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Anastasi JK, Capili B, Norton M, McMahon DJ, Marder K. Recruitment and retention of clinical trial participants: understanding motivations of patients with chronic pain and other populations. FRONTIERS IN PAIN RESEARCH 2024; 4:1330937. [PMID: 38606348 PMCID: PMC11006977 DOI: 10.3389/fpain.2023.1330937] [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] [Received: 10/31/2023] [Accepted: 12/20/2023] [Indexed: 04/13/2024] Open
Abstract
This paper aims to present and discuss the issues, challenges, and strategies related to recruitment and retention in clinical trials involving participants with chronic pain. The randomized controlled clinical trial (RCT) is widely regarded as the gold standard for evaluating clinical interventions. However, it is crucial to acknowledge and address the challenges associated with recruiting and retaining participants. To prioritize the experience of the study population, targeted outreach strategies and a patient-centric approach are necessary. Researchers should consider incorporating recruitment and retention strategies during the study design phase. Implementing multi-pronged recruitment methods, leveraging relationships with community providers, and involving representatives of the patient population are helpful approaches. Effective communication and maintaining a professional environment are vital for optimizing engagement and supporting the successful execution of clinical trials involving participants with chronic pain.
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Affiliation(s)
- Joyce K. Anastasi
- Division of Special Studies in Symptom Management, New York University, New York, NY, United States
| | - Bernadette Capili
- Heilbrunn Family Center for Research Nursing, The Rockefeller University, New York, NY, United States
| | - Margaret Norton
- Division of Special Studies in Symptom Management, New York University, New York, NY, United States
- Department of Nursing, St. Joseph's University, Brooklyn, NY, United States
| | - Donald J. McMahon
- Division of Special Studies in Symptom Management, New York University, New York, NY, United States
| | - Karen Marder
- Irving Medical Center, Columbia University, New York, NY, United States
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Millar MM, Taft T, Weir CR. Clinical trial recruitment in primary care: exploratory factor analysis of a questionnaire to measure barriers and facilitators to primary care providers' involvement. BMC PRIMARY CARE 2022; 23:311. [PMID: 36463123 PMCID: PMC9719201 DOI: 10.1186/s12875-022-01898-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 11/03/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Recruitment of sufficient participants for clinical trials remains challenging. Primary care is an important avenue for patient recruitment but is underutilized. We developed and pilot tested a questionnaire to measure relevant barriers and facilitators to primary care providers' involvement in recruiting patients for clinical trials. METHODS Prior research informed the development of the questionnaire. The initial instrument was revised using feedback obtained from cognitive interviews. We invited all primary care providers practicing within the University of Utah Health system to complete the revised questionnaire. We used a mixed-mode design to collect paper responses via in-person recruitment and email contacts to collect responses online. Descriptive statistics, exploratory factor analysis, Cronbach's alpha, and multivariable regression analyses were conducted. RESULTS Sixty-seven primary care providers participated in the survey. Exploratory factor analysis suggested retaining five factors, representing the importance of clinical trial recruitment in providers' professional identity, clinic-level interventions to facilitate referral, patient-related barriers, concerns about patient health management, and knowledge gaps. The five factors exhibited good or high internal consistency reliability. Professional identity and clinic-level intervention factors were significant predictors of providers' intention to participate in clinical trial recruitment activities. CONCLUSIONS Results of this exploratory analysis provide preliminary evidence of the internal structure, internal consistency reliability, and predictive validity of the questionnaire to measure factors relevant to primary care providers' involvement in clinical trial recruitment.
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Affiliation(s)
- Morgan M Millar
- Department of Internal Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT, USA.
| | - Teresa Taft
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
| | - Charlene R Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, USA
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Tilley BC, Mainous AG, Amorrortu RP, McKee MD, Smith DW, Li R, DeSantis SM, Vernon SW, Koch G, Ford ME, Diaz V, Alvidrez J. Using increased trust in medical researchers to increase minority recruitment: The RECRUIT cluster randomized clinical trial. Contemp Clin Trials 2021; 109:106519. [PMID: 34333138 PMCID: PMC8665835 DOI: 10.1016/j.cct.2021.106519] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/07/2021] [Accepted: 07/25/2021] [Indexed: 10/20/2022]
Abstract
While extensive literature exists on barriers and strategies to increase minority participation in clinical trials, progress is limited. Few strategies were evaluated in randomized trials. We studied the impact of RECRUIT, a trust-based, cluster randomized minority recruitment trial layered on top of four traditional NIH-funded parent trials (BMT CTN, CABANA, PACES, STEADY-PD III; fifty specialty sites). RECRUIT was conducted from July 2013 through April 2017. Intervention sites implemented trust-based approaches customized to individual sites, promoting relationships between physician-investigators and minority-serving physicians and their minority patients. Control sites implemented only parent trials' recruitment procedures. Adjusting for within-site clustering, we detected no overall intervention effect, odds ratio 1.3 (95% confidence limits 0.7,2.4). Heterogeneity among parent trials may have obscured the effect. Of the four parent trials, three enrolled more minorities in intervention versus control sites. CABANA odds ratio = 4.2 (adjusted 95%CL 1.5,11.3). PACES intervention sites enrolled 63% (10/16) minorities; control sites enrolled one participant in total, a minority, yielding an incalculable odds ratio. STEADY-PD III odds ratio = 2.2 (adjusted 95%CL 0.6,8.5). BMT CTN odds ratio < 1, 0.8 (adjusted 95%CL 0.4,1.8). In conclusion, RECRUIT findings suggest the unique trust-based intervention increased minority recruitment to intervention trials in ¾ of studied trials. Physician-investigators' participation was critical to recruitment success. Lack of commitment to minority recruitment remained a barrier for some physician-investigators, especially in control sites. We recommend prospective physician investigators commit to minority recruitment activities prior to selection as site investigators and trial funding include some compensation for minority recruitment efforts. TRIAL REGISTRATION ClinicalTrials.govNCT01911208.
