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Li V, Alibhai SMH, Noel K, Fazelzad R, Haase K, Mariano C, Durbano S, Sattar S, Newton L, Dawe D, Bell JA, Hsu T, Wong ST, Lofters A, Bender JL, Manthorne J, Puts MTE. Access to cancer clinical trials for racialised older adults: an equity-focused rapid scoping review protocol. BMJ Open 2024; 14:e074191. [PMID: 38245013 PMCID: PMC10807002 DOI: 10.1136/bmjopen-2023-074191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 01/09/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND The intersection of race and older age compounds existing health disparities experienced by historically marginalised communities. Therefore, racialised older adults with cancer are more disadvantaged in their access to cancer clinical trials compared with age-matched counterparts. To determine what has already been published in this area, the rapid scoping review question are: what are the barriers, facilitators and potential solutions for enhancing access to cancer clinical trials among racialised older adults? METHODS We will use a rapid scoping review methodology in which we follow the six-step framework of Arksey and O'Malley, including a systematic search of the literature with abstract and full-text screening to be conducted by two independent reviewers, data abstraction by one reviewer and verification by a second reviewer using an Excel data abstraction sheet. Articles focusing on persons aged 18 and over who identify as a racialised person with cancer, that describe therapies/therapeutic interventions/prevention/outcomes related to barriers, facilitators and solutions to enhancing access to and equity in cancer clinical trials will be eligible for inclusion in this rapid scoping review. ETHICS AND DISSEMINATION All data will be extracted from published literature. Hence, ethical approval and patient informed consent are not required. The findings of the scoping review will be submitted for publication in a peer-reviewed journal and presentation at international conferences.
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Affiliation(s)
- Vivian Li
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Shabbir M H Alibhai
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Faculty of Medicine and Dalla Lana School of Public Health and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Rouhi Fazelzad
- Library and Information Services, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Kristin Haase
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Caroline Mariano
- BC Cancer Agency Vancouver Centre, Vancouver, British Columbia, Canada
| | - Sara Durbano
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Schroder Sattar
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Lorelei Newton
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | - David Dawe
- CancerCare Manitoba Research Institute, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Jennifer A Bell
- Clinical and Organizational Ethics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Tina Hsu
- Department of Oncology, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada
| | - Sabrina T Wong
- Division of Intramural Research, National Institute of Nursing Research, Bethesda, Maryland, USA
| | - Aisha Lofters
- Peter Gilgan Centre for Women's Cancers, Women's College Hospital, Toronto, Ontario, Canada
| | - Jacqueline L Bender
- Department of Supportive Care, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
- Dalla Lana School of Public Health and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Martine T E Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Barry D, Steinberg JR, Towner M, Barber EL, Simon M, Roque DR. Enrollment of Racial and Ethnic Minoritized Groups in Gynecologic Oncology Clinical Trials: A Review of the Scope of the Problem, Contributing Factors, and Strategies to Improve Inclusion. Clin Obstet Gynecol 2023; 66:22-35. [PMID: 36657045 PMCID: PMC9869456 DOI: 10.1097/grf.0000000000000765] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Racial inequities are well-documented across the gynecologic oncology care continuum, including the representation of racial and ethnic minoritized groups (REMGs) in gynecologic oncology clinical trials. We specifically reviewed the scope of REMG disparities, contributing factors, and strategies to improve inclusion. We found systematic and progressively worsening under-enrollment of REMGs, particularly of Black and Latinx populations. In addition, race/ethnicity data reporting is poor, yet a prerequisite for accountability to recruitment goals. Trial participation barriers are multifactorial, and successful remediation likely requires multi-level strategies. More rigorous, transparent data on trial participants and effectiveness studies on REMG recruitment strategies are needed to improve enrollment.
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Affiliation(s)
- Danika Barry
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jecca R Steinberg
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mary Towner
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Emma L Barber
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Melissa Simon
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Dario R Roque
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
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Johnson MR, Raitt M, Asghar A, Condon DL, Beck D, Huang GD. Development and implementation of standardized study performance metrics for a VA healthcare system clinical research consortium. Contemp Clin Trials 2021; 108:106505. [PMID: 34265457 DOI: 10.1016/j.cct.2021.106505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/06/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
The cost of conducting clinical trials is continuously increasing and is driven in large part by the time and resources required to activate trials and reach accrual targets. The impact of low enrollment in a clinical trial can negatively affect the validity of study results and delay its generalizability to the broader population. Quality is a multidimensional concept which could relate to the design, conduct, and analysis of a trial, its clinical relevance, protection/safety of study participants, or quality of reporting. Furthermore, the quality of controlled trials is of obvious relevance to systematic reviews and if the "raw material" or "data" is flawed then the conclusions of systematic reviews cannot be trusted. To date, the literature surrounding the establishment of standardized study enrollment and quality metrics to assess site performance in clinical trial consortiums is scarce. The lack of these metrics presents challenges to study site teams, sponsors, and other clinical research enterprise key stakeholders for adequately monitoring and evaluating study site performance as it relates to fulfilling trial enrollment and quality goals. The Department of Veterans Affairs (VA) Cooperative Studies Program (CSP) Network of Dedicated Enrollment Sites (NODES) undertook an effort to determine the feasibility of establishing and implementing standardized study enrollment and quality metrics for a clinical research consortium (NODES) as a tool to evaluate its performance. In this manuscript, we describe the development and implementation of standardized study enrollment and quality metrics to assess site performance across studies in our clinical research consortium.
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Affiliation(s)
| | | | - Aliya Asghar
- VA Long Beach Healthcare System, Long Beach, CA, USA
| | | | | | - Grant D Huang
- Cooperative Studies Program, Office of Research & Development, U.S. Department of Veterans Affairs, Washington, DC, USA
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Lamberti MJ, Smith Z, Henry R, Howe D, Goodwin M, Williams A, Getz K. Benchmarking Patient Recruitment and Retention Practices. Ther Innov Regul Sci 2020; 55:19-32. [PMID: 32548703 DOI: 10.1007/s43441-020-00186-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 06/09/2020] [Indexed: 10/24/2022]
Abstract
Patient recruitment and retention continue to present challenges in conducting clinical trials. The objectives of the study were to benchmark patient recruitment and retention practices across recent global clinical trials from a working group of biopharmaceutical companies and to re-visit the results from an earlier study published 7 years ago. The data collection focused on patient and site enrollment metrics and recruitment and retention tactics used for studies. Analyses were conducted comparing the results from 2012 and 2019. The results indicated that more studies met or exceeded planned enrollment than the previous research and global differences were observed in the present study for site activation rates and target to actual enrollment rates. Since an updated set of recruitment and retention tactics were evaluated in the present study, no comparisons were made to previous data. Researchers suggest further study that would examine usage and effectiveness of specific recruitment and retention tactics across global studies.
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Affiliation(s)
- Mary Jo Lamberti
- Tufts Center for the Study of Drug Development, Tufts University, 75 Kneeland Street, Suite 1100, Boston, MA, 02111, USA.
| | - Zachary Smith
- Tufts Center for the Study of Drug Development, Tufts University, 75 Kneeland Street, Suite 1100, Boston, MA, 02111, USA
| | | | | | | | - Amanda Williams
- Janssen Pharmaceuticals, Pharmaceutical Company of Johnson & Johnson, Titusville, NJ, USA
| | - Kenneth Getz
- Tufts Center for the Study of Drug Development, Tufts University, 75 Kneeland Street, Suite 1100, Boston, MA, 02111, USA
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5
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Lim BT, Butow P, Sze ML, Girgis A, Jefford M, Goldstein D, Costa D. Impact of migrancy on cancer clinical trial participation: Factors associated with approach and consent in Australian-born versus migrant groups. Asia Pac J Clin Oncol 2020; 16:115-122. [PMID: 31957344 DOI: 10.1111/ajco.13290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 10/26/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND/AIMS This study compared rates of clinical trial participation and perceived adequacy of information provided prior to consent in migrant and Australian-born cancer patients, and explored factors associated with being approached and agreeing to participate. METHODS We utilized data from a larger cross-sectional survey assessing disparities in patient-reported outcomes in Chinese, Arabic, or Greek migrant versus English-speaking Australian-born cancer patients. Participants completed a questionnaire eliciting demographic and disease details, communication challenges, whether invited and consented to a clinical trial, and if so, adequacy of information received. RESULTS A total of 566 migrants (142 Arabic, 251 Chinese, and 173 Greek) and 270 English-speaking Australian-born patients participated. Overall, 25% were approached to participate in clinical trials, and of these, 74% consented. Migrants were significantly less likely to consent if asked to participate in clinical trials (P = .009), and fewer migrants (67.2%) reported receiving sufficient information prior to deciding on trial participation (82.1%; P = .04). Perceived understanding of the health system (odds ratio [OR] = 0.71), confidence in speaking (OR = 0.75), ability to understand English (OR = 0.80), and communicate with doctors in English (OR = 0.81) were significantly related to patients' likelihood of being approached to participate in clinical trials. Perceived understanding of the health system (OR = 0.66) was significantly associated with patients agreeing to take part in cancer clinical trials. CONCLUSIONS Our findings identified that barriers to migrants' self-reported participation in clinical trials include perceived lack of understanding of the health system and low English proficiency. Strategies that address these barriers are needed to increase migrant patients' participation in cancer clinical trials.
