The trust-builder: a cancer center director’s try-it-all strategy for breaking the barriers between research and Black patients

RICHMOND, Va. — The residents agreed: Nobody like Robert Winn — director of the Virginia Commonwealth University Massey Cancer Center — had ever visited the neighborhood before. This development on the outskirts of Richmond, more parking spots and asphalt than trees and lawn, was “the hood,” after all, they said. “This neighborhood — it’s been so long since we had anybody who even cares to come,” said Glenda Barnhart, a 68-year-old resident. Certainly not anybody from the big hospital.

And now, not only was this doctor with a cheesy grin and a bouncy step before them — he’d also brought along several local officials, including their county manager. At first it seemed that Winn, a pulmonologist-oncologist who calls himself first and foremost a bench scientist, had come to the squat buildings at the Coventry Gardens apartments to talk. But Winn had come to listen.

“That’s the most important thing,” he said. “Making sure that we get to hear. We scheduled this to make sure that I’m hearing you — like, what are your needs.”

Since Winn became the director of the Massey Cancer Center at the end of 2019, he’s tried to visit a neighborhood — particularly low-income, rural, or ethnic minority neighborhoods — in one of the 66 towns, cities, or counties that his hospital serves at least a couple times a year. He calls them district walks. It’s one of the cornerstones of an overarching strategy he calls “high tech, high touch.”

High tech, he said, is the wave of advancements in cancer that have revolutionized care. High touch are the personal interactions, often face-to-face, that he’s using to overhaul the way his academic medical institution interacts with marginalized communities. That includes meeting local and state representatives, greeting patients in the community when they go to his hospital for care, taking part in community events, and more. That contact, he hopes, will build trust, reduce health inequities, and increase diversity in clinical trials — a key part to both advancing science and ensuring the most state-of-the-art medicine is accessible to all patients.

“If you’re a minority in this country, it would be abnormal for you not to be suspicious of the health system,” Winn said in an interview after the district walk. “If we have the ability to be mindful of the nature of what that is and how to overcome that, we’re going to see a lot more positive results and — yeah — a lot more people on clinical trials. My district walks was to do two things: start building the foundational blocks of trust. People tend to trust you when they know you. Then, for me to get to see what really are the realities on the ground.”

What Winn learns from listening to people on these community visits has transformed into an eclectic array of projects that he spends both workdays and free time on. He’s thrown his energy into housing development, seed grants for community projects, influencing policy, building new health services at the Massey Cancer Center, and building close relationships with community organizations.

It’s an approach that health equity experts called both unusual and likely to make a lasting impact in health disparities. “It’s what we need to make a difference,” said Adana Llanos, a cancer researcher at Columbia University. “Not just novel, but innovative ways to address disparities.”

At Virginia Commonwealth University, which operates Massey Cancer Center, Winn’s up against quite a challenge. People of color, particularly Black folk, have long held a dim view of VCU Health — ever since the days it was called the Medical College of Virginia and it ran a separate “colored-only” hospital called St. Philip. This was the institution that performed one of the world’s first heart transplants from a Black man without his or his family’s consent and gave it to a white man. It was also the place that robbed Black graves for medical cadavers.

But you can’t build trust without showing up in person, Winn said. So, standing in the neighborhood’s packed community room and looking like anybody’s dad in a light green jacket and khakis, Winn introduced himself.

“Some people are sometimes surprised. They’ll say, well, you a cancer doctor. How come you sound – Well, I sound exactly like I sound because I’m actually proud of the people I came from. Period.” Winn said. “I came from a teenage mom, just being straight up. Didn’t think about being a doc. I was thinking of working at GM. I’ve learned how to put on a blue blazer and a bowtie, but at the end of the day if all we’re doing is sitting up there right at College Street up in Richmond and ain’t really think about how we’re getting out to the neighborhoods then this ain’t gonna work.”

With his district walks and relentless community outreach, Winn could be mistaken for a politician. He opens every community visit with something akin to a stump speech. He’s a natural orator, pulling the audience in with jokes and stories while promising to serve the community. Then he launches into a litany of statistics, starting with the fact that nearly a third of all adults will get cancer at some point in their lives — and Black Americans are more likely to die of cancer than any other racial group.

“Number one on the list for breast cancer: African American women. Number one on the list for prostate cancer: African American men. Number one on the list for lung cancer, GI cancer, pancreas,” Winn said. “Put it this way, most of our communities ain’t doing well. So while I’m here with breath in my body and the resources at my position, I’m just trying to figure out how we can work to do something better. That’s what this conversation is about.”

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