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Affiliation(s)
- Barbara C Tilley
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health (SPH), Houston, TX, United States of America.
| | - Arch G Mainous
- Department of Health Services Research Management and Policy, University of Florida College of Public Health and Health Professions, Gainesville, FL, United States of America
| | - Rossybelle P Amorrortu
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health (SPH), Houston, TX, United States of America; Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, United States of America
| | - M Diane McKee
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, United States of America; Department of Family Medicine, University of Massachusetts Medical School, Worcester, MA, United States of America
| | - Daniel W Smith
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States of America
| | - Ruosha Li
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health (SPH), Houston, TX, United States of America
| | - Stacia M DeSantis
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health (SPH), Houston, TX, United States of America
| | - Sally W Vernon
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, United States of America
| | - Gary Koch
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
| | - Marvella E Ford
- Hollings Cancer Center, Population Science and Health Disparities, Medical University of South Carolina, Charleston, SC, United States of America
| | - Vanessa Diaz
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC, United States of America
| | - Jennifer Alvidrez
- National Institute on Minority Health and Health Disparities, Bethesda, MD, United States of America
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Bailey M, Anderson S, Hall DA. Parkinson's Disease in African Americans: A Review of the Current Literature. JOURNAL OF PARKINSONS DISEASE 2021; 10:831-841. [PMID: 32417794 PMCID: PMC7458499 DOI: 10.3233/jpd-191823] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Parkinson’s disease (PD) is the second most common neurodegenerative disease, though evidence suggests that this disorder does not affect all racial groups similarly. Research in African Americans, in particular, has been conflicting. Some studies have found similar prevalence rates in African Americans and whites whereas other studies have found much lower prevalence and incidence rates in African Americans. A few studies identify potential factors underlying these discrepancies, including biologic differences as well as disparities in healthcare access. However, African Americans remain underrepresented in research studies, which make understanding the underlying reasons for these differences difficult. The purpose of this paper is to summarize existing research in African Americans with PD, highlight some of the reasons why differences exist in diagnostic rates of PD in this population, and briefly discuss interventions that may need to be made in order to ensure adequate care is provided to these patients.
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Affiliation(s)
- Meagan Bailey
- Rush University Medical Center Department of Neurological Sciences, Chicago, IL, USA
| | - Sharlet Anderson
- Rush University Medical Center Department of Neurological Sciences, Chicago, IL, USA
| | - Deborah A Hall
- Rush University Medical Center Department of Neurological Sciences, Chicago, IL, USA
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Golembiewski EH, Mainous AG, Rahmanian KP, Brumback B, Rooks BJ, Krieger JL, Goodman KW, Moseley RE, Harle CA. An Electronic Tool to Support Patient-Centered Broad Consent: A Multi-Arm Randomized Clinical Trial in Family Medicine. Ann Fam Med 2021; 19:16-23. [PMID: 33431386 PMCID: PMC7800739 DOI: 10.1370/afm.2610] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/27/2020] [Accepted: 06/03/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Patients are frequently asked to share their personal health information. The objective of this study was to compare the effects on patient experiences of 3 electronic consent (e-consent) versions asking patients to share their health records for research. METHODS A multi-arm randomized controlled trial was conducted from November 2017 through November 2018. Adult patients (n = 734) were recruited from 4 family medicine clinics in Florida. Using a tablet computer, participants were randomized to (1) a standard e-consent (standard), (2) an e-consent containing standard information plus hyperlinks to additional interactive details (interactive), or (3) an e-consent containing standard information, interactive hyperlinks, and factual messages about data protections and researcher training (trust-enhanced). Satisfaction (1 to 5), subjective understanding (0 to 100), and other outcomes were measured immediately, at 1 week, and at 6 months. RESULTS A majority of participants (94%) consented to future uses of their health record information for research. No differences in study outcomes between versions were observed at immediate or 1-week follow-up. At 6-month follow-up, compared with the standard e-consent, participants who used the interactive e-consent reported greater satisfaction (B = 0.43; SE = 0.09; P <.001) and subjective understanding (B = 18.04; SE = 2.58; P <.001). At 6-month follow-up, compared with the interactive e-consent, participants who used the trust-enhanced e-consent reported greater satisfaction (B = 0.9; SE = 1.0; P <.001) and subjective understanding (B = 32.2; SE = 2.6, P <.001). CONCLUSIONS Patients who used e-consents with interactive research details and trust-enhancing messages reported higher satisfaction and understanding at 6-month follow-up. Research institutions should consider developing and further validating e-consents that interactively deliver information beyond that required by federal regulations, including facts that may enhance patient trust in research.