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Affiliation(s)
- Bee Teng Lim
- The Psycho-oncology Co-operative Research Group, University of Sydney, Sydney, New South Wales, Australia
| | - Phyllis Butow
- The Psycho-oncology Co-operative Research Group, University of Sydney, Sydney, New South Wales, Australia
| | - Ming Lo Sze
- The Psycho-oncology Co-operative Research Group, University of Sydney, Sydney, New South Wales, Australia
| | - Afaf Girgis
- Translational Cancer Research Unit, Ingham Institute for Applied Medical Research, University of New South Wales, Liverpool, New South Wales, Australia
| | - Michael Jefford
- Department of Medical Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - David Goldstein
- Department of Medical Oncology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Daniel Costa
- The Psycho-oncology Co-operative Research Group, University of Sydney, Sydney, New South Wales, Australia
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McElfish PA, Su LJ, Lee JY, Runnells G, Henry-Tillman R, Kadlubar SA. Mobile Mammography Screening as an Opportunity to Increase Access of Rural Women to Breast Cancer Research Studies. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2019; 13:1178223419876296. [PMID: 31579384 PMCID: PMC6757489 DOI: 10.1177/1178223419876296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 08/26/2019] [Indexed: 12/25/2022]
Abstract
Objectives Rural women are underrepresented in cancer research. We hypothesized that providing access to a research study to rural, medically underserved women who were receiving their breast cancer screening using a mobile mammography unit would increase the representation of rural women in a cancer cohort study. Design This study is a cross-sectional study using a cohort of women who have been recruited to a breast cancer study in Arkansas. Setting Recruiters accompanied a mobile mammography unit, the MammoVan, to implement a novel method for reaching and recruiting underrepresented rural Arkansas women into the study. Participants include 5850 women recruited from 2010 through 2012 as part of the Arkansas Rural Community Health (ARCH) study. Results Participants recruited during their mammography screening on the MammoVan tended to be more rural, less educated, and more likely to be non-Hispanic than those recruited in other venues. A significant difference was not noted for race or age. Conclusion Collaboration with the MammoVan greatly aided the recruitment of rural participants. These strategies can facilitate the representation of this historically underserved and understudied rural population in future research studies.
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Affiliation(s)
- Pearl A McElfish
- Department of Internal Medicine, College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - L Joseph Su
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeanette Y Lee
- Department of Biostatistics, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Gail Runnells
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ronda Henry-Tillman
- Department of Surgery, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Susan A Kadlubar
- Division of Medical Genetics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Liljas AEM, Walters K, Jovicic A, Iliffe S, Manthorpe J, Goodman C, Kharicha K. Engaging 'hard to reach' groups in health promotion: the views of older people and professionals from a qualitative study in England. BMC Public Health 2019; 19:629. [PMID: 31122239 PMCID: PMC6533740 DOI: 10.1186/s12889-019-6911-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 04/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older people living in deprived areas, from black and minority ethnic groups (BME) or aged over 85 years (oldest old) are recognised as 'hard to reach'. Engaging these groups in health promotion is of particular importance when seeking to target those who may benefit the most and to reduce health inequalities. This study aimed to explore what influences them practicing health promotion and elicit the views of cross-sector professionals with experiences of working with 'hard to reach' older people, to help inform best practice on engagement. METHODS 'Hard to reach' older people were recruited through primary care by approaching those not attending for preventative healthcare, and via day centres. Nineteen participated in an interview (n = 15) or focus group (n = 4); including some overlaps: 17 were from a deprived area, 12 from BME groups, and five were oldest old. Cross-sector health promotion professionals across England with experience of health promotion with older people were identified through online searches and snowball sampling. A total of 31 of these 44 professionals completed an online survey including open questions on barriers and facilitators to uptake in these groups. Thematic analysis was used to develop a framework of higher and lower level themes. Interpretations were discussed and agreed within the team. RESULTS Older people's motivation to stay healthy and independent reflected their everyday behaviour including practicing activities to feel or stay well, level of social engagement, and enthusiasm for and belief in health promotion. All of the oldest old reported trying to live healthily, often facilitated by others, yet sometimes being restricted due to poor health. Most older people from BME groups reported a strong wish to remain independent which was often positively influenced by their social network. Older people living in deprived areas reported reluctance to undertake health promotion activities, conveyed apathy and reported little social interaction. Cross-sector health professionals consistently reported similar themes as the older people, reinforcing the views of the older people through examples. CONCLUSIONS The study shows some shared themes across the three 'hard-to-reach' groups but also some distinct differences, suggesting that a carefully outlined strategy should be considered to reach successfully the group targeted.
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Affiliation(s)
- Ann E M Liljas
- Primary Care and Population Health, University College London, London, UK
| | - Kate Walters
- Primary Care and Population Health, University College London, London, UK
| | - Ana Jovicic
- Primary Care and Population Health, University College London, London, UK
| | - Steve Iliffe
- Primary Care and Population Health, University College London, London, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, London, UK
| | - Claire Goodman
- Health and Social Work, University of Hertfordshire, Hatfield, UK
| | - Kalpa Kharicha
- Primary Care and Population Health, University College London, London, UK.
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Skinner JS, Fair AM, Holman AS, Boyer AP, Wilkins CH. The Impact of an Educational Video on Clinical Trial Enrollment and Knowledge in Ethnic Minorities: A Randomized Control Trial. Front Public Health 2019; 7:104. [PMID: 31106188 PMCID: PMC6498183 DOI: 10.3389/fpubh.2019.00104] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/10/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: Innovative methods to increase awareness about clinical trials and address barriers associated with low participation among racial/ethnic minorities are desperately needed. African Americans comprise 5% of all clinical trial participants, and Hispanics make up 1%. Use of multimedia educational material has shown promise as an effective strategy to increase minority clinical trial enrollment. However, this approach has not been broadly implemented. We tested the effect of a video educational program on clinical trial knowledge and enrollment in a sample of oncology outpatients. Methods: A randomized controlled trial was conducted with 63 oncology patients without previous history of clinical trial participation. Participants were randomly assigned to the intervention, to watch a clinical trial educational video in the office, or to the control group which did not receive in-office education. The Clinical Trial Knowledge survey was administered before the intervention and 1 week after the intervention. Participation in clinical trials was assessed 1-year post study participation. Results for white participants and ethnic minorities were compared. Ethnicity was self-reported through the electronic health record and confirmed by self-reporting on questionnaire. Results: Sixty-three participants were recruited in this study. At 1-year follow-up, 3 participants enrolled in clinical trials in the study group which had received office-based video intervention and 2 participants enrolled in the control group (Z = 0.39, p = 0.69). These results were not statistically significant. Impact of the intervention by ethnicity could not be assessed due to low total clinical trial enrollment. The video intervention did not change knowledge, attitudes, or barriers as measured by the Clinical Trial Knowledge Survey. Minority participants did report significantly more negative beliefs and barriers to participation than white participants. Conclusions: Increasing awareness and knowledge about clinical trials in underrepresented communities is an important step to providing opportunities for participation. Future studies should focus on how to address the negative expectations of clinical trials and the greater information needs in minority populations. Tailored or personalized messaging may address negative perceptions of clinical trial participation.
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Affiliation(s)
- Jeannine S Skinner
- Interdisciplinary Gerontology Program, Department of Psychological Sciences, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Alecia M Fair
- Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Alexis S Holman
- Sarah Cannon Research Institute, Sarah Cannon, Nashville, TN, United States
| | - Alaina P Boyer
- National Health Care for the Homeless Council, Nashville, TN, United States
| | - Consuelo H Wilkins
- Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Medicine, Meharry Medical College, Nashville, TN, United States
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Mueller J, Davies A, Jay C, Harper S, Blackhall F, Summers Y, Harle A, Todd C. Developing and testing a web-based intervention to encourage early help-seeking in people with symptoms associated with lung cancer. Br J Health Psychol 2019; 24:31-65. [PMID: 29999214 PMCID: PMC6492236 DOI: 10.1111/bjhp.12325] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/05/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To detail the development method used to produce an online, tailored, theory-based, user-centred intervention to encourage help-seeking for potential lung cancer symptoms. DESIGN Intervention development was structured around the person-based approach. The feasibility study involved a randomized controlled trial design. METHODS Intervention development drew on qualitative inquiries, the Theory of Planned Behaviour (TPB), and identifying concrete mechanisms of change to implement in the intervention (Behaviour Change Techniques). The final intervention involved two key features: (1) tailoring and (2) 'TPB components' to target beliefs about help-seeking. In an online feasibility study, we recruited people reporting potential lung cancer symptoms using mailing lists, social media, websites, and Google AdWords. Participants were randomized to the intervention, a tailored comparison group (CG) without TPB-components, an untailored CG with TPB components, or a CG with neither. Following treatment, participants clicked a button to indicate whether they wished to make an appointment and completed a TPB questionnaire. RESULTS A total of 130 participants reporting relevant symptoms were recruited (24% of website visitors). Participants in the intervention group reported higher intention to seek help than those who received tailored information without TPB components (p = .03). User comments indicate more support is needed for people who sought help for symptoms, but felt dismissed. CONCLUSIONS The potential for differential dropout in online randomized trials requires careful consideration. Future help-seeking interventions should provide support for those who have previously felt dismissed by health professionals. The feasibility study provides some evidence that our 'TPB components' were effective, but validation in a powered trial is necessary. Statement of contribution What is already known on this subject? People with lung cancer often delay presenting symptoms to health services. Some patients (or their family/friends) look up symptoms online before their diagnosis, to decide whether they should see a doctor. Interventions are needed to ensure people can find useful information online that will encourage them to seek help for relevant symptoms. What does this study add? Theory-mapping and user involvement facilitated systematic intervention development. Lung cancer help-seeking interventions should address salient beliefs and personal relevance. The potential for differential dropout in online randomized trials requires careful consideration.
