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Herrera-Añazco P, Benites-Meza JK, Caira-Chuquineyra B, Fernandez-Guzman D, Hernandez-Bustamante EA, Benites-Zapata VA. Ethnic Minority Participation in Clinical Trials from Latin America and the Caribbean: A Scoping Review. J Immigr Minor Health 2024; 26:604-622. [PMID: 38294634 DOI: 10.1007/s10903-023-01578-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 02/01/2024]
Abstract
We summarize the clinical trials (CTs) main characteristics, including members of ethnic minorities from Latin America. We carried out a systematic search in six databases. We made a descriptive synthesis of CTs, summarizing the characteristics, interventions, main findings, results, and conclusions reported. 4411 studies were acquired in search strategy, leaving 24 CTs in the final selection. Of these, ten were randomized, four were non-randomized, and the remainder had other designs. Most of the studies were carried out in the population of infants and children (08), ten of the studies included only women, and two studies included men. Nine studies were conducted in Mexico, with the Mayan ethnic minority being mostly evaluated (05). In only 15 it was mentioned that their research was approved by a research ethics committee. Finally, half of the CTs reported funding from international agencies and third reported funding from government agencies. Our results show that that CTs in ethnic minorities are limited and reduced to a few native peoples of the continent.
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Affiliation(s)
| | - Jerry K Benites-Meza
- Sociedad Científica de Estudiantes de Medicina de La Universidad Nacional de Trujillo, Trujillo, Peru
- Grupo Peruano de Investigación Epidemiológica, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | | | | | - Enrique A Hernandez-Bustamante
- Sociedad Científica de Estudiantes de Medicina de La Universidad Nacional de Trujillo, Trujillo, Peru
- Grupo Peruano de Investigación Epidemiológica, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Vicente A Benites-Zapata
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru.
- Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Campus 2, avenida La Fontana 750, La Molina, Lima, Peru.
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2
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Guo XM, Neuman MK, Vallejo A, Matsuo K, Roman LD. An absence of translated consent forms limits oncologic clinical trial enrollment for limited English proficiency participants. Gynecol Oncol 2024; 180:86-90. [PMID: 38061275 DOI: 10.1016/j.ygyno.2023.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/21/2023] [Accepted: 11/23/2023] [Indexed: 02/18/2024]
Abstract
OBJECTIVES A lack of diversity amongst participants in cancer clinical trials has raised scrutiny over the past decade. Patients with limited English proficiency (LEP) are further excluded. One modifiable reason for low LEP participation is a lack of non-English consent forms. METHODS We queried the clinical trials registry database at an academic hospital serving a predominantly Spanish-speaking patient population. Clinical trials related to gynecology oncology were evaluated for the availability of fully translated Spanish consent forms, the racial and ethnic identification of enrolled patients, and the number of signed Spanish consents. Enrolment data was compared before and after 2019, when institutional financial support for document translation was withdrawn. RESULTS Sixteen gynecologic oncology clinical trials were opened between 2014 and 2022, with 10 trials enrolling 128 patients. Eight trials opened prior to 2019, all with fully translated consent forms. Seven of these trials enrolled 99 participants, 70% of whom identified as Hispanic and 60% who signed a Spanish consent. Eight trials opened after 2019 and one had a fully translated consent form. Three of the trials enrolled 29 participants, with 10% of subjects identifying as Hispanic and none signing a Spanish consent form. CONCLUSIONS There was a decrease in fully translated clinical trial consent forms for gynecologic oncology studies following the loss of subsidized translation services in our single institution with a predominantly LEP population. This correlated with a decrease in enrollment of Hispanic subjects. To increase enrollment of diverse participants, including those with LEP, simple actions such as fully translating consent forms would help maintain equity in research conduct and improve clinical outcomes through trial involvement.
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Affiliation(s)
- X Mona Guo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA.