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Affiliation(s)
| | - Arch G Mainous
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida.,Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida
| | - Kiarash P Rahmanian
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida
| | - Babette Brumback
- Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Benjamin J Rooks
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida
| | - Janice L Krieger
- Department of Advertising, University of Florida, Gainesville, Florida
| | - Kenneth W Goodman
- Institute for Bioethics and Health Policy, Miller School of Medicine, University of Miami, Miami, Florida
| | - Ray E Moseley
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida
| | - Christopher A Harle
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida
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Warren RC. Clinical Trials Participation Among African Americans and the Ethics of Trust: Leadership Perspectives. JOURNAL OF HEALTHCARE, SCIENCE AND THE HUMANITIES 2020; 10:104-123. [PMID: 36818758 PMCID: PMC9930497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Background Assuring health equity throughout the U.S. continues to challenge the public and private research enterprise. Even with some progress, racial and ethnic health disparities continue, particularly among African Americans. Health equity for African Americans is improbable unless participation in clinical trials is measurably increased. Method To inform efforts to enhance participation, interviews were conducted with three African American leadership groups from across the country to document their perceptions of why the research community is unable to engage African Americans effectively in clinical trials. The results of thirty-five interviews, conducted from three leadership groups, were analyzed and are reported in this article. The leadership groups include health/education, faith, and civic society. Ethical Considerations This research was conducted based upon the ethical protocols of the National Center for Bioethics in Research and Health Care, research ethics, and confidentiality. Results Findings indicate that trustworthiness must precede trust; both are essential in enhancing African American participation in research, especially in less understood clinical trials. Conclusion Respondents agreed that the research community must demonstrate trustworthiness before trust can be established. They also indicated the importance of increasing the number of African American researchers in leadership roles. Also, suggestions were made regarding the need to develop short and long-term positive relationships between the research community and the African American population, at various levels, if increases in participation in clinical trials are expected. With the likely development of new clinical research and the attention to increasing excess deaths among African Americans, there must be representative numbers of African Americans and other underserved populations in leadership roles if health disparities are to be eliminated and health equity is to be achieved.
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Babiker HM, Davis L, Larson K, Placencia C, Swensen C, Tenneti P, Lim M, Cañamar R, Curtis J, Castillo E, Mancuso J, Rensvold D, Martinez S, Macias L, Recio-Boiles A, Chandana SR, Mahadevan D. A Multidisciplinary Evaluation of Barriers to Enrolling Cancer Patients into Early Phase Clinical Trials: Challenges and Patient-centric Recommendations. Expert Opin Investig Drugs 2019; 28:675-686. [PMID: 31327293 DOI: 10.1080/13543784.2019.1646726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: Early phase clinical trials are the first clinical research step to bringing new cancer therapeutics to patients. At this stage, a new drug's safety, dosing, and scheduling profiles are established as the main endpoints. However, excellent responses due to biomarker-guided and immune checkpoint trials in early phase have resulted in direct approvals of new anti-cancer drugs. Despite doubling of the success rate of new drug approvals, many barriers exist to expeditiously bring active new drugs to the clinic. Areas covered: This review covers roles of members of the early phase program and the challenges they face in enrolling advanced cancer patients to trials. Practical solutions are provided from the perspective of the investigators, regulatory, investigational pharmacy, research nurses, clinical research coordinators, budgets, contracts, and data management. Expert opinion: We are witnessing a burgeoning era in drug development with rapid approval of efficacious drugs. This is achieved by a strong collaboration between investigators, academic institutions, pharmaceutical sponsors, scientists, Food and Drug Administration (FDA), and community practices. Herein, we discuss some of the challenges faced by early phase clinical trials programs and discuss methods of improvement.
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Affiliation(s)
- Hani M Babiker
- a Department of Medicine, Division of Hematology-Oncology, University of Arizona Cancer Center, Early Phase Clinical Trials Program , Tucson , AZ , USA
| | - Lisa Davis
- a Department of Medicine, Division of Hematology-Oncology, University of Arizona Cancer Center, Early Phase Clinical Trials Program , Tucson , AZ , USA
| | - Kristian Larson
- a Department of Medicine, Division of Hematology-Oncology, University of Arizona Cancer Center, Early Phase Clinical Trials Program , Tucson , AZ , USA
| | - Crystal Placencia
- a Department of Medicine, Division of Hematology-Oncology, University of Arizona Cancer Center, Early Phase Clinical Trials Program , Tucson , AZ , USA
| | - Connor Swensen
- a Department of Medicine, Division of Hematology-Oncology, University of Arizona Cancer Center, Early Phase Clinical Trials Program , Tucson , AZ , USA
| | - Pavan Tenneti
- b Department of Medicine, Banner University Medical Center Phoenix , Phoenix , AZ , USA
| | - Melissa Lim
- a Department of Medicine, Division of Hematology-Oncology, University of Arizona Cancer Center, Early Phase Clinical Trials Program , Tucson , AZ , USA
| | - Ruth Cañamar
- a Department of Medicine, Division of Hematology-Oncology, University of Arizona Cancer Center, Early Phase Clinical Trials Program , Tucson , AZ , USA
| | - Jacqueline Curtis
- a Department of Medicine, Division of Hematology-Oncology, University of Arizona Cancer Center, Early Phase Clinical Trials Program , Tucson , AZ , USA
| | - Erica Castillo
- a Department of Medicine, Division of Hematology-Oncology, University of Arizona Cancer Center, Early Phase Clinical Trials Program , Tucson , AZ , USA
| | - James Mancuso
- c Department of Immunology, University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Diane Rensvold
- a Department of Medicine, Division of Hematology-Oncology, University of Arizona Cancer Center, Early Phase Clinical Trials Program , Tucson , AZ , USA
| | - Sarah Martinez
- a Department of Medicine, Division of Hematology-Oncology, University of Arizona Cancer Center, Early Phase Clinical Trials Program , Tucson , AZ , USA
| | - Lora Macias
- a Department of Medicine, Division of Hematology-Oncology, University of Arizona Cancer Center, Early Phase Clinical Trials Program , Tucson , AZ , USA
| | - Alejandro Recio-Boiles
