health equity, specifically around social determinants of health, community outreach and engagement across varied care delivery settings.
I am very passionate about elevating the voices of communities that have been underrepresented in clinical research. We need to be intentional about incorporating those who are most impacted by health disparities in our programs and partnering with them to design relevant and sustainable solutions. I believe my personal experiences, my professional expertise and my passion for learning from all communities have been excellent preparation for this role.
What aspects of care delivery have stood out to you over the years?
The focus on equity in care delivery, particularly the intervention on the social determinants of health to address cancer disparities, has gained increasing national attention. Interventions developed to improve care delivery with an equity lens require meaningful engagement across many levels, including at the community level. An example of how this has been done in the context of cancer care delivery research is the ACCURE trial, which stands for Accountability for Cancer Care through Undoing Racism and Equity (ACCURE). This multi-center trial led by investigators and community members at the University of North Carolina at Chapel Hill found that identifying and addressing barriers to patient completion of curative radiation therapy or surgery reduced early-stage breast and lung cancer disparities among black and white patients.
This equity-focused intervention implemented system-level changes to provide support for patients during cancer treatment, such as alerts within the medical record, patient navigation, identifying experts to work with the healthcare teams and delivering training sessions on health equity. This protocol stands out to me because it represents the outcomes of meaningful community engagement in cancer care delivery and demonstrates how organizations can integrate an equity lens as part of efforts to reduce cancer disparities.
There’s so much to be done to ensure that everyone can reap the benefits of modern-day cancer research. Diverse participation in clinical trials is critical, and that diversity must be based on the many factors that impact cancer outcomes, such as race, ethnicity, socioeconomic status, language availability and social risks. Making cancer trials more accessible to diverse communities and populations who are underrepresented in research has been and continues to be a priority for cancer research leaders, clinicians, patients and advocates. Populations of color are interested and willing to participate in clinical trials, so effectively engaging with community members well before a trial is even a consideration is needed.
We need to meet the communities where they are and we need to go to them; we need to hear and learn from them. Our community outreach and engagement should focus on how we can work together to improve cancer care delivery and outcomes and reduce the cancer burden in the community. It has to have meaning and relevance to everyone, as everyone deserves to have the choices that lead to optimal outcomes of a cancer diagnosis.
How do you think cancer research methods and treatment options might change over the next 10 years?
With new treatments and innovative modalities, I think the next ten years will challenge us to think about how we ensure that all patients — in particular, those who have not equally benefited from these discoveries — have fair and just opportunities to prevent and detect cancer, receive quality care and survive cancer with optimal quality of life. That is what equity in cancer care means. Thus, our strategies will need to expand beyond traditional cancer research silos to understand what the structural barriers are that impede accessibility to these advances. We can work with communities to overcome these barriers and bring quality cancer care closer to the communities where they live.
One exciting strategy for extending our cancer research capacity is leveraging digital and telehealth capabilities across the continuum of cancer care. I believe it will be important to focus on implementing community-informed strategies that enhance patient access to quality cancer care, incorporate lived experiences and patient voices, and improve inclusive participation in clinical trials.
What does success look like to you in the position? Why was it important for you to come to the CCR to achieve your goals?
For me, success in the short term means getting to know more about the clinical teams within CCR and being viewed as a partner and a resource to them regarding healthcare delivery and health equity. It also means having a greater understanding of the cancer patients that we serve locally and nationwide, and leveraging this understanding to inform the implementation of initiatives that can help us to improve access, outreach, engagement and diversity in clinical trials. CCR is such a unique place and plays an important role in reducing the cancer burden, so I really want to gain a full appreciation of how I can play a role in promoting this resource to our community and clinical partners.
It was important for me to come to CCR because it brought me closer to the cancer survivors, their caregivers and those that selflessly serve them every day. It brought me closer to where the activity was happening and allowed me to really think about how I can create opportunities to have a direct impact on how we improve equitable cancer care for all.