| | - Monica K Neuman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Andrew Vallejo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
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3
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Kuri L, Setru S, Liu G, Reed DM, Weigand D, Surampudi A, Berger S, Paulucci D, Rai A, Sethuraman V, Vito B, Kellar-Wood H, Balan MM. Data-driven strategies for increasing patient diversity in Bristol Myers Squibb-sponsored US oncology clinical trials. Clin Trials 2023; 20:585-593. [PMID: 37309819 PMCID: PMC10638849 DOI: 10.1177/17407745231180506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND/AIMS Determining whether clinical trial findings are applicable to diverse, real-world patient populations can be challenging when the full demographic characteristics of enrolled patients are not consistently reported. Here, we present the results of a descriptive analysis of racial and ethnic demographic information for patients in Bristol Myers Squibb (BMS)-sponsored oncology trials in the United States (US) and describe factors associated with increased patient diversity. METHODS BMS-sponsored oncology trials conducted at US sites with study enrollment dates between 1 January 2013 and 31 May 2021 were analyzed. Patient race/ethnicity information was self-reported in case report forms. As principal investigators (PIs) did not report their own race/ethnicity, a deep-learning algorithm (ethnicolr) was used to predict PI race/ethnicity. Trial sites were linked to counties to understand the role of county-level demographics. The impact of working with patient advocacy and community-based organizations to increase diversity in prostate cancer trials was analyzed. The magnitude of associations between patient diversity and PI diversity, US county demographics, and recruitment interventions in prostate cancer trials were assessed by bootstrapping. RESULTS A total of 108 trials for solid tumors were analyzed, including 15,763 patients with race/ethnicity information and 834 unique PIs. Of the 15,763 patients, 13,968 (89%) self-reported as White, 956 (6%) Black, 466 (3%) Asian, and 373 (2%) Hispanic. Among 834 PIs, 607 (73%) were predicted to be White, 17 (2%) Black, 161 (19%) Asian, and 49 (6%) Hispanic. A positive concordance was observed between Hispanic patients and PIs (mean = 5.9%; 95% confidence interval (CI) = 2.4, 8.9), a less positive concordance between Black patients and PIs (mean = 1.0%; 95% CI = -2.7, 5.5), and no concordance between Asian patients and PIs. Geographic analyses showed that more non-White patients enrolled in study sites in counties with higher proportions of non-White residents (e.g. a county population that was 5%-30% Black had 7%-14% more Black patients enrolled in study sites). Following purposeful recruitment efforts in prostate cancer trials, 11% (95% CI = 7.7, 15.3) more Black men enrolled in prostate cancer trials. CONCLUSION Most patients in these clinical trials were White. PI diversity, geographic diversity, and recruitment efforts were related to greater patient diversity. This report constitutes an essential step in benchmarking patient diversity in BMS US oncology trials and enables BMS to understand which initiatives may increase patient diversity. While complete reporting of patient characteristics such as race/ethnicity is critical, identifying diversity improvement tactics with the highest impact is essential. Strategies with the greatest concordance to clinical trial patient diversity should be implemented to make meaningful improvements to the diversity of clinical trial populations.
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Affiliation(s)
- Lorena Kuri
- Bristol Myers Squibb, Princeton, NJ, USA
- Diversity Strategy, Global Clinical Trial Planning & Alliances, Bristol Myers Squibb, Princeton, NJ, USA
| | | | | | | | | | | | | | | | - Angshu Rai
- Bristol Myers Squibb, Princeton, NJ, USA
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4
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Nemala A, Ullah A, Yacur M, Karim NA. Do Current Lung Cancer Clinical Trials Represent All Patient Populations Including Minorities? Clin Lung Cancer 2023; 24:573-580. [PMID: 37574437 DOI: 10.1016/j.cllc.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/23/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023]
Abstract
The under-representation of racial, sexual, and gender minorities in cancer clinical trials has long been a deficit in clinical cancer research. This review aims to survey current literature to determine the participation of minorities in the United States in lung cancer clinical trials and to find educational methods that have been studied and researched in order to improve patient clinical trial enrollment. A literature search of relevant articles published since 2015 was conducted using PubMed and Google Scholar. Clinical trials conducted in the United States from Clinicaltrials.gov were also collected to determine minority patient enrollment in lung cancer clinical trials. The results of the literature search yielded 6 relevant articles about racial minority representation in lung cancer clinical trials and one relevant article about LGBTQ+ minority representation in cancer clinical trials. Collectively, the literature highlighted the under-representation of racial minorities (such as Black, Hispanic, and American Indian) in clinical trials. Many articles showed that disparities in enrollment were less significant for Asian patients with lung cancer. However, many articles did not mention minorities like Middle Eastern/North Africans and failed to mention the lack of distinguishment of South Asian minorities from Pacific Asian minorities. The findings of this literature review support the idea that current lung cancer clinical trials lack representation of minority patient populations in the United States. The inclusion of racial, sexual, and gender diversity in clinical trial patient populations will aid providers in determining appropriate therapeutics and could potentially improve lung cancer outcomes. Future directions for improving diversity in lung cancer clinical trial enrollment include the utilization of various educational tools to increase minority patient participation in trials, the inclusion of detailed demographic data in cancer clinical trial analysis, and the recruitment of providers and research staff from various minorities to conduct cancer clinical trials.
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Affiliation(s)
| | - Asad Ullah
- Department of Pathology, Texas Tech University Health Sciences Center, Lubbock, TX
| | - Melissa Yacur
- Department of Hematology-Oncology, Inova Schar Cancer Institute, University of Virginia, Fairfax, VA
| | - Nagla Abdel Karim
- Department of Hematology-Oncology, Inova Schar Cancer Institute, University of Virginia, Fairfax, VA.