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Affiliation(s)
- Julia Mueller
- School of Health SciencesUniversity of ManchesterUK
- Manchester Academic Health Science CentreUK
- School of Computer ScienceUniversity of ManchesterUK
| | - Alan Davies
- School of Computer ScienceUniversity of ManchesterUK
| | - Caroline Jay
- School of Computer ScienceUniversity of ManchesterUK
| | - Simon Harper
- School of Computer ScienceUniversity of ManchesterUK
| | - Fiona Blackhall
- Manchester Academic Health Science CentreUK
- Department of Medical OncologyThe Christie NHS Foundation TrustManchesterUK
- Division of Molecular and Clinical Cancer SciencesUniversity of ManchesterUK
| | - Yvonne Summers
- Manchester Academic Health Science CentreUK
- Department of Medical OncologyThe Christie NHS Foundation TrustManchesterUK
| | - Amelie Harle
- Department of Medical OncologyPoole Hospital NHS Foundation TrustPooleUK
| | - Chris Todd
- School of Health SciencesUniversity of ManchesterUK
- Manchester Academic Health Science CentreUK
- Manchester University Foundation NHS TrustUK
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10
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Kenerson D, Fadeyi S, Liu J, Weriwoh M, Beard K, Hargreaves MK. Processes in Increasing Participation of African American Women in Cancer Prevention Trials: Development and Pretesting of an Audio-Card. JOURNAL OF HEALTH COMMUNICATION 2017; 22:933-941. [PMID: 29131708 DOI: 10.1080/10810730.2017.1382613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The enrollment of African American women into cancer prevention trials (CPTs) continues to be low despite their higher cancer mortality rates. Clinical trials are vital to the discovery of new prevention, diagnostic, and treatment methods that improve cancer outcomes. This study addressed attitudes and beliefs associated with the sub optimal participation of African American women in CPTs through the development and pretesting of an educational tool. The use of community-engaged research (CER) in the formative phase of this study was the basis for developing an audio-card. Cultural and linguistic elements were incorporated into the tool's audio and written messages, and visual images highlighted the importance of CPT participation among African American women. The CPT beliefs and behavioral intent of 30 African American women who received information from the audio-card were compared with 30 controls. Findings indicated statistically significant differences at posttest between the control and treatment groups in personal value (p = .03), social influence (p = .03), and personal barriers (p = .0001); personal barriers in the pretest group also demonstrated significant differences (p = .009). Consideration of cultural context and language needs of populations are vital to the development and design of effective health promoting tools.
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Affiliation(s)
- Donna Kenerson
- a College of Health Sciences , Tennessee State University , Nashville , Tennessee , USA
| | - Saudat Fadeyi
- b Department of Internal Medicine , Meharry Medical College , Nashville , Tennessee , USA
| | - Jianguo Liu
- b Department of Internal Medicine , Meharry Medical College , Nashville , Tennessee , USA
| | - Mirabel Weriwoh
- b Department of Internal Medicine , Meharry Medical College , Nashville , Tennessee , USA
| | - Katina Beard
- c Matthew Walker Community Health Center , Nashville , Tennessee , USA
| | - Margaret K Hargreaves
- b Department of Internal Medicine , Meharry Medical College , Nashville , Tennessee , USA
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11
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Frierson GM, Pinto BM, Denman DC, Leon PA, Jaffe AD. Bridging the Gap: Racial concordance as a strategy to increase African American participation in breast cancer research. J Health Psychol 2017; 24:1548-1561. [DOI: 10.1177/1359105317740736] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Lack of African American females in breast cancer research has been receiving substantial attention. This study seeks to identify research perceptions and motivating factors needed to increase racial/ethnic minority participation in breast cancer research. A total of 57 African American women (Σ = 47.8 years), from Rhode Island and Texas, completed a questionnaire and focus group. While many participants were not breast cancer survivors, they reported knowledge of their racial group’s risk for breast cancer. One major finding that could be seen as both a facilitator and barrier is racial concordance between participant and researcher. Cultural sensitivity and trust building is recommended to increase minority participation.
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12
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Thomson TL, Nemeth JM, Peng J, Lu B, Ferketich AK, Paskett ED, Wewers ME. Address-Based Sampling for Recruiting Rural Subpopulations: A 2-Phase, Multimode Approach. J Rural Health 2017; 34:193-201. [PMID: 28685888 DOI: 10.1111/jrh.12249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 04/20/2017] [Accepted: 04/21/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE This article describes recruitment of a subpopulation of women in a rural area, extending an existing method of a 2-phase address-based sampling protocol to include a mixed-mode approach. METHODS Phase 1 included a household enumeration questionnaire mailed to randomly selected households (n = 1,950) in 3 Ohio Appalachian counties to identify members of the eligible subgroup. The second phase of recruitment involved contacting 1 randomly selected eligible woman enumerated by each household, based on return of the questionnaire. These women (n = 599) were invited by field interviewers to participate in a one-time in-person health survey. FINDINGS Of the women invited to participate, a total of 408 completed the interview. Based on American Association for Public Opinion Research Response Rate 1 calculations, the response rates were 44.4% and 70.3% for phases 1 and 2, respectively. Response rates in this study were encouraging, especially for the second phase in-person interview. CONCLUSION We discuss implications for future research using a mixed-mode approach in this subpopulation.
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Affiliation(s)
- Tiffany L Thomson
- Division of Health Behavior and Health Promotion, Ohio State University College of Public Health, Columbus, Ohio
| | - Julianna M Nemeth
- Division of Health Behavior and Health Promotion, Ohio State University College of Public Health, Columbus, Ohio
| | - Juan Peng
- Center for Biostatistics, Ohio State University College of Medicine, Columbus, Ohio
| | - Bo Lu
- Division of Biostatistics, Ohio State University College of Public Health, Columbus, Ohio
| | - Amy K Ferketich
- Division of Epidemiology, Ohio State University College of Public Health, Columbus, Ohio
| | - Electra D Paskett
- Division of Cancer Prevention and Control, Department of Internal Medicine, Ohio State University College of Medicine, Columbus, Ohio
| | - Mary Ellen Wewers
- Division of Health Behavior and Health Promotion, Ohio State University College of Public Health, Columbus, Ohio
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Liljas AEM, Walters K, Jovicic A, Iliffe S, Manthorpe J, Goodman C, Kharicha K. Strategies to improve engagement of 'hard to reach' older people in research on health promotion: a systematic review. BMC Public Health 2017; 17:349. [PMID: 28431552 PMCID: PMC5399821 DOI: 10.1186/s12889-017-4241-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 04/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This systematic review aimed to identify facilitators, barriers and strategies for engaging 'hard to reach' older people in research on health promotion; the oldest old (≥80 years), older people from black and minority ethnic groups (BME) and older people living in deprived areas. METHODS Eight databases were searched to identify eligible studies using quantitative, qualitative, and mixed research methods. Using elements of narrative synthesis, engagement strategies, and reported facilitators and barriers were identified, tabulated and analysed thematically for each of the three groups of older people. RESULTS Twenty-three studies (3 with oldest-old, 16 with BME older people, 2 within deprived areas, 1 with both oldest-old and BME, 1 with both BME and deprived areas) were included. Methods included 10 quantitative studies (of which 1 was an RCT), 12 qualitative studies and one mixed-methods study. Facilitators for engaging the oldest old included gaining family support and having flexible sessions. Facilitators for BME groups included building trust through known professionals/community leaders, targeting personal interests, and addressing ethnic and cultural characteristics. Among older people in deprived areas, facilitators for engagement included encouragement by peers and providing refreshments. Across all groups, barriers for engagement were deteriorating health, having other priorities and lack of transport/inaccessibility. Feeling too tired and lacking support from family members were additional barriers for the oldest old. Similarly, feeling too tired and too old to participate in research on health promotion were reported by BME groups. Barriers for BME groups included lack of motivation and self-confidence, and cultural and language differences. Barriers identified in deprived areas included use of written recruitment materials. Strategies to successfully engage with the oldest old included home visits and professionals securing consent if needed. Strategies to engage older people from BME groups included developing community connections and organising social group sessions. Strategies to engage with older people in deprived areas included flexibility in timing and location of interventions. CONCLUSIONS This review identified facilitators, barriers and strategies for engaging 'hard to reach' older people in health promotion but research has been mainly descriptive and there was no high quality evidence on the effectiveness of different approaches.
