Health equity principles for oncology real world evidence studies
The Centers for Disease Control and Prevention (CDC) defines health equity as “the state in which everyone has a fair and just opportunity to attain their highest level of health.” Health equity particularly in the community setting is an imperative that demands attention and concerted effort. According to Olanisa et al, inequities in access to quality cancer care, health outcomes, and the financial costs of treatment remain significant challenges for various marginalized populations (ie, racial and ethnic minorities, individuals living in poverty, rural dwellers, etc.). Inequities are compounded by the existence of several social determinants of health (SDOH) that hinder access to optimal cancer care. SDOH are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. It has been suggested that real-world evidence holds promise in providing tangible insights for interventions that can improve health outcomes, particularly for groups like African Americans who experience disparities in cancer diagnosis, treatment, and survivorship. Real-world evidence offers a unique lens through which to gain a deeper understanding of the complex healthcare landscape patients navigate daily. Derived from routinely collected data, such as claims, billing activities, electronic medical records, and product and disease registries, real-world evidence reflects patients’ daily experiences within the healthcare system. Moreover, real-world evidence helps overcome the limitations of clinical trials because clinical trials may not always include a diverse range of participants, potentially leading to a lack of representation for certain populations, including those from underrepresented ethnic or socioeconomic groups. On the contrary, real-world evidence draws from a broader and more inclusive pool of patients, reflecting the diversity of individuals who receive healthcare. Thus, real-world evidence can illuminate the root causes of health disparities, identify opportunities for intervention, and guide the development of targeted strategies to narrow gaps in health equity. These benefits of real-world evidence underscore the growing enthusiasm for research based on real-world evidence, particularly in the realm of cancer care, which demands significant effort to navigate successfully. While numerous studies have addressed the broader goal of ensuring equity in healthcare in general and cancer care in particular, a growing body of research is actively exploring methodologies to conduct research to achieve health equity, particularly in community. , The CDC and the National Academies of Science, Engineering, and Medicine (NASEM) have played pivotal roles in equipping researchers with valuable tools and guidelines to advance health equity research. These tools are designed to empower researchers with community and practice-based strategies, fostering an inclusive and effective approach to public health research. Notable examples include the CDC’s (2013) Practitioner Guide for Advancing Health Equity and the NASEM’s (2017) report highlighting community-based health equity research guidelines. The CDC’s Practitioner Guide for Advancing Health Equity outlines essential skills for public health researchers to incorporate into their work to promote health equity within the public health field. These skills include how to build capacity, engage with communities meaningfully, form partnerships and coalitions, understand health inequities, select research strategies, design and implement plans, and evaluate the research activities. In this research endeavor, specialists in equity and real-world evidence, alongside patients and community members, aim to co-develop principles that will guide researchers in utilizing real-world data to address health equity in community oncology research. By co-developing principles, we aspire to ensure that research conducted using real-world data is not only scientifically rigorous but also deeply rooted in the lived experiences and needs of the communities it seeks to serve. These principles will serve as a compass, directing researchers toward the path of health equity and illuminating the way forward with a steadfast commitment to achieving equitable health outcomes for all.   Study design and sample selection This research employs qualitative methods, specifically key informant interviews, to explore perspectives and insights related to how health equity principles can be used by researchers applying real-world data to study oncology care in a community setting. Prior to commencing research, the study was approved and determined exempt by the University of Maryland Baltimore Institutional Review Board (IRB), ID: HP-00104230, ensuring compliance with ethical guidelines and standards for study procedures. A purposive sampling strategy was used to intentionally select participants who could provide valuable insights relevant to the research objective. Participants were recruited through recommendations from either the PATIENTS Program—a community-academic research partnership housed at the University of Maryland Baltimore School of Pharmacy—or Ontada—a company that provides insights and technical solutions for oncology providers. Initial contact was established via email, wherein potential participants were invited by a research team member to take part in the study. The inclusion criteria for the study were patients with lived experience of cancer, or experts on SDOH and health equity. Experts in SDOH and health equity were defined in our study as individuals who have been involved in both cancer research and SDOH or health equity research. In addition, only key informants with demonstrated ability to speak, read, and understand English, and the ability to attend virtual sessions on Zoom were eligible for the study. Conversely, the