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Brockhoven F, Raphael M, Currier J, Jäderholm C, Mody P, Shannon J, Starling B, Turner-Uaandja H, Pashayan N, Arteaga I. REPRESENT recommendations: improving inclusion and trust in cancer early detection research. Br J Cancer 2023; 129:1195-1208. [PMID: 37689805 PMCID: PMC10575902 DOI: 10.1038/s41416-023-02414-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 08/01/2023] [Accepted: 08/21/2023] [Indexed: 09/11/2023] Open
Abstract
Detecting cancer early is essential to improving cancer outcomes. Minoritized groups remain underrepresented in early detection cancer research, which means that findings and interventions are not generalisable across the population, thus exacerbating disparities in cancer outcomes. In light of these challenges, this paper sets out twelve recommendations to build relations of trust and include minoritized groups in ED cancer research. The Recommendations were formulated by a range of stakeholders at the 2022 REPRESENT consensus-building workshop and are based on empirical data, including a systematic literature review and two ethnographic case studies in the US and the UK. The recommendations focus on: Long-term relationships that build trust; Sharing available resources; Inclusive and accessible communication; Harnessing community expertise; Unique risks and benefits; Compensation and support; Representative samples; Demographic data; Post-research support; Sharing results; Research training; Diversifying research teams. For each recommendation, the paper outlines the rationale, specifications for how different stakeholders may implement it, and advice for best practices. Instead of isolated recruitment, public involvement and engagement activities, the recommendations here aim to advance mutually beneficial and trusting relationships between researchers and research participants embedded in ED cancer research institutions.
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Grants
- EICEDAAP\100011 Cancer Research UK
- Cancer Research UK (CRUK)
- The International Alliance for Cancer Early Detection, an alliance between Cancer Research UK [EICEDAAP\100011], Canary Center at Stanford University, the University of Cambridge, OHSU Knight Cancer Institute, University College London and the University of Manchester.
- This work was supported by the International Alliance for Cancer Early Detection, an alliance between Cancer Research UK [EICEDAAP\100011], Canary Center at Stanford University, the University of Cambridge, OHSU Knight Cancer Institute, University College London and the University of Manchester.
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Affiliation(s)
| | - Maya Raphael
- Department of Social Anthropology, University of Cambridge, Cambridge, UK
| | - Jessica Currier
- Division of Oncological Sciences, Oregon Health & Science University, Portland, OR, USA
| | - Christina Jäderholm
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
| | - Perveez Mody
- Department of Social Anthropology, University of Cambridge, Cambridge, UK
| | - Jackilen Shannon
- Division of Oncological Sciences, Oregon Health & Science University, Portland, OR, USA
| | - Bella Starling
- Vocal, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Nora Pashayan
- Department of Applied Health Research, University College London, London, UK
| | - Ignacia Arteaga
- Department of Social Anthropology, University of Cambridge, Cambridge, UK.
- Early Cancer Institute, University of Cambridge, Cambridge, UK.
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6
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Guerra C, Pressman A, Hurley P, Garrett-Mayer E, Bruinooge SS, Howson A, Kaltenbaugh M, Hanley Williams J, Boehmer L, Bernick LA, Byatt L, Charlot M, Crews J, Fashoyin-Aje L, McCaskill-Stevens W, Merrill J, Nowakowski G, Patel MI, Ramirez A, Zwicker V, Oyer RA, Pierce LJ. Increasing Racial and Ethnic Equity, Diversity, and Inclusion in Cancer Treatment Trials: Evaluation of an ASCO-Association of Community Cancer Centers Site Self-Assessment. JCO Oncol Pract 2023; 19:e581-e588. [PMID: 36630663 PMCID: PMC10101254 DOI: 10.1200/op.22.00560] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/25/2022] [Accepted: 11/29/2022] [Indexed: 01/13/2023] Open
Abstract
Clinical trial participants do not reflect the racial and ethnic diversity of people with cancer. ASCO and the Association of Community Cancer Centers collaborated on a quality improvement study to enhance racial and ethnic equity, diversity, and inclusion (EDI) in cancer clinical trials. The groups conducted a pilot study to examine the feasibility, utility, and face validity of a two-part clinical trial site self-assessment to enable diverse types of research sites in the United States to (1) review internal data to assess racial and ethnic disparities in screening and enrollment and (2) review their policies, programs, procedures to identify opportunities and strategies to improve EDI. Overall, 81% of 62 participating sites were satisfied with the assessment; 82% identified opportunities for improvement; and 63% identified specific strategies and 74% thought the assessment had potential to help their site increase EDI. The assessment increased awareness about performance (82%) and helped identify specific strategies (63%) to increase EDI in trials. Although most sites (65%) were able to provide some data on the number of patients that consented, only two sites were able to provide all requested trial screening, offering, and enrollment data by race and ethnicity. Documenting and evaluating such data are critical steps toward improving EDI and are key to identifying and addressing disparities more broadly. ASCO and Association of Community Cancer Centers will partner with sites to better understand their processes and the feasibility of collecting screening, offering, and enrollment data in systematic and automated ways.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Leigh Boehmer
- Association of Community Cancer Centers, Rockville, MD
| | | | - Leslie Byatt