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Affiliation(s)
- Ann E. M. Liljas
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Kate Walters
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Ana Jovicic
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Steve Iliffe
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King’s College London, London, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care (CRIPACC), University of Hertfordshire, Hatfield, UK
| | - Kalpa Kharicha
- Research Department of Primary Care and Population Health, University College London, London, UK
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Hurd TC, Kaplan CD, Cook ED, Chilton JA, Lytton JS, Hawk ET, Jones LA. Building trust and diversity in patient-centered oncology clinical trials: An integrated model. Clin Trials 2017; 14:170-179. [PMID: 28166647 DOI: 10.1177/1740774516688860] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/AIMS Trust is the cornerstone of clinical trial recruitment and retention. Efforts to decrease barriers and increase clinical trial participation among diverse populations have yielded modest results. There is an urgent need to better understand the complex interactions between trust and clinical trial participation. The process of trust-building has been a focus of intense research in the business community. Yet, little has been published about trust in oncology clinical trials or the process of building trust in clinical trials. Both clinical trials and business share common dimensions. Business strategies for building trust may be transferable to the clinical trial setting. This study was conducted to understand and utilize contemporary thinking about building trust to develop an Integrated Model of Trust that incorporates both clinical and business perspectives. METHODS A key word-directed literature search of the PubMed, Medline, Cochrane, and Google Search databases for entries dated between 1 January 1985 and 1 September 2015 was conducted to obtain information from which to develop an Integrated Model of Trust. RESULTS Successful trial participation requires both participants and clinical trial team members to build distinctly different types of interpersonal trust to effect recruitment and retention. They are built under conditions of significant emotional stress and time constraints among people who do not know each other and have never worked together before. Swift Trust and Traditional Trust are sequentially built during the clinical trial process. Swift trust operates during the recruitment and very early active treatment phases of the clinical trial process. Traditional trust is built over time and operates during the active treatment and surveillance stages of clinical trials. The Psychological Contract frames the participants' and clinical trial team members' interpersonal trust relationship. The "terms" of interpersonal trust are negotiated through the psychological contract. Contract renegotiation occurs in response to cyclical changes within the trust relationship throughout trial participation. CONCLUSION The Integrated Model of Trust offers a novel framework to interrogate the process by which diverse populations and clinical trial teams build trust. To our knowledge, this is the first model of trust-building in clinical trials that frames trust development through integrated clinical and business perspectives. By focusing on the process, rather than outcomes of trust-building diverse trial participants, clinical trials teams, participants, and cancer centers may be able to better understand, measure, and manage their trust relationships in real time. Ultimately, this may foster increased recruitment and retention of diverse populations to clinical trials.
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Affiliation(s)
- Thelma C Hurd
- 1 Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Charles D Kaplan
- 2 Haimovitch Center for Science in the Human Services, University of Southern California, Los Angeles, CA, USA
| | - Elise D Cook
- 3 Division of Cancer Prevention & Population Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Janice A Chilton
- 4 Department of Pharmacy, Health Sciences and Health Care Administration, Texas Southern University, Houston, TX, USA
| | - Jay S Lytton
- 2 Haimovitch Center for Science in the Human Services, University of Southern California, Los Angeles, CA, USA
| | - Ernest T Hawk
- 3 Division of Cancer Prevention & Population Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lovell A Jones
- 5 Department of Life Sciences, College of Science and Engineering, Texas A&M University-Corpus Christi, Corpus Christi, TX, USA
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Haley SJ, Southwick LE, Parikh NS, Rivera J, Farrar-Edwards D, Boden-Albala B. Barriers and Strategies for Recruitment of Racial and Ethnic Minorities: Perspectives from Neurological Clinical Research Coordinators. J Racial Ethn Health Disparities 2017; 4:1225-1236. [PMID: 28176157 DOI: 10.1007/s40615-016-0332-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/14/2016] [Accepted: 12/23/2016] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Randomized controlled trials (RCTs) are the gold standard within evidence-based research. Low participant accrual rates, especially of underrepresented groups (e.g., racial-ethnic minorities), may jeopardize clinical studies' viability and strength of findings. Research has begun to unweave clinical trial mechanics, including the roles of clinical research coordinators, to improve trial participation rates. METHODS Two semi-structured focus groups were conducted with a purposive sample of 29 clinical research coordinators (CRCs) at consecutive international stroke conferences in 2013 and 2014 to gain in-depth understanding of coordinator-level barriers to racial-ethnic minority recruitment and retention into neurological trials. Coded transcripts were used to create themes to define concepts, identify associations, summarize findings, and posit explanations. RESULTS Barriers related to translation, literacy, family composition, and severity of medical diagnosis were identified. Potential strategies included a focus on developing personal relationships with patients, community and patient education, centralized clinical trial administrative systems, and competency focused training and education for CRCs. CONCLUSION Patient level barriers to clinical trial recruitment are well documented. Less is known about barriers facing CRCs. Further identification of how and when barriers manifest and the effectiveness of strategies to improve CRCs recruitment efforts is warranted.
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Affiliation(s)
- Sean J Haley
- CUNY School of Public Health and Health Policy, City University of New York, 55 West 125th St., New York, NY, 10027, USA.
| | - Lauren E Southwick
- Division of Social Epidemiology, College of Global Public Health, New York University, 41 East 11th St, 7th Floor, New York, NY, USA
| | - Nina S Parikh
- Division of Social Epidemiology, College of Global Public Health, New York University, 41 East 11th St, 7th Floor, New York, NY, USA
| | - Jazmin Rivera
- Division of Social Epidemiology, College of Global Public Health, New York University, 41 East 11th St, 7th Floor, New York, NY, USA
| | - Dorothy Farrar-Edwards
- Department of Kinesiology, University of Wisconsin-Madison, 2176 Medical Sciences Center, 1300 University Avenue, Madison, WI, USA
| | - Bernadette Boden-Albala
- Division of Social Epidemiology, College of Global Public Health, New York University, 41 East 11th St, 7th Floor, New York, NY, USA
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A Model of Cancer Clinical Trial Decision-making Informed by African-American Cancer Patients. J Racial Ethn Health Disparities 2016; 2:192-9. [PMID: 25960945 DOI: 10.1007/s40615-014-0063-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Clinical trials are critical to advancing cancer treatment. Minority populations are underrepresented among trial participants, and there is limited understanding of their decision-making process and key determinants of decision outcomes regarding trial participation. METHODS To understand research decision-making among clinical trial-eligible African-American cancer patients at Johns Hopkins, we conducted seven focus groups (n=32) with trial-offered patients ≥ 18 years diagnosed with lung, breast, prostate, or colorectal cancer ≤ 5 years. Three "acceptor" and four "decliner" focus groups were conducted. Questions addressed: attitudes towards clinical trials, reasons for accepting or declining participation, and recommendations to improve minority recruitment and enrollment. Data were transcribed and analyzed using traditional approaches to content and thematic analysis in NVivo 9.0. Data coding resulted in themes that supported model construction. RESULTS Participant experiences revealed the following themes when describing the decision-making process: Information gathering, Intrapersonal perspectives, and Interpersonal influences. Decision outcomes included the presence or absence of decision regret and satisfaction. From these themes, we generated a Model of Cancer Clinical Trial Decision-making. CONCLUSION Our model should be tested in hypothesis-driven research to elucidate factors and processes influencing decision balance and outcomes of trial-related decision-making. The model should also be tested in other disparities populations and for diagnoses other than cancer.
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Jayaprakash M, Puri-Taneja A, Kandula NR, Bharucha H, Kumar S, Dave SS. Qualitative Process Evaluation of a Community-Based Culturally Tailored Lifestyle Intervention for Underserved South Asians. Health Promot Pract 2016; 17:802-813. [PMID: 27225217 DOI: 10.1177/1524839916650165] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction There are few examples of effective cardiovascular disease prevention interventions for South Asians (SAs). We describe the results of a process evaluation of the South Asian Heart Lifestyle Intervention for medically underserved SAs implemented at a community-based organization (CBO) using community-based participatory research methods and a randomized control design (n = 63). Method Interviews were conducted with 23 intervention participants and 5 study staff using a semistructured interview guide focused on participant and staff perceptions about the intervention's feasibility and efficacy. Data were thematically analyzed. Results Intervention success was attributed to trusted CBO setting, culturally concordant study staff, and culturally tailored experiential activities. Participants said that these activities helped increase knowledge and behavior change. Some participants, especially men, found that self-monitoring with pedometers helped motivate increased physical activity. Participants said that the intervention could be strengthened by greater family involvement and by providing women-only exercise classes. Staff identified the need to reduce participant burden due to multicomponent intervention and agreed that the CBO needed greater financial resources to address participant barriers. Conclusion Community-based delivery and cultural adaptation of an evidence-based lifestyle intervention were effective and essential components for reaching and retaining medically underserved SAs in a cardiovascular disease prevention intervention study.