study excluded individuals who did not meet one or more of the inclusion criteria. This recruitment approach ensured a targeted selection of individuals with diverse perspectives and experiences related to cancer, SDOH, and health equity. Those expressing interest and meeting the inclusion criteria were contacted by a research team member to further explain the research, answer any questions, and schedule the interview sessions. The study strictly adhered to ethical guidelines, ensuring that informed consent was obtained prior to conducting the research. Participants were verbally provided with comprehensive details about the interview process and the content to be discussed at the point of the interview. Prior to commencing the interview, participants were explicitly informed about the nature of the study, and they were asked to provide their voluntary and verbal consent to participate. Additionally, participants were specifically asked for their consent to have the interview recorded, and this consent was also obtained verbally before initiating the interview process. Instrument design and data collection A semi-structured interview guide (see for interview guide questions) was designed to explore several key topics, including reactions to findings of a previous scoping review on SDOH and health equity, new strategies and approaches to address health equity, inequity in electronic health records, and identification of principles needed by researchers utilizing real-world data to address health equity. The interviews were conducted via the Zoom video conferencing platform between March and May 2023. Zoom was also used to record and transcribe interviews. Interviews lasted between 13 and 42 minutes. Participants were at liberty to keep their cameras on or off during interviews. Each interview included an interviewer and a note-taker. The responsibilities of each role were defined to ensure a comprehensive and accurate record of the session. The interviewer conducted the interview by posing interview guide questions and facilitating a comfortable environment for participants to express their thoughts and experiences. The note-taker recorded key points, observations, and non-verbal participant responses during the interview. Throughout the interview process, confidentiality measures were upheld. Participants’ identities and any identifying information were safeguarded to protect their privacy and comply with ethical standards. Data were deidentified after data collection and stored in a password protected file only accessible to members of the research team. Following each interview, the note taker reviewed the interview transcripts generated by Zoom and edited as needed to ensure accuracy of study data. Data analysis Rapid qualitative analysis was used according to a process described by Hamilton. , This analysis aimed to identify key themes, patterns, and insights from the interview data (For a detailed overview of our analysis process, see ). The findings from the rapid qualitative analysis were summarized to provide a concise overview of the key themes and insights that emerged from the interviews. To enhance the rigor and credibility of the study, member checking was performed. On July 6, 2023, participants were sent an email with the summarized results and invited to provide feedback. This member-checking process ensured that the results accurately reflected participants’ perspectives and experiences. Based on the feedback received during the member-checking process, the results were revised as necessary to incorporate participants’ insights and ensure the accuracy of the findings.   This research employs qualitative methods, specifically key informant interviews, to explore perspectives and insights related to how health equity principles can be used by researchers applying real-world data to study oncology care in a community setting. Prior to commencing research, the study was approved and determined exempt by the University of Maryland Baltimore Institutional Review Board (IRB), ID: HP-00104230, ensuring compliance with ethical guidelines and standards for study procedures. A purposive sampling strategy was used to intentionally select participants who could provide valuable insights relevant to the research objective. Participants were recruited through recommendations from either the PATIENTS Program—a community-academic research partnership housed at the University of Maryland Baltimore School of Pharmacy—or Ontada—a company that provides insights and technical solutions for oncology providers. Initial contact was established via email, wherein potential participants were invited by a research team member to take part in the study. The inclusion criteria for the study were patients with lived experience of cancer, or experts on SDOH and health equity. Experts in SDOH and health equity were defined in our study as individuals who have been involved in both cancer research and SDOH or health equity research. In addition, only key informants with demonstrated ability to speak, read, and understand English, and the ability to attend virtual sessions on Zoom were eligible for the study. Conversely, the study excluded individuals who did not meet one or more of the inclusion criteria. This recruitment approach ensured a targeted selection of individuals with diverse perspectives and experiences related to cancer, SDOH, and health equity. Those expressing interest and meeting the inclusion criteria were contacted by a research team member to further explain the research, answer any questions, and schedule the interview sessions. The study strictly adhered to ethical guidelines, ensuring that informed consent was obtained prior to conducting the research. Participants were verbally provided with comprehensive details about the interview process and the content to be discussed at the point of the interview. Prior to commencing the interview, participants were explicitly informed about the nature of the study, and they were asked to provide their voluntary and verbal consent to participate. Additionally, participants were specifically asked for their consent to have the interview recorded, and this consent was also obtained verbally before initiating the interview process.   