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | | | | | | | | | | | | | | | | | | | - Randall A. Oyer
- Penn Medicine Lancaster General Health, Lancaster, PA
- Ann B Barshinger Cancer Institute, Lancaster, PA
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7
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Habr D, Corsaro M. Reimagining diversity in multiple myeloma clinical trials. Hematol Oncol 2022; 40:689-694. [PMID: 35391496 PMCID: PMC9790672 DOI: 10.1002/hon.2997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Dany Habr
- Pfizer OncologyPfizer Inc.New York CityNew YorkUSA
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8
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Shim JK, Bentz M, Vasquez E, Jeske M, Saperstein A, Fullerton SM, Foti N, McMahon C, Lee SSJ. Strategies of inclusion: The tradeoffs of pursuing "baked in" diversity through place-based recruitment. Soc Sci Med 2022; 306:115132. [PMID: 35728460 DOI: 10.1016/j.socscimed.2022.115132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/17/2022] [Accepted: 06/10/2022] [Indexed: 10/18/2022]
Abstract
US funding agencies have begun to institutionalize expectations that biomedical studies achieve defined thresholds for diversity among research participants, including in precision medicine research (PMR). In this paper, we examine how practices of recruitment have unfolded in the wake of these diversity mandates. We find that a very common approach to seeking diverse participants leverages understandings of spatial, geographic, and site diversity as proxies and access points for participant diversity. That is, PMR investigators recruit from a diverse sampling of geographic areas, neighborhoods, sites, and institutional settings as both opportunistic but also meaningful ways to "bake in" participant diversity. In this way, logics of geographic and institutional diversity shift the question from who to recruit, to where. However, despite seeing geographic and site diversity as social and scientific 'goods' in the abstract and as key to getting diverse participants, PMR teams told us that working with diverse sites was often difficult in practice due to constraints in funding, time, and personnel, and inadequate research infrastructures and capacity. Thus, the ways in which these geographic and institutional diversity strategies were implemented resulted ultimately in limiting the meaningful inclusion of populations and organizations that had not previously participated in biomedical research and reproduced the inclusion of institutions that are already represented. These prevailing assumptions about and practices of "baked-in" diversity in fact exacerbate and produce other forms of inequity, in research capacity and research representation. These findings underscore how structural inequities in research resources must be addressed for diversity to be achieved in both research sites and research participants.
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Affiliation(s)
- Janet K Shim
- Department of Social and Behavioral Sciences, University of California, San Francisco, USA.
| | - Michael Bentz
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, USA
| | - Emily Vasquez
- Department of Sociology, University of Illinois-Chicago, USA
| | - Melanie Jeske
- Institute on the Formation of Knowledge, University of Chicago, USA
| | | | - Stephanie M Fullerton
- Department of Bioethics & Humanities, School of Medicine, University of Washington, USA
| | - Nicole Foti
- Department of Social and Behavioral Sciences, University of California, San Francisco, USA
| | - Caitlin McMahon
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, USA
| | - Sandra Soo-Jin Lee
- Division of Ethics, Department of Medical Humanities and Ethics, Columbia University, USA
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9
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Arring NM, Aduse-Poku L, Jiagge E, Saylor K, White-Perkins D, Israel B, Walker EM, Hinebaugh A, Harb R, DeWitt J, Molnar M, Wilson-Powers E, Brush BL. A Scoping Review of Strategies to Increase Black Enrollment and Retention in Cancer Clinical Trials. JCO Oncol Pract 2022; 18:614-632. [DOI: 10.1200/op.21.00863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To address health disparities faced by Black patients with cancer, it is critical that researchers conducting cancer clinical trials (CCTs) equitably recruit and retain Black participants, develop strategies toward this aim, and document associated outcomes. This narrative scoping literature review, as part of a larger study, aimed to identify, describe, and categorize strategies and interventions intended to improve the recruitment and retention of Black participants with breast, lung, prostate, colorectal, or multiple myeloma cancer into CCTs. We conducted comprehensive searches in PubMed, Embase, Cochrane Library, PsycInfo, CINAHL, Scopus, and Web of Science with three main concepts: Black persons, neoplasms, and clinical trial recruitment. The search resulted in 1,506 articles, of which 15 met inclusion criteria. Five main categories of recruitment and retention strategies and interventions were identified based on their specific population focus and type of approach: (1) participant identification, (2) provider awareness/resources, (3) focused research staff interventions, (4) patient and community–focused awareness strategies, and (5) participant-directed resources. Thirteen studies had recruitment acceptance rates of over 30%. Eight studies with acceptance rates of ≥ 50% reported implementing ≥ 5 strategies, with an average use of seven strategies across multiple categories. Five studies with acceptance rates ≥ 50% implemented strategies in ≥ 3 categories. Four studies reported retention rates ≥ 74%. Three studies with reported retention rates ≥ 74% used strategies in ≥ 3 categories, and all included strategies aimed at meeting participant needs beyond the study. Our results show that many efforts that aim to increase the recruitment and retention of Black participants into CCTs have great potential, but the most promising strategies use a multiprong approach.