- a Department of Medicine, Division of Hematology-Oncology, University of Arizona Cancer Center, Early Phase Clinical Trials Program , Tucson , AZ , USA
| | - Sreenivasa R Chandana
- d Department of Gastrointestinal Medical Oncology, Cancer and Hematology Centers of Western Michigan, Phase I Program, START Midwest , Grand Rapids , MI , USA
| | - Daruka Mahadevan
- a Department of Medicine, Division of Hematology-Oncology, University of Arizona Cancer Center, Early Phase Clinical Trials Program , Tucson , AZ , USA
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Warren R, Shedlin M, Alema-Mensah E, Obasaju C, Augustin Hodge D. Clinical trials participation among African Americans and the ethics of trust: Leadership perspectives. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.jemep.2019.100405] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Griffiths R, Mansell W, Carey TA, Edge D, Emsley R, Tai SJ. Method of levels therapy for first-episode psychosis: rationale, design and baseline data for the feasibility randomised controlled Next Level study. BJPsych Open 2018; 4:339-345. [PMID: 30140445 PMCID: PMC6094182 DOI: 10.1192/bjo.2018.44] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 06/26/2018] [Accepted: 06/29/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Method of levels (MOL) is an innovative transdiagnostic cognitive therapy with potential advantages over existing psychological treatments for psychosis. AIMS The Next Level study is a feasibility randomised controlled trial (RCT) of MOL for people experiencing first-episode psychosis. It aims to determine the suitability of MOL for further testing in a definitive trial (trial registration ISRCTN13359355). METHOD The study uses a parallel group non-masked feasibilityRCT design with two conditions: (a) treatment as usual (TAU) and (b) TAU plus MOL. Participants (n = 36) were recruited from early intervention in psychosis services. Outcome measures are completed at baseline, 10 and 14 months. The primary outcomes are recruitment and retention. RESULTS Participants' demographic and clinical characteristics are presented along with baseline data. CONCLUSIONS Next Level has recruited to target, providing evidence that it is feasible to recruit to a RCT of MOL for first-episode psychosis. DECLARATION OF INTEREST None.
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Affiliation(s)
- Robert Griffiths
- NIHR Clinical Doctoral Research Fellow and Psychological Therapist, School of Psychological Sciences, The University of Manchester and Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Warren Mansell
- Reader in Clinical Psychology, School of Psychological Sciences, The University of Manchester, UK
| | - Timothy A Carey
- Director, Centre for Remote Health, Flinders University, Australia
| | - Dawn Edge
- Senior Lecturer, School of Psychological Sciences, The University of Manchester, UK
| | - Richard Emsley
- Professor of Medical Statistics & Trials Methodology, Biostatistics and Health Informatics Department, Institute of Psychiatry, King's College London, UK
| | - Sara J Tai
- Senior Lecturer in Clinical Psychology, School of Psychological Sciences, The University of Manchester, UK
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Abstract
Enrolling severely burn injured patients into prospective research studies poses specific challenges to investigators. The authors describe their experience of recruiting adults with ≥20% TBSA burns or inhalation injury admitted to a single academic burn unit into observational research with minimally invasive specimen collection. The authors outline iterative changes that they made to their recruitment processes in response to perceived weaknesses leading to delays in enrollment. The primary outcome was the change in days to consent for enrolled patients or cessation of recruitment for nonenrolled patients before and after the interventional modifications. The authors assessed change in overall enrollment as a secondary outcome. Study enrollment was approximately 70% in both 4-month study periods before and after the intervention. Following the intervention, time to consent by surrogate decision maker decreased from a median of 26.5 days (interquartile range [IQR] 14-41) to 3 days (IQR 3-6) (P = .004). Time to initial consent by patient changed from a median of 15 days (IQR 2-30) to 3 days (IQR 2-6) (P = .27). Time to decline for nonenrolled patients decreased from a median of 12 days (IQR 6.5-27) to 1.5 days (IQR 1-3.5) (P = .026). Both the findings of the study and a brief literature review suggest that careful design of the recruitment protocol, increased experience of the study team, and broad time windows for both approach and enrollment improve the efficiency of recruiting critically injured burn patients into research.
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Chhatre S, Jefferson A, Cook R, Meeker CR, Kim JH, Hartz KM, Wong YN, Caruso A, Newman DK, Morales KH, Jayadevappa R. Patient-centered recruitment and retention for a randomized controlled study. Trials 2018; 19:205. [PMID: 29587805 PMCID: PMC5870194 DOI: 10.1186/s13063-018-2578-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 03/09/2018] [Indexed: 11/17/2022] Open
Abstract
Background Recruitment and retention strategies for patient-centered outcomes research are evolving and research on the subject is limited. In this work, we present a conceptual model of patient-centered recruitment and retention, and describe the recruitment and retention activities and related challenges in a patient-centered comparative effectiveness trial. Methods This is a multicenter, longitudinal randomized controlled trial in localized prostate cancer patients. Results We recruited 743 participants from three sites over 15 months period (January 2014 to March 2015), and followed them for 24 months. At site 1, of the 773 eligible participants, 551 (72%) were enrolled. At site 2, 34 participants were eligible and 23 (68%) enrolled. Of the 434 eligible participants at site 3, 169 (39%) enrolled. We observed that strategies related to the concepts of trust (e.g., physician involvement, ensuring protection of information), communication (e.g., brochures and pamphlets in physicians’ offices, continued contact during regular clinic visits and calling/emailing assessment), attitude (e.g., emphasizing the altruistic value of research, positive attitude of providers and research staff), and expectations (e.g., full disclosure of study requirements and time commitment, update letters) facilitated successful patient recruitment and retention. A stakeholders’ advisory board provided important input for the recruitment and retention activities. Active engagement, reminders at the offices, and personalized update letters helped retention during follow-up. Usefulness of telephone recruitment was site specific and, at one site, the time requirement for telephone recruitment was a challenge. Conclusions We have presented multilevel strategies for successful recruitment and retention in a clinical trial using a patient-centered approach. Our strategies were flexible to accommodate site-level requirements. These strategies as well as the challenges can aid recruitment and retention efforts of future large-scale, patient-centered research studies. Trial registration Clinicaltrials.gov, ID: NCT02032550. Registered on 22 November 2013.