A semi-structured interview guide (see for interview guide questions) was designed to explore several key topics, including reactions to findings of a previous scoping review on SDOH and health equity, new strategies and approaches to address health equity, inequity in electronic health records, and identification of principles needed by researchers utilizing real-world data to address health equity. The interviews were conducted via the Zoom video conferencing platform between March and May 2023. Zoom was also used to record and transcribe interviews. Interviews lasted between 13 and 42 minutes. Participants were at liberty to keep their cameras on or off during interviews. Each interview included an interviewer and a note-taker. The responsibilities of each role were defined to ensure a comprehensive and accurate record of the session. The interviewer conducted the interview by posing interview guide questions and facilitating a comfortable environment for participants to express their thoughts and experiences. The note-taker recorded key points, observations, and non-verbal participant responses during the interview. Throughout the interview process, confidentiality measures were upheld. Participants’ identities and any identifying information were safeguarded to protect their privacy and comply with ethical standards. Data were deidentified after data collection and stored in a password protected file only accessible to members of the research team. Following each interview, the note taker reviewed the interview transcripts generated by Zoom and edited as needed to ensure accuracy of study data.   Rapid qualitative analysis was used according to a process described by Hamilton. , This analysis aimed to identify key themes, patterns, and insights from the interview data (For a detailed overview of our analysis process, see ). The findings from the rapid qualitative analysis were summarized to provide a concise overview of the key themes and insights that emerged from the interviews. To enhance the rigor and credibility of the study, member checking was performed. On July 6, 2023, participants were sent an email with the summarized results and invited to provide feedback. This member-checking process ensured that the results accurately reflected participants’ perspectives and experiences. Based on the feedback received during the member-checking process, the results were revised as necessary to incorporate participants’ insights and ensure the accuracy of the findings.   Participants Study interviews yielded information regarding researcher principles for addressing health equity in community oncology research using real-world data. Our research team interviewed a total of 13 individuals (see for participant information). Study participants included the following: (1) 2 patient advisors who had a prior diagnosis of cancer, (2) 1 community advisor who was the pastor of an African American church, (3) 3 stakeholder advisors inclusive of a clinical university faculty member, a pharmaceutical company representative, and a representative of a medical supplier company, (4) a hematologist oncologist, (5) 1 medical insurance representative, (6) 2 advocates for cancer patients and families, and (7) 3 senior leaders of the same medical supply company that distributes medical supplies, health information technology, and care management tools. Researcher principles for RWE studies Data analysis generated 3 overarching categories for researcher best principles in addressing health equity when utilizing real world data: (1) education; (2) community engagement; and (3) research design and implementation (see Appendix for summary results). The first category highlights the necessity of training in relevant skills to address health equity. Community engagement principles highlight various actions that community oncology researchers can take to conduct research inclusive of community concerns regarding health equity. The research design and implementation category provides practical guidelines for researchers in planning, conducting, and disseminating community oncology research to address health equity. The following sections detail major themes from the researcher principles document (see Appendix for details on researcher principles). Education Education principles note that researchers should receive training to obtain competencies in health equity knowledge and cultural sensitivity. This involves researchers gaining the ability to identify and address issues relevant to these competencies. Training in health equity knowledge was particularly important as some study participants with a background in medicine reported that medical researchers often do not understand the concept of health equity and are not trained explicitly in how to address health equity. The vice president of a medical supplier company highlighted this lack of training, saying that medical researchers are “not trained...on health equity... how to do this stuff.” A participant who was a practicing hematologist oncologist affirmed the importance of health equity training: “health equity needs to be incorporated [in] medical education... how to address [health equity] and be aware of it.” The Education category principles also require that researchers gain knowledge of how to access data pertinent for community oncology research addressing health equity. Community engagement Principles in this category focus on eliciting community and