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Affiliation(s)
| | | | | | | | - Santosh Kumar
- Metropolitan Asian Family Services, Chicago, IL, USA
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Banda DR, Germain DS, McCaskill-Stevens W, Ford JG, Swain SM. A critical review of the enrollment of black patients in cancer clinical trials. Am Soc Clin Oncol Educ Book 2016:153-7. [PMID: 24451726 DOI: 10.14694/edbook_am.2012.32.88] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Although clinical trials represent a vital opportunity for improvements in cancer treatment, data show that a small proportion of patients with newly diagnosed cancer participate in clinical research. Black patients continue to have a worse prognosis for most cancers compared with other patients of other races/ethnicities. Racial/ethnic- and age-related disparities in clinical trial accrual are also well documented. The recruitment and retention of minorities in these trials present an even greater challenge despite regulatory efforts and initiatives to increase representation. Treatment data from homogenous populations prevent us from understanding therapeutic response and the true safety profile of novel therapies. Patient-, physician-, and system-level factors that affect trial participation have been extensively studied. However, years of accrual data remain largely unchanged, suggesting the challenge lies in effectively addressing these factors. Furthermore, data showing that black patients tend to have more advanced stage cancers at the time of diagnosis in fact beg their overrepresentation on clinical trials. An inability to successfully enroll diverse populations in clinical trials only exacerbates racial/ethnic differences in cancer treatment and survivorship.
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Affiliation(s)
- Deliya R Banda
- From the Washington Cancer Institute at Medstar Washington Hospital Center, Washington, DC; Medstar Health Research Institute, Hyattsville, MD; Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Johns Hopkins Center to Reduce Cancer Disparities, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Diane St Germain
- From the Washington Cancer Institute at Medstar Washington Hospital Center, Washington, DC; Medstar Health Research Institute, Hyattsville, MD; Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Johns Hopkins Center to Reduce Cancer Disparities, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Worta McCaskill-Stevens
- From the Washington Cancer Institute at Medstar Washington Hospital Center, Washington, DC; Medstar Health Research Institute, Hyattsville, MD; Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Johns Hopkins Center to Reduce Cancer Disparities, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jean G Ford
- From the Washington Cancer Institute at Medstar Washington Hospital Center, Washington, DC; Medstar Health Research Institute, Hyattsville, MD; Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Johns Hopkins Center to Reduce Cancer Disparities, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Sandra M Swain
- From the Washington Cancer Institute at Medstar Washington Hospital Center, Washington, DC; Medstar Health Research Institute, Hyattsville, MD; Division of Cancer Prevention, National Cancer Institute, Bethesda, MD; Johns Hopkins Center to Reduce Cancer Disparities, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Tanner A, Bergeron CD, Zheng Y, Friedman DB, Kim SH, Foster CB. Communicating Effectively About Clinical Trials With African American Communities: A Comparison of African American and White Information Sources and Needs. Health Promot Pract 2015; 17:199-208. [PMID: 26715695 DOI: 10.1177/1524839915621545] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Clinical trial (CT) participation is low among African Americans (AAs). To better communicate with AAs about the importance of CTs, the purpose of this study was to explore the communication sources and perceived effective communication channels and strategies through which the general public, AAs, and White individuals receive CT information. A quantitative telephone survey was conducted with AAs and Whites in one Southern state (N = 511). The measures assessed CT sources of information, perceived effectiveness of communication channels and strategies, CT understanding, and CT participation. Descriptive and bivariate analyses were used to compare responses overall and by race. AAs reported being exposed to more CT information than Whites. AAs received CT information most often through television, social media, and doctors compared to Whites. Perceived effectiveness of communication strategies and channels varied by race. AAs preferred simple and easy-to-understand CT information distributed through faith-based organizations. Whites preferred to receive CT information through a trustworthy source (e.g., doctor). There were no significant differences between AAs and Whites in their perceived effectiveness of media sources (e.g., Internet). Recommendations are provided to help health promotion practitioners and CT recruiters tailor information and communicate it effectively to potential AA and White CT participants.
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Affiliation(s)
| | | | - Yue Zheng
- University of South Carolina, Columbia, SC, USA
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Rafie C, Ayers A, Cadet D, Quillin J, Hackney MH. Reaching Hard to Reach Populations with Hard to Communicate Messages: Efficacy of a Breast Health Research Champion Training Program. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2015; 30:599-606. [PMID: 25171905 PMCID: PMC4345135 DOI: 10.1007/s13187-014-0720-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
A Breast Health Research Champion training program was a developed targeting self-identified community breast health advocates from a predominant African-American community with a significant breast cancer mortality disparity. Twelve individuals completed the program that provided training in breast cancer risk and screening, breast cancer research, biospecimen in cancer research, and human research subject protection. The training emphasized four key messages to be disseminated to the community. Trainees hosted a minimum of two social chats with individuals from their social networks and functioned as community researchers, acquiring consent and gathering follow-up data from attendees. Trainees reached 199 individuals from their social networks, and chats were diverse in the venue selected, mode of message transmission, and the audience reached. Post/pre questionnaire data from attendees at the chats showed significant improvement in knowledge, attitudes, and intended behaviors as it relates to breast cancer screening, clinical research, and biospecimen in research. Forty percent of attendees provided 4-week follow-up information. Of respondents eligible for mammography, 38 % had taken action to be screened, and 86 % of respondents had spoken about the information to someone else in their social network. Trainees expressed feelings of empowerment after completing the project, "feeling like the expert," and all trainees were surprised at the enthusiastic response from attendees of their chats. Trainees continued to disseminate the information learned from the training program during the 6 months following the training, reaching an additional 786 individuals in the community.
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Affiliation(s)
- Carlin Rafie
- Massey Cancer Center, Virginia Commonwealth University, 1201 East Marshall Street, P.O. Box 980070, 23298-0070, Richmond, VA, USA,
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A Review of Barriers to Minorities’ Participation in Cancer Clinical Trials: Implications for Future Cancer Research. J Immigr Minor Health 2015; 18:447-53. [DOI: 10.1007/s10903-015-0198-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Tanner A, Kim SH, Friedman DB, Foster C, Bergeron CD. Promoting clinical research to medically underserved communities: current practices and perceptions about clinical trial recruiting strategies. Contemp Clin Trials 2014; 41:39-44. [PMID: 25542611 DOI: 10.1016/j.cct.2014.12.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 12/15/2014] [Accepted: 12/16/2014] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Although clinical trials have the potential to provide the most advanced medical treatments and screening options, accrual rates remain low among medically underserved populations. Strategies to enhance clinical trial recruitment are frequently undertaken without developing, implementing, and evaluating communication and educational activities. This study assesses the current clinical trial recruiting efforts taking place at academic medical centers in a southeastern state and explores principal investigators' attitudes and beliefs about how to successfully recruit for clinical trials, in the general population, and in African American and rural communities. METHODS An online survey was used to collect responses from clinical trial principal investigators working in a southeastern state's five main academic medical centers. Respondents were asked about their experience with recruitment and recruiting strategies, in general, and in the African American and rural communities. RESULTS Respondents said that it was most difficult to find rural residents to participate in clinical trials (M=3.60, SD=.93), followed by the general public (M=3.30, SD=.99) and African American residents (M=3.15, SD=.99). Investigators most often reported personally recruiting their patients (M=3.50, SD=1.34) and through local doctors (M=2.80, SD=1.20). Principal investigators rarely recruit through faith-based organizations (M=1.74, SD=1.05), or by using radio (M=1.62, SD=.90), or television ads (M=1.42, SD=.75). CONCLUSION Clinical trial investigators rarely communicate about clinical research outside of the medical setting or partner with community organizations or local doctors to reach individuals in medically underserved communities. Study implications describe the importance of educating research teams about how best to promote clinical trial awareness and knowledge.
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Affiliation(s)
- Andrea Tanner
- School of Journalism and Mass Communications, University of South Carolina, Columbia, SC, United States.
| | - Sei-Hill Kim
- School of Journalism and Mass Communications, University of South Carolina, Columbia, SC, United States
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States; Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, United States
| | | | - Caroline D Bergeron
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
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Bonevski B, Randell M, Paul C, Chapman K, Twyman L, Bryant J, Brozek I, Hughes C. Reaching the hard-to-reach: a systematic review of strategies for improving health and medical research with socially disadvantaged groups. BMC Med Res Methodol 2014; 14:42. [PMID: 24669751 PMCID: PMC3974746 DOI: 10.1186/1471-2288-14-42] [Citation(s) in RCA: 700] [Impact Index Per Article: 70.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 03/20/2014] [Indexed: 11/15/2022] Open
Abstract
Background This study aims to review the literature regarding the barriers to sampling, recruitment, participation, and retention of members of socioeconomically disadvantaged groups in health research and strategies for increasing the amount of health research conducted with socially disadvantaged groups. Methods A systematic review with narrative synthesis was conducted. Searches of electronic databases Medline, PsychInfo, EMBASE, Social Science Index via Web of Knowledge and CINHAL were conducted for English language articles published up to May 2013. Qualitative and quantitative studies as well as literature reviews were included. Articles were included if they reported attempts to increase disadvantaged group participation in research, or the barriers to research with disadvantaged groups. Groups of interest were those described as socially, culturally or financially disadvantaged compared to the majority of society. Eligible articles were categorised according to five phases of research: 1) sampling, 2) recruitment and gaining consent, 3) data collection and measurement, 4) intervention delivery and uptake, and 5) retention and attrition. Results In total, 116 papers from 115 studies met inclusion criteria and 31 previous literature reviews were included. A comprehensive summation of the major barriers to working with various disadvantaged groups is provided, along with proposed strategies for addressing each of the identified types of barriers. Most studies of strategies to address the barriers were of a descriptive nature and only nine studies reported the results of randomised trials. Conclusions To tackle the challenges of research with socially disadvantaged groups, and increase their representation in health and medical research, researchers and research institutions need to acknowledge extended timeframes, plan for higher resourcing costs and operate via community partnerships.