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Affiliation(s)
- Sumedha Chhatre
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St. Suite 4051, Philadelphia, PA, 19104, USA.
| | - Ashlie Jefferson
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ratna Cook
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Caitlin R Meeker
- Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Ji Hyun Kim
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Yu-Ning Wong
- Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | - Adele Caruso
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Diane K Newman
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Knashawn H Morales
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ravishankar Jayadevappa
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
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Recruitment of racial and ethnic minorities to clinical trials conducted within specialty clinics: an intervention mapping approach. Trials 2018; 19:115. [PMID: 29454389 PMCID: PMC5816509 DOI: 10.1186/s13063-018-2507-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 01/26/2018] [Indexed: 11/21/2022] Open
Abstract
Background Despite efforts to increase diversity in clinical trials, racial/ethnic minority groups generally remain underrepresented, limiting researchers’ ability to test the efficacy and safety of new interventions across diverse populations. We describe the use of a systematic framework, intervention mapping (IM), to develop an intervention to modify recruitment behaviors of coordinators and specialist investigators with the goal of increasing diversity in trials conducted within specialty clinics. To our knowledge IM has not been used in this setting. Methods The IM framework was used to ensure that the intervention components were guided by health behavior theories and the evidence. The IM steps consisted of (1) conducting a needs assessment, (2) identification of determinants and objectives, (3) selection of theory-informed methods and practical applications, (4) development and creation of program components, (5) development of an adoption and implementation plan, and (6) creation of an evaluation plan. Results The intervention included five educational modules, one in-person and four web-based, plus technical assistance calls to coordinators. Modules addressed the intervention rationale, development of clinic-specific plans to obtain minority-serving physician referrals, physician-centered and patient-centered communication, and patient navigation. The evaluation, a randomized trial, was recently completed in 50 specialty clinics and is under analysis. Conclusions Using IM we developed a recruitment intervention that focused on building relationships with minority-serving physicians to encourage minority patient referrals. IM enhanced our understanding of factors that may influence minority recruitment and helped us integrate strategies from multiple disciplines that were relevant for our audience.
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Tilley BC, Mainous AG, Smith DW, McKee MD, Amorrortu RP, Alvidrez J, Diaz V, Ford ME, Fernandez ME, Hauser RA, Singer C, Landa V, Trevino A, DeSantis SM, Zhang Y, Daniels E, Tabor D, Vernon SW. Design of a cluster-randomized minority recruitment trial: RECRUIT. Clin Trials 2017; 14:286-298. [PMID: 28545336 PMCID: PMC5448312 DOI: 10.1177/1740774517690146] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Racial/ethnic minority groups remain underrepresented in clinical trials. Many strategies to increase minority recruitment focus on minority communities and emphasize common diseases such as hypertension. Scant literature focuses on minority recruitment to trials of less common conditions, often conducted in specialty clinics and dependent on physician referrals. We identified trust/mistrust of specialist physician investigators and institutions conducting medical research and consequent participant reluctance to participate in clinical trials as key-shared barriers across racial/ethnic groups. We developed a trust-based continuous quality improvement intervention to build trust between specialist physician investigators and community minority-serving physicians and ultimately potential trial participants. To avoid the inherent biases of non-randomized studies, we evaluated the intervention in the national Randomized Recruitment Intervention Trial (RECRUIT). This report presents the design of RECRUIT. Specialty clinic follow-up continues through April 2017. METHODS We hypothesized that specialist physician investigators and coordinators trained in the trust-based continuous quality improvement intervention would enroll a greater proportion of minority participants in their specialty clinics than specialist physician investigators in control specialty clinics. Specialty clinic was the unit of randomization. Using continuous quality improvement, the specialist physician investigators and coordinators tailored recruitment approaches to their specialty clinic characteristics and populations. Primary analyses were adjusted for clustering by specialty clinic within parent trial and matching covariates. RESULTS RECRUIT was implemented in four multi-site clinical trials (parent trials) supported by three National Institutes of Health institutes and included 50 associated specialty clinics from these parent trials. Using current data, we have 88% power or greater to detect a 0.15 or greater difference from the currently observed control proportion adjusting for clustering. We detected no differences in baseline matching criteria between intervention and control specialty clinics (all p values > 0.17). CONCLUSION RECRUIT was the first multi-site randomized control trial to examine the effectiveness of a trust-based continuous quality improvement intervention to increase minority recruitment into clinical trials. RECRUIT's innovations included its focus on building trust between specialist investigators and minority-serving physicians, the use of continuous quality improvement to tailor the intervention to each specialty clinic's specific racial/ethnic populations and barriers to minority recruitment, and the use of specialty clinics from more than one parent multi-site trial to increase generalizability. The effectiveness of the RECRUIT intervention will be determined after the completion of trial data collection and planned analyses.