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Affiliation(s)
| | | | | | - Kate Saylor
- University of Michigan Library, Ann Arbor, MI
| | | | - Barbara Israel
- University of Michigan School of Public Health, Ann Arbor, MI
| | | | | | - Rayya Harb
- University of Michigan School of Public Health, Ann Arbor, MI
| | | | - Maxim Molnar
- University of Michigan School of Nursing, Ann Arbor, MI
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10
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Oyer RA, Hurley P, Boehmer L, Bruinooge SS, Levit K, Barrett N, Benson A, Bernick LA, Byatt L, Charlot M, Crews J, DeLeon K, Fashoyin-Aje L, Garrett-Mayer E, Gralow JR, Green S, Guerra CE, Hamroun L, Hardy CM, Hempstead B, Jeames S, Mann M, Matin K, McCaskill-Stevens W, Merrill J, Nowakowski GS, Patel MI, Pressman A, Ramirez AG, Segura J, Segarra-Vasquez B, Hanley Williams J, Williams JE, Winkfield KM, Yang ES, Zwicker V, Pierce LJ. Increasing Racial and Ethnic Diversity in Cancer Clinical Trials: An American Society of Clinical Oncology and Association of Community Cancer Centers Joint Research Statement. J Clin Oncol 2022; 40:2163-2171. [PMID: 35588469 DOI: 10.1200/jco.22.00754] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
A concerted commitment across research stakeholders is necessary to increase equity, diversity, and inclusion (EDI) and address barriers to cancer clinical trial recruitment and participation. Racial and ethnic diversity among trial participants is key to understanding intrinsic and extrinsic factors that may affect patient response to cancer treatments. This ASCO and Association of Community Cancer Centers (ACCC) Research Statement presents specific recommendations and strategies for the research community to improve EDI in cancer clinical trials. There are six overarching recommendations: (1) clinical trials are an integral component of high-quality cancer care, and every person with cancer should have the opportunity to participate; (2) trial sponsors and investigators should design and implement trials with a focus on reducing barriers and enhancing EDI, and work with sites to conduct trials in ways that increase participation of under-represented populations; (3) trial sponsors, researchers, and sites should form long-standing partnerships with patients, patient advocacy groups, and community leaders and groups; (4) anyone designing or conducting trials should complete recurring education, training, and evaluation to demonstrate and maintain cross-cultural competencies, mitigation of bias, effective communication, and a commitment to achieving EDI; (5) research stakeholders should invest in programs and policies that increase EDI in trials and in the research workforce; and (6) research stakeholders should collect and publish aggregate data on racial and ethnic diversity of trial participants when reporting results of trials, programs, and interventions to increase EDI. The recommendations are intended to serve as a guide for the research community to improve participation rates among people from racial and ethnic minority populations historically under-represented in cancer clinical trials. ASCO and ACCC will work at all levels to advance the recommendations in this publication.
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Affiliation(s)
- Randall A Oyer
- Penn Medicine Lancaster General Health Ann B Barshinger Cancer Institute, Lancaster, PA
| | | | - Leigh Boehmer
- Association of Community Cancer Centers, Rockville, MD
| | | | - Kathryn Levit
- American Society of Clinical Oncology, Alexandria, VA
| | - Nadine Barrett
- Duke Clinical and Translational Science Institute, Raleigh, NC
| | - Al Benson
- Northwestern University, Evanston, IL
| | | | - Leslie Byatt
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | | | | | - Kyle DeLeon
- American Cancer Society Cancer Action Network, Washington, DC
| | - Lola Fashoyin-Aje
- US Food and Drug Administration Oncology Center of Excellence, Silver Spring, MD
| | | | | | - Sybil Green
- American Society of Clinical Oncology, Alexandria, VA
| | - Carmen E Guerra
- University of Pennsylvania Raymond and Ruth Perelman School of Medicine, Philadelphia, PA
| | - Leila Hamroun
- ChristianaCare Oncology Patient Advocates for Clinical Trials, Newark, DE
| | - Claudia M Hardy
- University of Alabama at Birmingham O'Neal Comprehensive Cancer Center, Birmingham, AL
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Eddy S Yang
- University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL
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11
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Wieland J, Jordan BL, Jatoi A. Equity. Cancer 2022; 128:2240-2242. [PMID: 35403209 DOI: 10.1002/cncr.34179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Jana Wieland
- Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Barbara L Jordan
- Office of Education Diversity, Equity, and Inclusion, Mayo Clinic, Rochester, Minnesota
| | - Aminah Jatoi
- Department of Oncology, Mayo Clinic, Rochester, Minnesota
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12
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Gross AS, Harry AC, Clifton CS, Pasqua OD. Clinical Trial Diversity: An Opportunity for Improved Insight into the Determinants of Variability in Drug Response. Br J Clin Pharmacol 2022; 88:2700-2717. [PMID: 35088432 PMCID: PMC9306578 DOI: 10.1111/bcp.15242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/22/2021] [Accepted: 01/02/2022] [Indexed: 11/27/2022] Open
Abstract
Although the number of countries participating in pivotal trials submitted to enable drug registration has nearly doubled over the past 25 years, there has not been a substantial increase in the diversity of clinical trial populations. In parallel, our understanding of factors that influence medicine response and variability has continued to evolve. The notion of intrinsic and extrinsic sources of variability has been embedded into different regulatory guidelines, including the recent guideline on the importance of enhancing the diversity of clinical trial populations. In addition to presenting the clinical and scientific reasons for ensuring that clinical trial populations represent the demographics of patient populations, this overview outlines the efforts of regulatory agencies, patient advocacy groups and clinical researchers to attain this goal through strategies to meet representation in recruitment targets and broaden eligibility criteria. Despite these efforts, challenges to participation in clinical trials remain, and certain groups continue to be underrepresented in development programmes. These challenges are amplified when the representativeness of specific groups may vary across countries and regions in a global clinical programme. Whilst enhanced trial diversity is a critical step towards ensuring that results will be representative of patient populations, a concerted effort is required to characterise further the factors influencing interindividual and regional differences in response for global populations. Quantitative clinical pharmacology principles should be applied to allow extrapolation of data across groups or regions as well as provide insight into the effect of patient‐specific characteristics on a medicine's dose rationale and efficacy and safety profiles.