patient stakeholder perspectives regarding health equity issues and research plans before, during, and after research. Principles also validate the expertise of patients and key stakeholders on health equity matters impacting them, to be used for the purpose of conducting studies addressing health equity. Patient advisors and the community advisor interviews particularly showed the importance of sharing study results that may have benefit to the population of interest. One of the patient advisors shared that researchers often did not provide the “end result” of a study after getting data from the community.” She emphasized the importance of coming back “to those participants in that community and say[ing] hey, this is what we found. and this is what we recommend, and let’s talk about it.” Related to this, one principle speaks to researchers developing relationships with individuals from populations of interest so as to build partnerships that can sustain community oncology research addressing health equity. This allows the research to have direct benefit for the community, rather than the community “hear about the details [of the research] on the news [after researchers have taken community] information.” (pastor of African American church). Research design and implementation The vast majority of principles are found within the research design and implementation category. These principles reflect the importance of researchers ensuring research plans are patient-centered and address SDOH. For example, one principle states that stakeholder and patient advisors must be a part of the reviewer team when determining whether patient record data should be used by a researcher. An important consideration, particularly for patient and community advisors, was that researchers should examine and address mental and emotional needs of cancer patients through their research. One patient advisor said that “when it comes to health equity it needs to be another key component that needs to be looked at, and that would be mental health...To be treated for cancer...your doctor really needs to also pay attention to your emotional state and to your mental health. and address those needs if necessary.” Principles also note that researchers should abide by national ethical standards such as informed consent and independent review, and have a standardized process for reporting research information. In line with the need to be transparent and ensure that research is truly addressing health equity, it is necessary for researchers to present a publicly accessible final report that gives a summary of their research process and outcomes, including any benefits from the research for addressing health equity. Patient understanding and accessibility was another large theme in this category. Exemplary principles note the necessity of making sure study results are accessible to populations of interest when possible and are disseminated to organizations that interact with patient populations such as patient advocacy networks. The inclusion of diverse and under-represented groups in studies relevant to the population of the referral geography was another key issue associated with patient access that came up in interviews. It was important to consider diversity and inclusion for patients and for individuals designing and implementing studies. As stated by a patient cancer advocate, “greater efforts to increase involvement in research studies from different groups [representative of the population of interest] would be a continued important initiative... a lot of opportunity for improvements in that area.” Research designers and implementers have a role in assuring patient access through their engagement with patients. Researchers must be respectful of patients and transparent regarding study information requested by patients. In essence, researchers should see their role as not only a designer or conductor of a study but also as one who serves patients through the research process. As one patient advisor emphatically stated, “Researchers need to make us feel valued.... I want to be looked at as a person that has an illness [eg, cancer] that could possibly further research to save people’s lives down the road. Don’t make me feel like you [ie, medical researcher] just recruiting me because I fit your profile. That’s important. Don’t make me feel that way.” Related to this, researchers should not only disseminate study results to physicians, but also to other health care providers such as social workers to inform their engagement of patients for research studies addressing health equity.   Study interviews yielded information regarding researcher principles for addressing health equity in community oncology research using real-world data. Our research team interviewed a total of 13 individuals (see for participant information). Study participants included the following: (1) 2 patient advisors who had a prior diagnosis of cancer, (2) 1 community advisor who was the pastor of an African American church, (3) 3 stakeholder advisors inclusive of a clinical university faculty member, a pharmaceutical company representative, and a representative of a medical supplier company, (4) a hematologist oncologist, (5) 1 medical insurance representative, (6) 2 advocates for cancer patients and families, and (7) 3 senior leaders of the same medical supply company that distributes medical supplies, health information technology, and care management tools.   