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Affiliation(s)
- Barbara C Tilley
- Department of Biostatistics, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Arch G Mainous
- Department of Health Services Research Management and Policy, University of Florida College of Public Health and Health Professions, Gainesville, FL, USA
| | - Daniel W Smith
- National Crime Victims Research and Treatment Center, Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - M Diane McKee
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Rossybelle P Amorrortu
- Department of Biostatistics, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | | | - Vanessa Diaz
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Marvella E Ford
- Department of Public Health Sciences and Cancer Disparities, Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, USA
| | - Maria E Fernandez
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Robert A Hauser
- Departments of Neurology, Molecular Pharmacology and Physiology, College of Medicine, University of South Florida, Tampa, FL, USA
| | - Carlos Singer
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Veronica Landa
- Department of Biostatistics, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Aron Trevino
- Department of Epidemiology & Biostatistics, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Stacia M DeSantis
- Department of Biostatistics, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Yefei Zhang
- Department of Biostatistics, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Elvan Daniels
- Cancer Control and Prevention, American Cancer Society, Inc., Atlanta, GA, USA
| | | | - Sally W Vernon
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
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Mainous AG. Physicians should declare financial incentives for recruiting minority ethnic patients into clinical trials. BMJ 2014; 348:g2985. [PMID: 24806316 PMCID: PMC4707709 DOI: 10.1136/bmj.g2985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Mistrust may explain why non-white people are under-represented in clinical trials despite apparent willingness. Arch G Mainous III suggests doctors who recruit such patients should
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Affiliation(s)
- Arch G Mainous
- Department of Health Services Research, Management and Policy and Department of Community Health and Family Medicine, University of Florida, PO Box 100195, Gainesville, FL 32610, USA
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15
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Bhatnagar S, Hoberman A, Kearney DH, Shaikh N, Moxey-Mims MM, Chesney RW, Carpenter MA, Greenfield SP, Keren R, Mattoo TK, Mathews R, Gravens-Mueller L, Ivanova A. Development and impact of an intervention to boost recruitment in a multicenter pediatric randomized clinical trial. Clin Pediatr (Phila) 2014; 53:151-7. [PMID: 24151147 PMCID: PMC4086359 DOI: 10.1177/0009922813506961] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Our primary objective was to develop and evaluate an intervention to increase recruitment in a multicenter pediatric randomized clinical trial (RCT). Our secondary objective was to assess the impact beyond 120 days. METHODS The study was conducted at 17 academic centers participating in a pediatric RCT. The intervention consisted of utilizing a recruitment assessment tool at a site visit or teleconference with key site personnel. RESULTS We found a significant increase in the number of individuals enrolled for all 17 sites at 120 days postintervention (mean = 1.12 per site; median = 1 per site; 95% confidence interval = 1-2; P = .04). No significant differences were apparent beyond the first 120 days postintervention. CONCLUSIONS Successful recruitment in RCTs is essential to the quality, generalizability, and cost-effectiveness of clinical research. Implementation of this recruitment intervention may effectively increase recruitment in RCTs. Beyond the first 120 days postintervention, repeated interventions may be required. What is new? Despite general and pediatric-specific challenges to recruitment in RCTs, a paucity of evidence exists on effective recruitment strategies or assessment tools to reliably enhance recruitment. We developed a recruitment intervention for use in RCTs that enables clinical researchers to enhance recruitment.
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Affiliation(s)
- Sonika Bhatnagar
- University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh, Division of General Academic Pediatrics, Pittsburgh, Pennsylvania
| | - Alejandro Hoberman
- University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh, Division of General Academic Pediatrics, Pittsburgh, Pennsylvania
| | - Diana H. Kearney
- University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh, Division of General Academic Pediatrics, Pittsburgh, Pennsylvania
| | - Nader Shaikh
- University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh, Division of General Academic Pediatrics, Pittsburgh, Pennsylvania
| | - Marva M. Moxey-Mims
- NIH/National Institute of Diabetes, Digestive and Kidney Disease, Division of Kidney, Urologic and Hematologic Diseases, Bethesda, Maryland
| | - Russell W. Chesney
- Le Bonheur Children’s Medical Center, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Myra A. Carpenter
- University of North Carolina at Chapel Hill, Department of Biostatistics, Collaborative Studies Coordinating Center, Chapel Hill, North Carolina
| | - Saul P. Greenfield
- Women and Children’s Hospital of Buffalo, Division of Pediatric Urology, Buffalo, New York
| | - Ron Keren
- The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Ranjiv Mathews
- The Johns Hopkins School of Medicine, Children’s Urology Associates, Baltimore, Maryland
| | - Lisa Gravens-Mueller
- University of North Carolina at Chapel Hill, Department of Biostatistics, Collaborative Studies Coordinating Center, Chapel Hill, North Carolina
| | - Anastasia Ivanova
- University of North Carolina at Chapel Hill, Department of Biostatistics, Collaborative Studies Coordinating Center, Chapel Hill, North Carolina
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16
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Tchalla A, Adam C, Gayot C, Cowppli-Bony P, Preux P, Dantoine T. Optimization of the inclusion of Alzheimer's disease patients in international multicenter randomized trials: results of a national survey conducted in memory research centers in france. Dement Geriatr Cogn Dis Extra 2013; 3:417-25. [PMID: 24348503 PMCID: PMC3843923 DOI: 10.1159/000353891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Since 2002, with the creation of Centers of Memory Resources and Research (CMRR), considerable progress has been made in France regarding the administrative and institutional framework within which Alzheimer's disease (AD) is managed. In this study, we explore three approaches that can help optimize the inclusion of patients in clinical trials related to AD. They are as follows: to assess communication concerning clinical trials on AD in French CMRR, to analyze the internal organization of these centers concerning the dynamics of inclusion, and to evaluate screening tools used. METHODS A national, descriptive, cross-sectional survey was conducted in all CMRR in France between May 1 and July 31, 2011, using a self-administered questionnaire. All investigators, subinvestigators and the relevant CMRR personnel were involved. RESULTS A total of 75% of the CMRR participated, and about 30% of the physicians contacted responded positively to the survey. Only 50% reported having communicated with health care professionals at least once in the previous 3 months, and less than 50% had communicated occasionally with the general public. A total of 75% of those surveyed had a research group but only half of the groups were active, 50% of the physicians did not have a consultation time dedicated to study recruitment, and 75% of the respondents had a screening tool in their CMRR but over half of them were not satisfied with it. CONCLUSION This investigation provides a basis for improving the screening of patients by both internal organizational development and adaptation of tools already available. Improvement requires promoting regular communication that is appropriate and targeted to health care professionals, smaller memory centers, associations and the public, and therefore, familiarizing the whole population with clinical research on AD.