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Affiliation(s)
- Billie Bonevski
- School of Medicine & Public Health, Faculty of Health & Medicine, University of Newcastle, Callaghan, NSW, Australia.
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Wang JHY, Sheppard VB, Liang W, Ma GX, Maxwell AE. Recruiting Chinese Americans into cancer screening intervention trials: strategies and outcomes. Clin Trials 2014; 11:167-77. [PMID: 24567288 DOI: 10.1177/1740774513518849] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cancer is the leading cause of death among Asian Americans. While Asian Americans are the fastest growing minority population in the United States, they are underrepresented in cancer research and report poor adherence to cancer screening guidelines. PURPOSE This study utilized data from two large randomized intervention trials to evaluate strategies to recruit first-generation Chinese American immigrants from community settings and Chinese American physician practices. Findings will inform effective strategies for promoting Asian American participation in cancer control research. METHODS Chinese Americans who were non-adherent to annual mammography screening guidelines (Study 1 with 664 immigrant women > 40 years of age) and to colorectal cancer screening guidelines (Study 2 with 455 immigrants > 50 years of age) were enrolled from the greater Washington DC, New York City (NYC), and Philadelphia (PA) areas. Both studies trained bilingual staff to enroll Chinese-speaking participants with the aid of linguistically appropriate fliers and brochures to obtain consent. Study 1 adopted community approaches and worked with community organizations to enroll participants. Study 2 randomly selected potential participants through 24 Chinese American primary-care physician offices, and mailed letters from physicians to enroll patients, followed by telephone calls from research staff. The success of recruitment approaches was assessed by yield rates based on number of participants approached, ineligible, and consented. RESULTS Most participants (70%) of Study 1 were enrolled through in-person community approaches (e.g., Chinese schools, stores, health fairs, and personal networks). The final yield of specific venues differed widely (6% to 100%) due to various proportions of ineligible subjects (2%-64%) and refusals (0%-92%). The Study 2 recruitment approach (physician letter followed by telephone calls) had different outcomes in two geographic areas, partially due to differences in demographic characteristics in the DC and NYC/PA areas. The community approaches enrolled more recent immigrants and uninsured Chinese Americans than the physician and telephone call approach (p < .001). Enrollment cost is provided to inform future research studies. LIMITATIONS Our recruitment outcomes might not be generalizable to all Chinese Americans or other Asian American populations because they may vary by study protocols (e.g., length of trials), target populations (i.e., eligibility criteria), and available resources. CONCLUSIONS Use of multiple culturally relevant strategies (e.g., building trusting relationships through face-to-face enrollment, use of bilingual and bicultural staff, use of a physician letter, and employing linguistically appropriate materials) was crucial for successfully recruiting a large number of Chinese Americans in community and clinical settings. Our data demonstrate that substantial effort is required for recruitment; studies need to budget for this effort to ensure the inclusion of Asian Americans in health research.
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Affiliation(s)
- Judy Huei-yu Wang
- aDepartment of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
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George S, Duran N, Norris K. A systematic review of barriers and facilitators to minority research participation among African Americans, Latinos, Asian Americans, and Pacific Islanders. Am J Public Health 2014; 104:e16-31. [PMID: 24328648 PMCID: PMC3935672 DOI: 10.2105/ajph.2013.301706] [Citation(s) in RCA: 949] [Impact Index Per Article: 94.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2013] [Indexed: 11/04/2022]
Abstract
To assess the experienced or perceived barriers and facilitators to health research participation for major US racial/ethnic minority populations, we conducted a systematic review of qualitative and quantitative studies from a search on PubMed and Web of Science from January 2000 to December 2011. With 44 articles included in the review, we found distinct and shared barriers and facilitators. Despite different expressions of mistrust, all groups represented in these studies were willing to participate for altruistic reasons embedded in cultural and community priorities. Greater comparative understanding of barriers and facilitators to racial/ethnic minorities' research participation can improve population-specific recruitment and retention strategies and could better inform future large-scale prospective quantitative and in-depth ethnographic studies.
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Affiliation(s)
- Sheba George
- Sheba George is with the Center for Biomedical Informatics, Charles R. Drew University of Medicine and Science, and the Department of Community Health Sciences, University of California Los Angeles (UCLA) Fielding School of Public Health, Los Angeles. Nelida Duran is with the Department of Community Health Sciences, UCLA Fielding School of Public Health. Keith Norris is with the Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles
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Uniting postcolonial, discourse, and linguistic theory to explore participation of African Americans in cancer research as an effect of social and historical race relationships. ANS Adv Nurs Sci 2014; 37:32-47. [PMID: 24469087 DOI: 10.1097/ans.0000000000000015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article uses a historical framework of postcolonialism; discourse analytic concepts (significance, identity, and relationships); and 5 social and cultural linguistic principles of emergence, positionality, indexicality, relationality, and partialness as a theoretical and methodological triangulation approach to data analysis of focus group discussion. Exemplars of focus group data from a study exploring African American participation in research demonstrate the application of this combined framework as a useful tool for analysis. This approach allows for examination of identity and interaction and generates a more rigorous and complete understanding of how individuals use language to construct identity as participants or nonparticipants in research.
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Getrich CM, Sussman AL, Campbell-Voytal K, Tsoh JY, Williams RL, Brown AE, Potter MB, Spears W, Weller N, Pascoe J, Schwartz K, Neale AV. Cultivating a cycle of trust with diverse communities in practice-based research: a report from PRIME Net. Ann Fam Med 2013; 11:550-8. [PMID: 24218379 PMCID: PMC3823726 DOI: 10.1370/afm.1543] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Practice-based research networks (PBRNs) are increasingly seen as important vehicles to translate research into practice, although less is known about the process of engaging diverse communities in PBRN research. The objective of this study was to identify strategies for successfully recruiting and retaining diverse racial/ethnic communities into PBRN research studies. METHODS This collaborative, multisite study engaged 5 of the 8 networks of the PRImary care MultiEthnic Network (PRIME Net) consortium that conducts research with traditionally underrepresented/underserved populations. We used a sequential, qualitative research design. We first conducted 1 key informant interview with each of 24 researchers experienced in recruiting research participants from 5 racial/ethnic communities (African American, Arab/Chaldean, Chinese, Hispanic, and Native American). Subsequently, we conducted 18 focus groups with 172 persons from these communities. RESULTS Participants' comments indicated that successful recruitment and retention of underrepresented populations in PBRN studies is linked to the overall research process. This process, which we termed the cycle of trust, entailed developing and sustaining relationships of trust during 4 interrelated stages: before the study, during study recruitment, throughout study conduct, and after study completion. Participants identified a set of flexible strategies within each stage and called for close engagement with clinic and community partners. CONCLUSIONS Our participants suggest that approaches to research that lay a foundation of trust, demonstrate respect for community members, and extend beyond the enrollment and data collection phases are essential to enhance the participation of diverse populations in PBRN research. These findings offer the PBRN community a guide toward achieving this important goal.
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Fracasso PM, Goodner SA, Creekmore AN, Morgan HP, Foster DM, Hardmon AA, Engel SJ, Springer BC, Mathews KJ, Fisher EB, Walker MS. Coaching intervention as a strategy for minority recruitment to cancer clinical trials. J Oncol Pract 2013; 9:294-9. [PMID: 24130255 PMCID: PMC3825290 DOI: 10.1200/jop.2013.000982] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Lack of trust and rapport with health care providers has been identified in the under-representation of racial/ethnic minorities within clinical trials. Our study used a coach to promote trust among minority patients with advanced cancer. PATIENTS AND METHODS Minority patients with advanced breast, colorectal, lung, or prostate carcinoma were randomly assigned to receive a coach Intervention (CI) or usual care (UC). All patients completed baseline and 6-month telephone interviews to assess demographics, trust in health care providers, attitudes toward clinical trials, and quality of life. Patients randomly assigned to CI were assigned a coach, who made biweekly contacts for 6 months to address general issues, progress or development in cancer care, and available resources. Patients randomly assigned to UC received the standard of care, without this intervention. Clinical trial enrollment was assessed. RESULTS Over 21 months, we screened 268 patients and enrolled 73 African Americans and two Asian Americans. Patients were randomly assigned to CI (n = 38) or to UC (n = 37). Longitudinal analyses were conducted on 69 patients who completed the 6-month follow-up assessment. Trial enrollment was 16 and 13 patients for the CI and UC groups, respectively. This difference was not significant (P = .351). Higher quality of life (1-point odds ratio on Functional Assessment of Cancer Treatment-General = 1.033, P = .036) and positive attitudes toward trials predicted enrollment. There was no significant difference between these groups in quality of life, attitudes toward clinical trials, perceptions of racism, trust in doctors, or depression. CONCLUSIONS Quality of life and positive attitude toward trials predicted trial enrollment, regardless of assignment to CI or UC.