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Affiliation(s)
- Annette S Gross
- Clinical Pharmacology Modelling & Simulation, GlaxoSmithKline R&D, Sydney, Australia.,Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Anya C Harry
- Global Demographics & Diversity, Global Clinical Sciences and Delivery, GlaxoSmithKline R&D, Upper Providence, USA.,Current Address: West Pharmaceutical Services, King of Prussia, USA
| | - Christine S Clifton
- Clinical Pharmacology Modelling & Simulation, GlaxoSmithKline R&D, Sydney, Australia
| | - Oscar Della Pasqua
- Clinical Pharmacology Modelling & Simulation, GlaxoSmithKline R&D, Brentford, United Kingdom.,Clinical Pharmacology & Therapeutics Group, School of Pharmacy - University College London, London, UK
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13
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Patients' Perceptions at Diagnosis: Lung Cancer Discovery and Provider Relationships. Cancer Nurs 2022; 45:397-405. [PMID: 35067577 PMCID: PMC9294071 DOI: 10.1097/ncc.0000000000001050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND In the United States, most lung cancer cases are diagnosed at advanced stages, limiting treatment options and impacting survival. This study presents patients' perspectives on the complexity of factors influencing a lung cancer diagnosis. Lung cancer awareness regarding risks, symptoms, smoking behaviors, family history, and environmental factors can lead to preventative and early detection measures. OBJECTIVE The aim of this study was to explore lung cancer patient perspectives on lung cancer awareness within the context of an earlier study to understand sleep-wake disturbances in adults with non-small cell lung cancer. METHODS A content analysis was used to analyze the original deidentified longitudinal interview data collected from 26 patients diagnosed with lung cancer. RESULTS Of the original 26 participants, 16 were included in this secondary data analysis. The participants were primarily females (n = 10) and Whites (n = 13), with ages ranging between 49 and 83 years. Half of the sample was diagnosed with stage IV lung cancer and most of the sample was on chemotherapy (n = 10). Two key themes were identified: the lung cancer discovery and the patient-physician relationship. CONCLUSIONS Unspecific initial symptoms, lack of knowledge and screening, as well as fear of the diagnosis delayed seeking medical care. Patient-physician relationships were hindered by smoking-associated stigma, inadequate sharing of information, and lack of coordinated, holistic care. Positive communication strategies are critical between patients and providers to meet patients' specific needs. IMPLICATIONS FOR PRACTICE Educational interventions that enhance lung cancer awareness may improve prevention and screening actions, improve timely healthcare intervention, and reduce incidence and mortality.
