Nadine Barrett

Overview:

As a Medical Sociologist with over 15 years of experience engaging diverse health systems and communities to improve community and population health, I have devoted my career to reducing health disparities among disadvantaged and vulnerable populations and effectively training health care and research professionals and trainees in community engagement, diversity and inclusion, and the principles of authentic and impactful stakeholder collaborations. My expertise can be defined broadly within the context of developing effective community and health system partnerships to improve health outcomes, and conducting community health assessments to inform strategic priority setting, and program development, implementation and evaluation. I serve as the inaugural director of the Office of Health Equity and Disparities at the Duke Cancer Institute, and the Director of the Community Connections and Collaborations Core within the Duke CTSA and the Center for Community and Population Health Improvement. I am also faculty in the Department of Community and Family Medicine, Division of Community Health. 
I have several funded project including Project PLACE (Population Level Approaches to Cancer Elimination), funded by the NCI is a three pronged research project designed to implement three robust mechanisms to inform the health equity strategic direction of the DCI over the next 5- 8 years. Project PLACE  is a highly intensive community engagement model and platform designed to shape robust scholarly productivity, partnered research and community programs to improve population health. I am also the Duke PI (subcontract) with Kevin Williams (lead-PI)of a national Susan G. Komen pipeline training grant on translational research in Inflammatory Breast Cancer, and community engaged research. I also co-direct the NCI funded Cancer Research and Education Program Core of the NCCU/DCI Translational Health Disparities Research Program which incorporates specified training in minority accrual in clinical research, a program I developed within the DCI entitled, Just Ask.  

Positions:

Assistant Professor in Family Medicine and Community Health

Family Medicine and Community Health, Community Health
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

Ph.D. 2005

Texas Womans University

Grants:

Just Ask - Increasing Diversity in Oncology Clinical Research and Trials An Institutional and Stakeholder Engagement Approach

Administered By
Duke Cancer Institute
Awarded By
V Foundation for Cancer Research
Role
Principal Investigator
Start Date
End Date

Lung Cancer Screening Initiative

Administered By
Duke Cancer Institute
Role
Principal Investigator
Start Date
End Date

Breast Cancer Awareness to Action Ambassador Program (BCAAAP)

Administered By
Duke Cancer Institute
Role
Principal Investigator
Start Date
End Date

Publications:

Evolution of a longitudinal, multidisciplinary, and scalable patient navigation matrix model.

This Longitudinal patient navigation Matrix Model was developed to overcome barriers across the cancer care continuum by offering prepatients, patients, and their families with support services. The extraordinary heterogeneity of patient needs during cancer screening, risk assessment, treatment, and survivorship as well as the vast heterogeneity of oncology care settings make it nearly impossible to follow a static navigation model. Our model of patient cancer navigation is unique as it enhances the traditional model by being highly adaptable based on both patient and family needs and scalable based on institutional needs and resources (eg, clinical volumes, financial resources, and community-based resources). This relatively new operational model for system-wide and systematic navigation incorporates a carefully cultivated supportive care program that evolved over the last decade from a bottom up approach that identified patient and family needs and developed appropriate resources. A core component of this model includes shifting away from department-centric operations. This model does not require a patient to opt in or independently be able to report their needs or ask for services-it is an opt out model. The multidisciplinary "cross-training" model can also facilitate reimbursement and sustainability by clarifying the differentiating actions that define navigation services: identification of barriers to quality care and specific actions taken to overcome those barriers, across the full continue of cancer care from community engagement to survivorship or end-of-life care.
Authors
Corbett, CM; Somers, TJ; Nuñez, CM; Majestic, CM; Shelby, RA; Worthy, VC; Barrett, NJ; Patierno, SR
MLA Citation
Corbett, Cheyenne M., et al. “Evolution of a longitudinal, multidisciplinary, and scalable patient navigation matrix model.Cancer Med, vol. 9, no. 9, May 2020, pp. 3202–10. Pubmed, doi:10.1002/cam4.2950.
URI
https://scholars.duke.edu/individual/pub1434148
PMID
32129946
Source
pubmed
Published In
Cancer Medicine
Volume
9
Published Date
Start Page
3202
End Page
3210
DOI
10.1002/cam4.2950

Factors associated with biomedical research participation within community-based samples across 3 National Cancer Institute-designated cancer centers.