Data analysis generated 3 overarching categories for researcher best principles in addressing health equity when utilizing real world data: (1) education; (2) community engagement; and (3) research design and implementation (see Appendix for summary results). The first category highlights the necessity of training in relevant skills to address health equity. Community engagement principles highlight various actions that community oncology researchers can take to conduct research inclusive of community concerns regarding health equity. The research design and implementation category provides practical guidelines for researchers in planning, conducting, and disseminating community oncology research to address health equity. The following sections detail major themes from the researcher principles document (see Appendix for details on researcher principles).   Education principles note that researchers should receive training to obtain competencies in health equity knowledge and cultural sensitivity. This involves researchers gaining the ability to identify and address issues relevant to these competencies. Training in health equity knowledge was particularly important as some study participants with a background in medicine reported that medical researchers often do not understand the concept of health equity and are not trained explicitly in how to address health equity. The vice president of a medical supplier company highlighted this lack of training, saying that medical researchers are “not trained...on health equity... how to do this stuff.” A participant who was a practicing hematologist oncologist affirmed the importance of health equity training: “health equity needs to be incorporated [in] medical education... how to address [health equity] and be aware of it.” The Education category principles also require that researchers gain knowledge of how to access data pertinent for community oncology research addressing health equity.   Principles in this category focus on eliciting community and patient stakeholder perspectives regarding health equity issues and research plans before, during, and after research. Principles also validate the expertise of patients and key stakeholders on health equity matters impacting them, to be used for the purpose of conducting studies addressing health equity. Patient advisors and the community advisor interviews particularly showed the importance of sharing study results that may have benefit to the population of interest. One of the patient advisors shared that researchers often did not provide the “end result” of a study after getting data from the community.” She emphasized the importance of coming back “to those participants in that community and say[ing] hey, this is what we found. and this is what we recommend, and let’s talk about it.” Related to this, one principle speaks to researchers developing relationships with individuals from populations of interest so as to build partnerships that can sustain community oncology research addressing health equity. This allows the research to have direct benefit for the community, rather than the community “hear about the details [of the research] on the news [after researchers have taken community] information.” (pastor of African American church).   The vast majority of principles are found within the research design and implementation category. These principles reflect the importance of researchers ensuring research plans are patient-centered and address SDOH. For example, one principle states that stakeholder and patient advisors must be a part of the reviewer team when determining whether patient record data should be used by a researcher. An important consideration, particularly for patient and community advisors, was that researchers should examine and address mental and emotional needs of cancer patients through their research. One patient advisor said that “when it comes to health equity it needs to be another key component that needs to be looked at, and that would be mental health...To be treated for cancer...your doctor really needs to also pay attention to your emotional state and to your mental health. and address those needs if necessary.” Principles also note that researchers should abide by national ethical standards such as informed consent and independent review, and have a standardized process for reporting research information. In line with the need to be transparent and ensure that research is truly addressing health equity, it is necessary for researchers to present a publicly accessible final report that gives a summary of their research process and outcomes, including any benefits from the research for addressing health equity. Patient understanding and accessibility was another large theme in this category. Exemplary principles note the necessity of making sure study results are accessible to populations of interest when possible and are disseminated to organizations that interact with patient populations such as patient advocacy networks. The inclusion of diverse and under-represented groups in studies relevant to the population of the referral geography was another key issue associated with patient access that came up in interviews. It was important to consider diversity and inclusion for patients and for individuals designing and implementing studies. As stated by a patient cancer advocate, “greater efforts to increase involvement in research studies from different groups [representative of the population of interest] would be a continued important initiative... a lot of opportunity for improvements in that area.” Research designers and implementers have a role in assuring patient access through their engagement with patients. Researchers must be respectful of patients and transparent regarding study information requested by patients. In essence, researchers should see their role as not only a designer or conductor of a study but also as one who serves patients through the research process. As one patient advisor emphatically stated, “Researchers need to make us feel valued.... I want to be looked at as a person that has an illness [eg, cancer] that could possibly further research to save people’s lives down the road. Don’t make me feel like you [ie, medical researcher] just recruiting me because I fit your profile. That’s important. Don’t make me feel that way.” Related to this, researchers should not only disseminate study results to physicians, but also to other health care providers such as social workers to inform their engagement of patients for research studies addressing health equity.   