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14
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Guerard E, Dodge AB, Le-Rademacher JG, Kemeny MM, Ojelabi M, Sedrak MS, Hopkins J, Shahrokni A, Harlos E, Muss H, Cohen HJ, Lafky J, Sloan J, Jatoi A, Hurria A. Electronic Geriatric Assessment: Is It Feasible in a Multi-Institutional Study That Included a Notable Proportion of Older African American Patients? (Alliance A171603). JCO Clin Cancer Inform 2021; 5:435-441. [PMID: 33852323 DOI: 10.1200/cci.20.00163] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This study determined whether an electronic version of the geriatric assessment is feasible in a multi-institutional, diverse setting. METHODS Ten sites within the Alliance for Clinical Trials in Oncology participated. Patients who had active cancer or a history of cancer and were 65 years of age or older were eligible. The geriatric assessment was completed with an electronic data capture system that had been loaded onto iPads. Feasibility was defined a priori as completion in at least 70% of patients either with or without help. To enhance racial diversity, the original sample size was later changed and augmented by 50% with the intention of increasing enrollment of older minority patients. RESULTS A total of one hundred fifty-four patients were registered with a median age of 72 years (range, 65-91 years). Forty-three (28%) identified themselves as African American or Black. One hundred forty-one patients (92%) completed the electronic geriatric assessment. Feasibility was observed across all subgroups, regardless of race, education, performance status, comorbidities, and cognition; 124 patients (81%) completed the geriatric assessment without help. Reasons for not completing the geriatric assessment are as follows: clinic visit did not occur (n = 6), no iPad connection to the Internet (n = 3), patient declined (n = 2), prolonged hospitalization (n = 1), and patient died (n = 1). Reasons for needing help, as reported by study personnel, were as follows: the patient preferred that research personnel ask the questions (n = 9), vision problem (n = 3), lack of comfort with the iPad (n = 2), questions were not clear (n = 1), less proficient in English (n = 1), and challenge in pressing the green button to go to the next question (n = 1). CONCLUSION The electronic geriatric assessment is feasible in a multi-institutional setting that includes a notable proportion of African American or Black patients.
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Affiliation(s)
- Emily Guerard
- University of Wisconsin Hospital and Clinics, Madison, WI
| | - Andrew B Dodge
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | | | | | | | - Mina S Sedrak
- City of Hope Comprehensive Cancer Center, Duarte, CA
| | | | | | | | - Hyman Muss
- University of North Carolina, Chapel Hill, NC
| | | | | | - Jeff Sloan
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | | | - Arti Hurria
- City of Hope Comprehensive Cancer Center, Duarte, CA.,Deceased
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15
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Siddiqui N, Chiu RG, Nunna RS, Glastris G, Mehta AI. Effect of the FDA Safety and Innovation Act on racial and gender diversity in neurosurgical device trials. J Neurosurg 2021; 136:274-281. [PMID: 34171831 DOI: 10.3171/2020.10.jns202155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/22/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The US FDA uses evidence from clinical trials in its determination of safety and utility. However, these trials have often suffered from limited external validity and generalizability due to unrepresentative study populations with respect to clinical patient demographics. Section 907 of the FDA Safety and Innovation Act (FDASIA) of 2012 attempted to address this issue by mandating the reporting of certain study demographics in new device applications. However, no study has been performed on its effectiveness in the participant diversity of neurosurgical device trials. METHODS The FDA premarket approval (PMA) online database was queried for all original neurosurgical device submissions from January 1, 2006, to December 31, 2019. Endpoints of the study included racial and gender demographics of reported effectiveness trials, which were summated for each submission. Chi-square tests were performed on both endpoints for before and after years of FDASIA passage and implementation. RESULTS A total of 33 device approvals were analyzed, with 14 occurring before SIA implementation and 19 after. Most trials (96.97%) reported gender to the FDA, while 66.67% reported race and 63.64% reported ethnicity. Gender breakdown did not change significantly post-SIA (53.30% female, p = 0.884). Racial breakdown was significantly different from the 2010 US Census for all races (p < 0.001) both pre- and post-SIA. Only Native American race was significantly different in terms of representation post-SIA, increasing from 0% to 0.63% (p = 0.0187). There was no significant change in ethnicity. CONCLUSIONS The FDASIA, as currently written, does not appear to have had a significant impact on the racial or gender diversity of neurosurgical device clinical trial populations. This may be due to the noncompulsory nature of its guidance, or a lack of more stringent regulation on the composition of clinical trials themselves.
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Affiliation(s)
- Neha Siddiqui
- 1Carle Illinois College of Medicine, University of Illinois, Champaign; and.,2Department of Neurosurgery, University of Illinois at Chicago, Illinois
| | - Ryan G Chiu
- 2Department of Neurosurgery, University of Illinois at Chicago, Illinois
| | - Ravi S Nunna
- 2Department of Neurosurgery, University of Illinois at Chicago, Illinois
| | - Georgia Glastris
- 2Department of Neurosurgery, University of Illinois at Chicago, Illinois
| | - Ankit I Mehta
- 2Department of Neurosurgery, University of Illinois at Chicago, Illinois
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16
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Habr D, Ferdinand R. Addressing racial/ethnic disparities in cancer clinical trials: Everyone has a role to play. Cancer 2021; 127:3282-3289. [PMID: 33904590 DOI: 10.1002/cncr.33600] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/25/2021] [Accepted: 03/27/2021] [Indexed: 12/12/2022]
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17
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Winkfield KM, Regnante JM, Miller-Sonet E, González ET, Freund KM, Doykos PM. Development of an Actionable Framework to Address Cancer Care Disparities in Medically Underserved Populations in the United States: Expert Roundtable Recommendations. JCO Oncol Pract 2021; 17:e278-e293. [PMID: 33464925 PMCID: PMC8202060 DOI: 10.1200/op.20.00630] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Cancer disparities persist among medically underserved populations despite widespread efforts to address them. We describe the development of a framework for addressing cancer care disparities across the cancer care continuum (CCC), guided by the CCC domains established by the Institute of Medicine/National Academies of Sciences, Engineering, and Medicine (IOM/NAS).