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Affiliation(s)
- Paula M. Fracasso
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Sherry A. Goodner
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Allison N. Creekmore
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Helen P. Morgan
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Denise M. Foster
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Angela A. Hardmon
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Seth J. Engel
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Brian C. Springer
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Katherine J. Mathews
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Edwin B. Fisher
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
| | - Mark S. Walker
- Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO
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Denicoff AM, McCaskill-Stevens W, Grubbs SS, Bruinooge SS, Comis RL, Devine P, Dilts DM, Duff ME, Ford JG, Joffe S, Schapira L, Weinfurt KP, Michaels M, Raghavan D, Richmond ES, Zon R, Albrecht TL, Bookman MA, Dowlati A, Enos RA, Fouad MN, Good M, Hicks WJ, Loehrer PJ, Lyss AP, Wolff SN, Wujcik DM, Meropol NJ. The National Cancer Institute-American Society of Clinical Oncology Cancer Trial Accrual Symposium: summary and recommendations. J Oncol Pract 2013; 9:267-76. [PMID: 24130252 PMCID: PMC3825288 DOI: 10.1200/jop.2013.001119] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Many challenges to clinical trial accrual exist, resulting in studies with inadequate enrollment and potentially delaying answers to important scientific and clinical questions. METHODS The National Cancer Institute (NCI) and the American Society of Clinical Oncology (ASCO) cosponsored the Cancer Trial Accrual Symposium: Science and Solutions on April 29-30, 2010 to examine the state of accrual science related to patient/community, physician/provider, and site/organizational influences, and identify new interventions to facilitate clinical trial enrollment. The symposium featured breakout sessions, plenary sessions, and a poster session including 100 abstracts. Among the 358 attendees were clinical investigators, researchers of accrual strategies, research administrators, nurses, research coordinators, patient advocates, and educators. A bibliography of the accrual literature in these three major areas was provided to participants in advance of the meeting. After the symposium, the literature in these areas was revisited to determine if the symposium recommendations remained relevant within the context of the current literature. RESULTS Few rigorously conducted studies have tested interventions to address challenges to clinical trials accrual. Attendees developed recommendations for improving accrual and identified priority areas for future accrual research at the patient/community, physician/provider, and site/organizational levels. Current literature continues to support the symposium recommendations. CONCLUSIONS A combination of approaches addressing both the multifactorial nature of accrual challenges and the characteristics of the target population may be needed to improve accrual to cancer clinical trials. Recommendations for best practices and for future research developed from the symposium are provided.
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Affiliation(s)
- Andrea M. Denicoff
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Worta McCaskill-Stevens
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Stephen S. Grubbs
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Suanna S. Bruinooge
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Robert L. Comis
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Peggy Devine
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - David M. Dilts
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Michelle E. Duff
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Jean G. Ford
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Steven Joffe
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Lidia Schapira
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Kevin P. Weinfurt
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Margo Michaels
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Derek Raghavan
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Ellen S. Richmond
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Robin Zon
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Terrance L. Albrecht
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Michael A. Bookman
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Afshin Dowlati
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Rebecca A. Enos
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Mona N. Fouad
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Marjorie Good
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - William J. Hicks
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Patrick J. Loehrer
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Alan P. Lyss
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Steven N. Wolff
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Debra M. Wujcik
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Neal J. Meropol
- National Cancer Institute; Education Network to Advance Cancer Clinical Trials, Bethesda; The EMMES Corporation, Rockville, MD; Delaware Cancer Consortium, Dover; Helen F. Graham Cancer Center, Newark, DE; American Society of Clinical Oncology, Alexandria, VA; Coalition of Cancer Cooperative Groups; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Cancer Information & Support Network, Auburn, CA; Oregon Health & Science University, Portland, OR; Pancreatic Cancer Action Network; Brooklyn Hospital Center, New York, NY; Massachusetts General Hospital, Boston, MA; Duke Clinical Research Institute, Durham; Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC; Michiana Hematology Oncology and Northern Indiana Cancer Research Consortium, South Bend, IN; Barbara Ann Karmanos Cancer Institute, Detroit, MI; University of Arizona Cancer Center, Tucson, AZ; University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland; The Ohio State University, Columbus, OH; University of Alabama at Birmingham, Birmingham, AL; Indiana University Simon Cancer Center, Indianapolis, IN; Heartland Cancer Research CCOP, St. Louis, MO; Meharry Medical College; and Vanderbilt-Ingram Cancer Center, Nashville, TN
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Collins BN, Wileyto EP, Hovell MF, Nair US, Jaffe K, Tolley NM, Audrain-McGovern J. Proactive recruitment predicts participant retention to end of treatment in a secondhand smoke reduction trial with low-income maternal smokers. Transl Behav Med 2013; 1:394-9. [PMID: 24073063 DOI: 10.1007/s13142-011-0059-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Improving smoking intervention trial retention in underserved populations remains a public health priority. Low retention rates undermine clinical advancements that could reduce health disparities. To examine the effects of recruitment strategies on participant retention among 279 low-income, maternal smokers who initiated treatment in a 16-week behavioral counseling trial to reduce child secondhand smoke exposure (SHSe). Participants were recruited using either reactive strategies or methods that included proactive strategies. Logistic regression analysis was used to test associations among retention and recruitment method in the context of other psychosocial and sociodemographic factors known to relate to retention. Backwards stepwise procedures determined the most parsimonious solution. Ninety-four percent of participants recruited with proactive + reactive methods were retained through end of treatment compared to 74.7% of reactive-recruited participants. Retention likelihood was five times greater if participants were recruited with proactive + reactive strategies rather than reactive recruitment alone (odds ration [OR] = 5.36; confidence interval [CI], 2.31-12.45). Greater knowledge of SHS consequences (OR = 1.58; CI, 1.07-2.34) was another significant factor retained in the final LR model. Proactive recruitment may improve retention among underserved smokers in behavioral intervention trials. Identifying factors influencing retention may improve the success of recruitment strategies in future trials, in turn, enhancing the impact of smoking interventions.
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Affiliation(s)
- Bradley N Collins
- Health Behavior Research Clinic, Temple University Department of Public Health, 1301 Cecil B. Moore Avenue, Ritter Annex, Room 929, Philadelphia, PA 19122 USA
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Wells KJ, McIntyre J, Gonzalez LE, Lee JH, Fisher KJ, Jacobsen PB, Meade C, Muñoz-Antonia T, Quinn GP. Feasibility trial of a Spanish-language multimedia educational intervention. Clin Trials 2013; 10:767-74. [PMID: 23935161 DOI: 10.1177/1740774513495984] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hispanic cancer patients are underrepresented in clinical trials; research suggests lack of knowledge and language barriers contribute to low accrual. Multimedia materials offer advantages to Hispanic populations because they have high acceptability, are easy to disseminate, and can be viewed with family. PURPOSE Hispanic cancer patients and caregivers participated in focus groups to aid in developing a Spanish-language multimedia intervention to educate Hispanic cancer patients about clinical trials. We explored the feasibility of delivering the intervention in medical oncology clinics. METHODS A total of 35 patients were randomized to either the multimedia intervention group (n = 18) or a control group (n = 17) who were asked to read the National Cancer Institute's Spanish-language clinical trials brochure. Self-reported data on knowledge about and attitudes toward clinical trials, self-efficacy for participating in a clinical trial, intention to participate in a clinical trial if asked, and receptivity to information about a clinical trial were collected at baseline and 10 days later. RESULTS Delivery of the multimedia presentation in oncology clinics was feasible. The intervention group had more knowledge about clinical trials at follow-up than the control group; scores for intention to participate in a clinical trial by participants in the intervention group increased from 3.8 to 4.0 of a possible 5, but declined in the control group from 4.5 to 4.1. No statistically significant difference was detected between groups in scores for attitudes or self-efficacy for making a decision to participate in a clinical trial. LIMITATIONS Our sample size was inadequate to identify differences between the informational methods. Although all patients were asked about their willingness to participate in a clinical trial, this decision was hypothetical. In addition, the study was conducted with a sample of Spanish-speaking Hispanic cancer patients at a comprehensive cancer center in Florida. Thus, the results may not generalize to other Hispanic populations. CONCLUSION In the pilot project, we demonstrated the feasibility of delivering multimedia information to patients in medical oncology clinics. Because delivery in a clinical setting was found to be feasible, a larger study should be conducted to evaluate the efficacy of the multimedia intervention with respect to promoting accrual of Hispanic patients to clinical trials.