BACKGROUND: Engaging diverse populations in biomedical research, including biospecimen donation, remains a national challenge. This study examined factors associated with an invitation to participate in biomedical research, intent to participate in biomedical research in the future, and participation in biomedical research and biospecimen donation among a diverse, multilingual, community-based sample across 3 distinct geographic areas. METHODS: Three National Cancer Institute-designated cancer centers engaged in community partnerships to develop and implement population health assessments, reaching a convenience sample of 4343 participants spanning their respective catchment areas. Data harmonization, multiple imputation, and multivariable logistic modeling were used. RESULTS: African Americans, Hispanic/Latinos, and other racial minority groups were more likely to be offered opportunities to participate in biomedical research compared to whites. Access to care, history of cancer, educational level, survey language, nativity, and rural residence also influenced opportunity, intent, and actual participation in biomedical research. CONCLUSIONS: Traditionally underserved racial and ethnic groups reported heightened opportunity and interest in participating in biomedical research. Well-established community partnerships and long-standing community engagement around biomedical research led to a diverse sample being reached at each site and may in part explain the current study findings. However, this study illustrates an ongoing need to establish trust and diversify biomedical research participation through innovative and tailored approaches. National Cancer Institute-designated cancer centers have the potential to increase opportunities for diverse participation in biomedical research through community partnerships and engagement. Additional work remains to identify and address system-level and individual-level barriers to participation in both clinical trials and biospecimen donation for research.
Authors
Barrett, NJ; Rodriguez, EM; Iachan, R; Hyslop, T; Ingraham, KL; Le, GM; Martin, K; Haring, RC; Rivadeneira, NA; Erwin, DO; Fish, LJ; Middleton, D; Hiatt, RA; Patierno, SR; Sarkar, U; Gage-Bouchard, EA
MLA Citation
Barrett, Nadine J., et al. “Factors associated with biomedical research participation within community-based samples across 3 National Cancer Institute-designated cancer centers.Cancer, vol. 126, no. 5, Mar. 2020, pp. 1077–89. Pubmed, doi:10.1002/cncr.32487.
URI
https://scholars.duke.edu/individual/pub1426848
PMID
31909824
Source
pubmed
Published In
Cancer
Volume
126
Published Date
Start Page
1077
End Page
1089
DOI
10.1002/cncr.32487

Project PLACE: Enhancing community and academic partnerships to describe and address health disparities.

Achieving cancer health equity is a national imperative. Cancer is the second leading cause of death in the United States and in North Carolina (NC), where the disease disproportionately impacts traditionally underrepresented race and ethnic groups, those who live in rural communities, the impoverished, and medically disenfranchised and/or health-disparate populations at high-risk for cancer. These populations have worse cancer outcomes and are less likely to be participants in clinical research and trials. It is critical for cancer centers and other academic health centers to understand the factors that contribute to poor cancer outcomes, the extent to which they impact the cancer burden, and develop effective interventions to address them. Key to this process is engaging diverse stakeholders in the development and execution of community and population health assessments, and the subsequent programs and interventions designed to address the need across the catchment area. This chapter describes the processes and lessons learned of the Duke Cancer Institute's (DCI) long standing community partnerships that led to Project PLACE (Population Level Approaches to Cancer Elimination), a National Cancer Institute (NCI)-funded community health assessment reaching 2315 respondents in 7 months, resulting in a community partnered research agenda to advance cancer equity within the DCI catchment area. We illustrate the application of a community partnered health assessment and offer examples of strategic opportunities, successes, lessons learned, and implications for practice.
Authors
Barrett, NJ; Ingraham, KL; Bethea, K; Hwa-Lin, P; Chirinos, M; Fish, LJ; Randolph, S; Zhang, P; Le, P; Harvey, D; Godbee, RL; Patierno, SR
MLA Citation
Barrett, Nadine J., et al. Project PLACE: Enhancing community and academic partnerships to describe and address health disparities. Vol. 146, 2020, pp. 167–88. Pubmed, doi:10.1016/bs.acr.2020.01.009.
URI
https://scholars.duke.edu/individual/pub1436736
PMID
32241388
Source
pubmed
Volume
146
Published Date
Start Page
167
End Page
188
DOI
10.1016/bs.acr.2020.01.009

Reducing Disparities in the Quality of Palliative Care for Older African Americans through Improved Advance Care Planning: Study Design and Protocol.