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Affiliation(s)
- Karen M Winkfield
- Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, Nashville, TN
| | | | | | - Evelyn T González
- Fox Chase Cancer Center/Temple University Health System, Philadelphia, PA
| | - Karen M Freund
- Sara Murray Jordan Professor of Medicine, Tufts University School of Medicine, Boston, MA
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18
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Behar-Horenstein L, Warren RC, Setiawan VW, Perkins C, Schmittgen TD. Enhancing African American Participation in Biospecimens: A Case in Point for Pancreatic Cancer. Cancer Epidemiol Biomarkers Prev 2020; 29:10.1158/1538-7755.DISP20-PO-236. [PMID: 34296063 PMCID: PMC8294622 DOI: 10.1158/1538-7755.disp20-po-236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Diseases of the pancreas (i.e. chronic pancreatitis, diabetes, and pancreatic cancer) disproportionally affect the African American community. Challenges associated with engaging the African American community in biospecimen research are longstanding. We surveyed a number of pancreas-related biobanks, and data repositories for African American representation. While some of the biobanks and databases surveyed contain biospecimens and data from African American donors at levels that reflect minority representation among the general population, others do not. A number of factors have historically contributed to reduced participation of the African Americans community in biospecimen donation including medical mistrust, lack of transparency, fear, and a poor knowledge and understanding about the use of biospecimens for research. Suggestions for increasing African American participation in organ and biospecimen donation include educational interventions, particularly in community groups, and providing printed and online recruitment materials to patients, patient advocates, and care partners. Increasing awareness of the many benefits of biospecimen donation among African Americans will positively affect health disparities research into pancreatic cancer and other diseases.
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Affiliation(s)
- Linda Behar-Horenstein
- Colleges of Education, University of Florida, Gainesville, FL, USA
- Florida-California Cancer Research, Education and Engagement (CaRE), Health Equity Center
| | | | - V. Wendy Setiawan
- College of Medicine, University of Southern California, Los Angeles, CA, USA
- Florida-California Cancer Research, Education and Engagement (CaRE), Health Equity Center
| | - Corey Perkins
- Pharmacy, University of Florida, Gainesville, FL, USA
| | - Thomas D. Schmittgen
- Pharmacy, University of Florida, Gainesville, FL, USA
- Florida-California Cancer Research, Education and Engagement (CaRE), Health Equity Center
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19
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Stewart AL, Nápoles AM, Piawah S, Santoyo-Olsson J, Teresi JA. Guidelines for Evaluating the Feasibility of Recruitment in Pilot Studies of Diverse Populations: An Overlooked but Important Component. Ethn Dis 2020; 30:745-754. [PMID: 33250621 PMCID: PMC7683033 DOI: 10.18865/ed.30.s2.745] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background In health disparities research, studies often fall short of their recruitment goals. Conducting a pilot feasibility study of recruitment in which data are collected systematically on recruitment processes can help investigators refine methods for the larger study. However, there are few guidelines for conducting pilot feasibility studies, and recruitment methods are seldom the focus. Feasibility indicators differ from traditional reports of recruitment results by focusing on the extent to which recruitment goals are met. Methods We present an organizing framework for assessing the feasibility of recruitment that includes eight steps, briefly: 1) specify recruitment goals; 2) specify recruitment processes; 3) establish a tracking system for each individual; 4) establish a tracking database for monitoring processes and results; 5) implement recruitment and track each individual's progress; 6) summarize recruitment results; 7) calculate and interpret feasibility measures - were goals met; and 8) if goals were not met, utilize tracking data to modify methods for the larger study. We describe methods within each step, with added details for steps 2-5 (the specific processes). The framework draws from a small literature on recruitment feasibility with a focus on health disparities populations. The guidelines blend well-known methods of recruitment with additional information on calculating feasibility indicators. Conclusions These guidelines provide a first step in thinking systematically about recruitment feasibility, to advance the field of measuring feasibility. Feasibility indicators also can be used to track the effectiveness of innovative recruitment strategies as part of building the science of recruitment, especially in disparities populations.
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Affiliation(s)
- Anita L. Stewart
- Center for Aging in Diverse Communities, Institute for Health & Aging, University of California San Francisco, CA
| | - Anna María Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Sorbarikor Piawah
- Department of Medicine, Division of Hematology/Oncology, University of California San Francisco, CA
| | - Jasmine Santoyo-Olsson
- Department of Medicine, Division of Internal Medicine, University of California San Francisco, and School of Public Health, University of California Berkeley, CA
| | - Jeanne A. Teresi
- Columbia University Stroud Center at New York State Psychiatric Institute and Columbia Center for Interdisciplinary Research on Alzheimer’s Disease Disparities (CIRAD), New York, NY
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