We co-developed, with patients and experts in health equity and SDOH, principles to guide researchers in addressing health equity in their real-world evidence research protocols. Principles were based on the perspectives of health equity experts who were patients, providers, community members, advocates, and leaders of healthcare companies. The principles covered the education of community oncology researchers in health equity, engagement of patients and community stakeholders through all phases of research, and practices for ethical and rigorous research that promote health equity. The researcher's principles are important to promoting health equity in community oncology research and can support oncology researchers in gaining access to patient data for their studies. Researchers may use these principles as a guide to address health equity. Research based on these principles may inform interventions that promote better health outcomes for populations (eg, African Americans) impacted by health inequities in cancer diagnosis, treatment, and survivorship. Findings from this research may also lead to prevention and intervention initiatives that help reduce cancer disparities. In practice, real-world researchers should leverage the SDOH data available to them in medical records, such as race, ethnicity, geographic area, to ascertain any differences in oncology treatment like time to diagnosis or treatment, type of treatment received, and treatment outcomes among diverse patient groups. Once we better understand current differences across groups, interventions may be developed to address health disparities in oncology treatment and bring them to public awareness. Other researcher principles have been created specific to promoting greater health equity in healthcare as we did, some specific to cancer care. In addition to obtaining the perspectives of key stakeholders and patients, some researcher principles have been formulated through iterative consensus-building activities with community, patient, and researcher networks. , Others based principles on previous health equity frameworks or health equity research, exploring how principles could be implemented in research with marginalized populations in contrast to our focus on cultivating the lived experiences of study participants to create principles. Adsul et al, Bailie et al, and Chebli et al’s guiding principles for research addressing health equity in cancer care included similar principles to ours such as the importance of community engagement and prioritization of stakeholder and patient ideas regarding research plans. They also developed principles that did not emerge in our study, related to addressing power relations. , In contrast to our principles, there was a strong emphasis on practically addressing health equity issues in the stakeholder communities sustainably, and on explicitly addressing racial inequities in cancer care. , The lack of direct emphasis on racial equity and on addressing power dynamics in our principles could be due to the fact that we primarily focused on researcher-initiated studies as opposed to assuming research project plans where researchers and marginalized community members or patients are involved in all aspects of research. There is literature that similarly notes the importance of community engagement to health equity researcher principles as we did. Emmons et al highlighted the importance of community engagement to address health equity in the process of cancer research. Further, he suggests data sharing or dissemination, as was suggested by participants in our study, to ensure both community and researcher understanding of the issues involved and move toward shared benefits. Instead of formulating principles, though, Emmons et al evaluated and critiqued community engagement researcher principles developed by NIH with a view to strengthening greater equity in the data-sharing process. Similarly, one of the patient advisors who is the author of this paper, related that our researcher's principle regarding the submission of a final research report should not only be disseminated in ways that providers or researchers understand but should also be disseminated in ways that are understandable to the communities that are the focus of the study. Kruse et al show how community engagement principles as created by the Clinical and Translational Science Awards Consortium’s Community Engagement Key Function Committee Task Force on the Principles of Community Engagement (2011) can be implemented in community cancer centers in a particular locality—such as the city of Boston. These principles focus explicitly on community engagement practices for research as we did but provide greater detail about understanding the context of the populations of interest to promote long-term health change. As we noted in our principles, it is very important to engage patients when conducting community oncology research which was also affirmed in Charlot et al Charlot et al found that patient advisors for research projects focusing on cancer can support patient enrollment in studies, including clinical trials. There were also some challenges to engaging patients, although, that we did not consider in our principles which should be assessed when implementing principles. Charlot et al had difficulties with retaining patient advisors due to some of them having to attend to their own health treatment and due to a lack of balance between English and non-English speakers on the advisory board. A balance of