Advance care planning (ACP) improves end-of-life care for patients and their caregivers. However, only one-third of adults have participated in ACP and rates are substantially lower among African Americans than among whites. Importantly, ACP improves many domains of care where there are racial disparities in outcomes, including receipt of goal-concordant care, hospice use, and provider communication. Yet, few studies have examined the effectiveness of ACP interventions among African Americans. The objectives of reducing disparities in the quality of palliative care for older African Americans through improved advance care planning (EQUAL ACP) are as follows: to compare the effectiveness of two interventions in (1) increasing ACP among African Americans and whites and (2) reducing racial disparities in both ACP and end-of-life care; and to examine whether racial concordance of the interventionist and patient is associated with ACP. EQUAL ACP is a longitudinal, multisite, cluster randomized trial and a qualitative study describing the ACP experience of participants. The study will include 800 adults ≥65 years of age (half African American and half white) from 10 primary care clinics in the South. Eligible patients have a serious illness (advanced cancer, heart failure, lung disease, etc.), disability in activities of daily living, or recent hospitalization. Patients are followed for one year and participate in either a patient-guided, self-management ACP approach, including a Five Wishes form or structured ACP with Respecting Choices First Steps. The primary outcome is formal or informal ACP-completion of advance directives, documented discussions with clinicians, and other written or verbal communication with surrogate decision makers about care preferences. Secondary outcomes assessed through after-death interviews with surrogates of patients who die during the study include receipt of goal-concordant care, health services use in the last year of life, and satisfaction with care. EQUAL ACP is the first large study to assess which strategies are most effective at both increasing rates of ACP and promoting equitable palliative care outcomes for seriously ill African Americans.
Authors
Ejem, DB; Barrett, N; Rhodes, RL; Olsen, M; Bakitas, M; Durant, R; Elk, R; Steinhauser, K; Quest, T; Dolor, RJ; Johnson, K
MLA Citation
Ejem, Deborah B., et al. “Reducing Disparities in the Quality of Palliative Care for Older African Americans through Improved Advance Care Planning: Study Design and Protocol.J Palliat Med, vol. 22, no. S1, Sept. 2019, pp. 90–100. Pubmed, doi:10.1089/jpm.2019.0146.
URI
https://scholars.duke.edu/individual/pub1409801
PMID
31486728
Source
pubmed
Published In
Journal of Palliative Medicine
Volume
22
Published Date
Start Page
90
End Page
100
DOI
10.1089/jpm.2019.0146

Perspectives on Inflammatory Breast Cancer (IBC) Research, Clinical Management and Community Engagement from the Duke IBC Consortium.

Inflammatory breast cancer (IBC) is an understudied and aggressive form of breast cancer with a poor prognosis, accounting for 2-6% of new breast cancer diagnoses but 10% of all breast cancer-related deaths in the United States. Currently there are no therapeutic regimens developed specifically for IBC, and it is critical to recognize that all aspects of treating IBC - including staging, diagnosis, and therapy - are vastly different than other breast cancers. In December 2014, under the umbrella of an interdisciplinary initiative supported by the Duke School of Medicine, researchers, clinicians, research administrators, and patient advocates formed the Duke Consortium for IBC to address the needs of patients in North Carolina (an ethnically and economically diverse state with 100 counties) and across the Southeastern United States. The primary goal of this group is to translate research into action and improve both awareness and patient care through collaborations with local, national and international IBC programs. The consortium held its inaugural meeting on Feb 28, 2018, which also marked Rare Disease Day and convened national research experts, clinicians, patients, advocates, government representatives, foundation leaders, staff, and trainees. The meeting focused on new developments and challenges in the clinical management of IBC, research challenges and opportunities, and an interactive session to garner input from patients, advocates, and community partners that would inform a strategic plan toward continuing improvements in IBC patient care, research, and education.
Authors
Devi, GR; Hough, H; Barrett, N; Cristofanilli, M; Overmoyer, B; Spector, N; Ueno, NT; Woodward, W; Kirkpatrick, J; Vincent, B; Williams, KP; Finley, C; Duff, B; Worthy, V; McCall, S; Hollister, BA; Palmer, G; Force, J; Westbrook, K; Fayanju, O; Suneja, G; Dent, SF; Hwang, ES; Patierno, SR; Marcom, PK
MLA Citation
Devi, Gayathri R., et al. “Perspectives on Inflammatory Breast Cancer (IBC) Research, Clinical Management and Community Engagement from the Duke IBC Consortium.J Cancer, vol. 10, no. 15, 2019, pp. 3344–51. Pubmed, doi:10.7150/jca.31176.
URI
https://scholars.duke.edu/individual/pub1395729
PMID
31293637
Source
pubmed
Published In
Journal of Cancer
Volume
10
Published Date
Start Page
3344
End Page
3351
DOI
10.7150/jca.31176