clearly within the purview of NCI and NIH. While many factors pose challenges to improvement (e.g., community mistrust), without a concerted effort to enhance this process, minority and medically underserved communities will continue to lag behind the American "majority" in benefiting from the tremendous recent scientific advancements and medical breakthroughs in cancer prevention, treatment, and control. The following recommendations were offered in this chapter:

Recommendation 5-1: NIH and other federal agencies (particularly the Health Care Financing Administration) should continue to coordinate to address funding for clinical trials, particularly to address the additional diagnostic and therapeutic costs associated with prevention trials and third-party payment barriers associated with clinical treatment trials.

Recommendation 5-2: NCI should continue to work with other appropriate federal agencies and institutional review boards to explore creative approaches to improving patients' understanding of research and encouraging them to provide consent to participate in research. These approaches should address cultural bias, mistrust, literacy, and other issues that may pose barriers to the participation of ethnic minority and medically underserved groups.

Recommendation 5-3: NCI should report on the accrual and retention of ethnic minority and medically underserved populations in clinical trials using a consistent definition for medically underserved populations, including such characteristics as rural versus urban population, insurance status, socioeconomic status, and level of literacy.

Recommendation 5-4: NCI should continue to assess its dissemination practices to identify effective cancer information delivery strategies among ethnic minority and medically underserved populations, revise and implement the strategic dissemination plan on this basis of the results of that research, and institute an ongoing system of monitoring to assess its effectiveness.

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