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Affiliation(s)
- A.E. Tchalla
- Service de Médecine Interne Gériatrique, Pôle de Personnes Âgées et Soins à Domicile, Centre Hospitalier Universitaire de Limoges, Bordeaux, France
- EA 6310 HAVAE Handicap Autonomie Vieillissement Activité Environnement, Université de Limoges, Bordeaux, France
| | - C. Adam
- Service de Médecine Interne Gériatrique, Pôle de Personnes Âgées et Soins à Domicile, Centre Hospitalier Universitaire de Limoges, Bordeaux, France
| | - C. Gayot
- Service de Médecine Interne Gériatrique, Pôle de Personnes Âgées et Soins à Domicile, Centre Hospitalier Universitaire de Limoges, Bordeaux, France
- EA 6310 HAVAE Handicap Autonomie Vieillissement Activité Environnement, Université de Limoges, Bordeaux, France
| | | | - P.M. Preux
- IFR 145 GEIST, Institut d'Epidémiologie Neurologique et de Neurologie Tropicale, INSERM UMR 1094 NeuroEpidemiologie Tropicale, Université de Limoges, Limoges, Bordeaux, France
| | - T. Dantoine
- Service de Médecine Interne Gériatrique, Pôle de Personnes Âgées et Soins à Domicile, Centre Hospitalier Universitaire de Limoges, Bordeaux, France
- EA 6310 HAVAE Handicap Autonomie Vieillissement Activité Environnement, Université de Limoges, Bordeaux, France
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Leiner M, Peinado J, Villanos MTM, Jimenez P. Assessment Disparities among Pediatric Patients: Advantages of Pictorial Descriptions. Front Pediatr 2013; 1:28. [PMID: 24400274 PMCID: PMC3864193 DOI: 10.3389/fped.2013.00028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 10/02/2013] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marie Leiner
- Department of Pediatrics, Texas Tech University Health Sciences El Paso, TX, USA ; Department of Social Sciences and Administration, Universidad Autonoma de Ciudad Juarez, Ciudad Juarez Chihuahua, Mexico
| | - Jesus Peinado
- Department of Pediatrics, Texas Tech University Health Sciences El Paso, TX, USA
| | | | - Patricia Jimenez
- Department of Social Sciences and Administration, Universidad Autonoma de Ciudad Juarez, Ciudad Juarez Chihuahua, Mexico
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Sherer TB, Chowdhury S, Peabody K, Brooks DW. Overcoming obstacles in Parkinson's disease. Mov Disord 2012; 27:1606-11. [PMID: 23115047 DOI: 10.1002/mds.25260] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 08/28/2012] [Accepted: 09/27/2012] [Indexed: 11/11/2022] Open
Abstract
Improved symptomatic and disease-modifying treatments are needed for Parkinson's disease (PD). Although significant advances have been made in the understanding of PD etiology, the translation of these discoveries into novel transformative therapies has been limited as a result of systemic challenges in PD drug development. Preclinical testing lacks clear standards and prioritization criteria for advancing therapies to the clinic. Clinical testing is marked by expensive, long, and uninformative studies. In parallel to these scientific challenges, funding of late-stage drug development has become increasingly scarce and risk averse. In this context, novel models of collaboration and funding are opening up new avenues for pursuing treatments. This review will discuss the most critical challenges in PD drug development and the innovative approaches being developed to overcome these hurdles.
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Affiliation(s)
- Todd B Sherer
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York 10163-4777, USA.