patient advisors regarding relevant social identities and developing creative ways to involve patients in advisory boards that take account of their healthcare needs may need to be considered when recruiting and engaging patient advisors. Education of community oncology researchers was an important insight noted by participants in this study. However, more literature focuses on educating providers in the medical field than medical researchers in terms of addressing health inequities and communicating with patients about inequities. Relevant to education is the importance of researchers gaining skills in cultural sensitivity. In line with our principles regarding training in cultural sensitivity, Lett et al notes the importance of self-reflection on biases as a safeguard for perpetuating further inequities in healthcare research. In conducting research, we also note the importance of attending to diversity and inclusion for patients and research staff in researcher principles to address health equity. Although not specific to cancer care, researcher commentary speaks to the importance of diversity and inclusion in research addressing health equity. Fleming and Burgette note that diversity and inclusion in research teams lead to more innovative and relevant science that connects with populations of interest. Strengths and limitations Our research has the distinction of not using any pre-determined framework to develop principles, but rather we examined the lived experiences of community oncology stakeholders regarding the necessary guidelines for addressing health equity in oncology research. Particularly noteworthy were the insights gained from medical practitioners and researchers who shared that lack of training in health equity for medical providers could make it difficult for them to even know how to address health equity through their research. As such, these principles may be highly important as guidelines for medical providers engaging in this type of research. Limitations of this research are that we did not include a large or balanced amount of community and patient advisors from various social groups, which may have provided a greater understanding of health equity principles needed for different communities. For example, a patient advisor on our study reported that future research principles should be explored concerning full disclosure to community members of who comprises the research team and self-disclosure of researcher experiences (eg, caregiving for family member with cancer) within boundaries that may connect with patients and others when engaging communities. In addition, the patient advisor stated that a plan needs to be developed for how to implement the principles regarding health equity education. It is also important to evaluate the usefulness of these principles for community oncology research in other contexts, such as clinics, hospitals, and other organizations who interface with cancer patients but have little to no cancer research expertise.   Our research has the distinction of not using any pre-determined framework to develop principles, but rather we examined the lived experiences of community oncology stakeholders regarding the necessary guidelines for addressing health equity in oncology research. Particularly noteworthy were the insights gained from medical practitioners and researchers who shared that lack of training in health equity for medical providers could make it difficult for them to even know how to address health equity through their research. As such, these principles may be highly important as guidelines for medical providers engaging in this type of research. Limitations of this research are that we did not include a large or balanced amount of community and patient advisors from various social groups, which may have provided a greater understanding of health equity principles needed for different communities. For example, a patient advisor on our study reported that future research principles should be explored concerning full disclosure to community members of who comprises the research team and self-disclosure of researcher experiences (eg, caregiving for family member with cancer) within boundaries that may connect with patients and others when engaging communities. In addition, the patient advisor stated that a plan needs to be developed for how to implement the principles regarding health equity education. It is also important to evaluate the usefulness of these principles for community oncology research in other contexts, such as clinics, hospitals, and other organizations who interface with cancer patients but have little to no cancer research expertise.   We developed guiding principles for researchers to address SDOH in real-world oncology research protocols in order to promote health equity. Our principles require researchers to obtain proper education to address health equity in research, engage communities and patients as part of the research process, and design and implement research studies that address SDOH and promote health equity. Researcher principles should be operationalized and evaluated, to ensure they align with the goal of health equity promotion in community oncology research. Researchers utilizing our principles to promote health equity should tailor their research approach to the specific research context, drawing upon the expertise of relevant patients and key stakeholders. The researcher principles can also be used as a template for others who may want to co-develop guiding principles for researchers to promote health equity in other areas of health research. As we did in this study, patients, community members, and other experts in health equity and SDOH can provide their perspectives on necessary researcher principles to promote health equity, using our researcher principles as a basis for discussions.   