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Tilley BC, Mainous AG, Elm JJ, Pickelsimer E, Soderstrom LH, Ford ME, Diaz VA, Siminoff LA, Burau K, Smith DW. A randomized recruitment intervention trial in Parkinson's disease to increase participant diversity: early stopping for lack of efficacy. Clin Trials 2012; 9:188-97. [PMID: 22496398 DOI: 10.1177/1740774512436881] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Failure to include participants of diverse race and ethnicity (i.e. those other than European Caucasian, non-Hispanic) in clinical trials impedes the safe development of new therapies given the potential for racial/ethnicity-related variations in treatment response. Increasing diversity is problematic for low prevalence diseases, where most community-based approaches do not reach those with the disease. PURPOSE Increase racial/ethnic diversity of participants in a Parkinson's disease therapeutic trial. METHODS We incorporated a randomized Ancillary Trial into the multisite National Institute of Neurologic Disorders and Stroke Exploratory Trials in Parkinson's Disease Long-Term Study 1. Movement disorders clinics already participating in long-term trial 1 were eligible and were the unit of randomization and analysis. At least 14% of adult residents over age 55 and living within 30 miles of the eligible site were from a diverse population, or there was a near-by zip code with a highly diverse population. Eligible sites also agreed to be randomized. The intervention was designed to increase community physicians' trust in long-term trial 1 investigators and address recruitment barriers in diverse populations. Primary outcomes included percentage of participants from diverse racial/ethnic groups enrolled in long-term trial 1, and qualitative findings from key informant interviews of the Ancillary Trial investigators and coordinators at the end of the trial. RESULTS The Ancillary Trial stopped early for lack of efficacy, conditional power less than 1%. The 17 intervention sites had 12.6% diverse participants compared to 15.6% in 15 control clinics; odds ratio 0.82 (95% confidence interval = 0.32-2.16). In key informant interviews, high enrollers of diverse participants reported more use of existing physician relationships, untargeted community outreach, and extensive efforts to overcome participants' barriers. Low enrollers reported more use of patients in their practices and placed more responsibility for low enrollment on prospective participants. LIMITATIONS The Ancillary Trial included only those with Parkinson's disease. Whether our findings generalize to trials in other low prevalence diseases is unknown. CONCLUSIONS Increasing diversity in Parkinson's disease clinical trials requires new paradigms for trial investigator and coordinator interactions with community physicians and prospective trial participants.
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Affiliation(s)
- Barbara C Tilley
- Division of Biostatistics, The University of Texas School of Public Health at Houston, Houston, TX 77030, USA.
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Aylward A, Castillo A, Parsons R, Kreshka MA, Ferrier S, von Friederichs-Fitzwater M, Graddy K, Koopman C. Recruiting Women with Breast Cancer in Rural Communities for a Community Initiated Clinical Trial: Effective Strategies. Breast J 2012; 18:188-90. [DOI: 10.1111/j.1524-4741.2011.01215.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Holmes DR, Major J, Lyonga DE, Alleyne RS, Clayton SM. Increasing minority patient participation in cancer clinical trials using oncology nurse navigation. Am J Surg 2011; 203:415-22. [PMID: 21996347 DOI: 10.1016/j.amjsurg.2011.02.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Revised: 02/28/2011] [Accepted: 02/28/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Residential distance from an academic or cancer center is a significant barrier to minority patient participation in cancer research. Most cancer clinical trials (CTs) are only accessible at academic and cancer centers, yet most cancer patients receive treatment in their home communities where access to CTs may be limited. Oncology nurse navigation is an innovative approach for increasing minority CT participation by facilitating access to cancer CTs in communities where minority patients live. The purpose of this study was to evaluate the impact of oncology nurse navigation on community-based recruitment of black patients to breast cancer CTs at a major cancer center. METHODS We merged the roles of a traditional oncology research nurse and a professional patient navigator to create a novel health care provider role, the oncology nurse navigator. The primary duties of the oncology nurse navigator were to engage black cancer patients in the offices of their community physicians and to collaborate with community physicians to increase black patient participation in cancer research. The oncology nurse navigator played a key role in all phases of the CT participation process (e.g., screening for eligibility and completion of informed consent and clinical research forms) and guided each patient around barriers in the health care system. The accrual of eligible patients to breast cancer CTs was used to assess the impact of oncology nurse navigation on community-based recruitment of blacks to cancer CTs. RESULTS Between January 2007 and December 2008, a total of 132 black breast cancer patients were screened by a single oncology nurse navigator for eligibility to University of Southern California-sponsored breast cancer CTs. Fifty-nine patients were eligible for CTs, and each was invited to participate in 1 or more CTs for which they were eligible. Fifty-one of 59 eligible black patients (86% of eligible patients) were enrolled to 1 or more research protocols. The estimated cost per enrolled patient was $5,677, nearly half the expected per patient cost of treating patients on CT at an academic or cancer center. CONCLUSIONS Oncology nurse navigation is an effective outreach strategy for increasing black patient participation in cancer research and may be achieved at nearly half the cost of traditional methods of enrolling patients in CTs at cancer centers.
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Affiliation(s)
- Dennis Ricky Holmes
- University of Southern California Kenneth Norris Jr. Comprehensive Cancer Center, Los Angeles, CA 90033, USA.
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Asian women are less likely to express interest in infertility research. Fertil Steril 2010; 94:1249-1253. [DOI: 10.1016/j.fertnstert.2009.08.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Revised: 08/05/2009] [Accepted: 08/05/2009] [Indexed: 11/22/2022]
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Clinical trial recruitment challenges with older adults with cancer. Appl Nurs Res 2009; 23:233-7. [PMID: 21035034 DOI: 10.1016/j.apnr.2008.12.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Revised: 11/11/2008] [Accepted: 12/02/2008] [Indexed: 11/22/2022]
Abstract
Older adults continue to be disproportionately represented in research studies and cancer-related clinical trials. As survival rates for patients with cancer continue to increase, it is critical that we begin to gather data on how to provide the best care to the patient population where cancer is most prevalent. The purpose of this article was to provide an overview of barriers encountered during recruitment to clinical trials of older patients with cancer. Two clinical trials involving older patients with cancer are presented to describe strategies used by the principal investigators to enhance recruitment and enrollment to their clinical research trials. These two exemplars suggest that planning and regular meetings by the research team and transparent communication are essential for successful clinical trial recruitment of older patients with cancer.
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