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Affiliation(s)
- Kristen J Wells
- aDepartment of Psychology, San Diego State University, San Diego, CA, USA
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Anwuri VV, Hall LE, Mathews K, Springer BC, Tappenden JR, Farria DM, Jackson S, Goodman MS, Eberlein TJ, Colditz GA. An institutional strategy to increase minority recruitment to therapeutic trials. Cancer Causes Control 2013; 24:1797-809. [PMID: 23846282 DOI: 10.1007/s10552-013-0258-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 07/03/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE Participation in therapeutic clinical trials rarely reflects the race and ethnic composition of the patient population. To meet National Institutes of Health-mandated goals, strategies to increase participation are required. We present a framework for institutional enhancement of minority clinical trial accrual. METHODS We implemented structural changes on four levels to induce and sustain minority accrual to clinical trials: (1) leadership support; (2) center-wide policy change; (3) infrastructural process control, data analysis, and reporting; and (4) follow-up with clinical investigators. A Protocol Review and Monitoring Committee reviews studies and monitors accrual, and the Program for the Elimination Cancer Disparities leads efforts for proportional accrual, supporting the system through data tracking, Web tools, and feedback to investigators. RESULTS Following implementation in 2005, minority accrual to therapeutic trials increased from 12.0 % in 2005 to 14.0 % in 2010. The "rolling average" minority cancer incidence at the institution during this timeframe was 17.5 %. In addition to therapeutic trial accrual rates, we note significant increase in the number of minorities participating in all trials (therapeutic and nontherapeutic) from 2005 to 2010 (346-552, 60 % increase, p < 0.05) compared to a 52 % increase for Caucasians. CONCLUSIONS Implementing a system to aid investigators in planning and establishing targets for accrual, while requiring this component as a part of annual protocol review and monitoring of accrual, offers a successful strategy that can be replicated in other cancer centers, an approach that may extend to other clinical and translational research centers.
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Affiliation(s)
- Victoria V Anwuri
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Simmons RG, Lee YCA, Stroup AM, Edwards SL, Rogers A, Johnson C, Wiggins CL, Hill DA, Cress RD, Lowery J, Walters ST, Jasperson K, Higginbotham JC, Williams MS, Burt RW, Schwartz MD, Kinney AY. Examining the challenges of family recruitment to behavioral intervention trials: factors associated with participation and enrollment in a multi-state colonoscopy intervention trial. Trials 2013; 14:116. [PMID: 23782890 PMCID: PMC3691526 DOI: 10.1186/1745-6215-14-116] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 04/02/2013] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Colonoscopy is one of the most effective methods of cancer prevention and detection, particularly for individuals with familial risk. Recruitment of family members to behavioral intervention trials remains uniquely challenging, owing to the intensive process required to identify and contact them. Recruiting at-risk family members involves contacting the original cancer cases and asking them to provide information about their at-risk relatives, who must then be contacted for study enrollment. Though this recruitment strategy is common in family trials, few studies have compared influences of patient and relative participation to nonparticipation. Furthermore, although use of cancer registries to identify initial cases has increased, to our knowledge no study has examined the relationship between registries and family recruitment outcomes. METHODS This study assessed predictors of case participation and relative enrollment in a recruitment process that utilized state cancer registries. Participation characteristics were analyzed with separate multivariable logistic regressions in three stages: (1) cancer registry-contacted colorectal cancer (CRC) cases who agreed to study contact; (2) study-contacted CRC cases who provided at-risk relative information; and (3) at-risk relatives contacted for intervention participation. RESULTS Cancer registry source was predictive of participation for both CRC cases and relatives, though relative associations (odds ratios) varied across registries. Cases were less likely to participate if they were Hispanic or nonwhite, and were more likely to participate if they were female or younger than 50 at cancer diagnosis. At-risk relatives were more likely to participate if they were from Utah, if another family member was also participating in the study, or if they had previously had a colonoscopy. The number of eligible cases who had to be contacted to enroll one eligible relative varied widely by registry, from 7 to 81. CONCLUSIONS Family recruitment utilizing cancer registry-identified cancer cases is feasible, but highly dependent on both the strategies and protocols of those who are recruiting and on participant characteristics such as sex, race, or geography. Devising comprehensive recruitment protocols that specifically target those less likely to enroll may help future research meet recruitment goals. TRIAL REGISTRATION Family Colorectal Cancer Awareness and Risk Education Project NCT01274143.
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Affiliation(s)
- Rebecca G Simmons
- Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Yuan-Chin Amy Lee
- Department of Family and Preventive Medicine, University of Utah, 375 Chipeta Way, Suite A, Salt Lake City, UT, 84108, USA
| | - Antoinette M Stroup
- Utah Cancer Registry, 650 Komas Drive, Suite 106B, Salt Lake City, UT, 84108, USA
- Department of Internal Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - Sandra L Edwards
- Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Amy Rogers
- Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - Christopher Johnson
- Cancer Data Registry of Idaho, 615 N. 7th Street, PO Box 1278, Boise, ID, 83701, USA
| | - Charles L Wiggins
- New Mexico Tumor Registry, University of New Mexico Cancer Center, MSC 11 6020, 1 University of New Mexico, Albuquerque, NM, 87131, USA
| | - Deirdre A Hill
- Department of Internal Medicine, Division of Epidemiology and Biostatistics and University of New Mexico Cancer Research and Treatment Center, University of New Mexico School of Medicine, MSC 10 5550, 1 University of New Mexico, Albuquerque, NM, 87131, USA
| | - Rosemary D Cress
- California Cancer Registry, 1825 Bell Street, Suite 102, Sacramento, CA, 95825, USA
| | - Jan Lowery
- University of Colorado Cancer Center, 13001 E. 17th St., MS F-538, Aurora, CO, 80045, USA
| | - Scott T Walters
- University of North Texas Health Science Center, 3500 Camp Bowie Blvd, EAD 709, Fort Worth, TX, 76107, USA
| | - Kory Jasperson
- Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
| | - John C Higginbotham
- Institute for Rural Health, University of Alabama, Tuscaloosa Campus, 850 5th Avenue East, Tuscaloosa, AL, 35401, USA
| | - Marc S Williams
- Genomic Medicine Institute, Geisinger Research, Weis Center for Research, 100 N Academy Ave. Mail Stop 26-20, Danville, PA, 17822, USA
| | - Randall W Burt
- Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
- Department of Internal Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - Marc D Schwartz
- Georgetown University, Harris Building, 3300 Whitehaven St., N.W., Washington DC, 20007, USA
- Lombardi Comprehensive Cancer Center, 3970 Reservoir Rd NW E501, Washington, DC, 20007, USA
| | - Anita Y Kinney
- Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT, 84112, USA
- Department of Internal Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA
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Banda DR, Libin AV, Wang H, Swain SM. A pilot study of a culturally targeted video intervention to increase participation of African American patients in cancer clinical trials. Oncologist 2013; 17:708-14. [PMID: 22639112 DOI: 10.1634/theoncologist.2011-0454] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Barriers to clinical trial participation among African American cancer patients are well characterized in the literature. Attitudinal barriers encompassing fear, distrust, and concerns about ethical misconduct are also well documented. To increase trial accrual, these attitudes must be adequately addressed, yet there remains a lack of targeted interventions toward this end. We developed a 15-minute culturally targeted video designed to impact six specific attitudes of African American cancer patients toward therapeutic trials. We conducted a pilot study to test in the first such intervention to increase intention to enroll. PATIENTS AND METHODS The primary study outcome was self-reported likelihood to participate in a therapeutic trial. Using a mixed methods approach, we developed the Attitudes and Intention to Enroll in Therapeutic Clinical Trials (AIET) instrument, a 30-item questionnaire measuring six attitudinal barriers to African American trial participation. We enrolled 108 eligible active treatment patients at a large urban cancer institute. McNemar's test for matched pairs was used to assess changes in attitudes and likelihood to enroll in a clinical trial at baseline and immediately after the video. Pre- and post-video AIET summative scores were analyzed by paired t-test for each attitudinal barrier. RESULTS Patients' likelihood of enrolling in a clinical trial significantly increased post-video with 36% of the sample showing positive changes in intention [McNemar's χ(2) = 33.39, p < .001]. Paired t-tests showed significant changes in all six attitudinal barriers measured via AIET summative scores from pre- to post-video. CONCLUSION These data suggest utility of our video for increasing African American participation in clinical trials.
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Affiliation(s)
- Deliya R Banda
- Medstar Health Research Institute, Hyattsville, Maryland, USA.
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Chan AW, Tetzlaff JM, Gøtzsche PC, Altman DG, Mann H, Berlin JA, Dickersin K, Hróbjartsson A, Schulz KF, Parulekar WR, Krleza-Jeric K, Laupacis A, Moher D. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ 2013; 346:e7586. [PMID: 23303884 PMCID: PMC3541470 DOI: 10.1136/bmj.e7586] [Citation(s) in RCA: 3349] [Impact Index Per Article: 304.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2012] [Indexed: 02/06/2023]
Abstract
High quality protocols facilitate proper conduct, reporting, and external review of clinical trials. However, the completeness of trial protocols is often inadequate. To help improve the content and quality of protocols, an international group of stakeholders developed the SPIRIT 2013 Statement (Standard Protocol Items: Recommendations for Interventional Trials). The SPIRIT Statement provides guidance in the form of a checklist of recommended items to include in a clinical trial protocol. This SPIRIT 2013 Explanation and Elaboration paper provides important information to promote full understanding of the checklist recommendations. For each checklist item, we provide a rationale and detailed description; a model example from an actual protocol; and relevant references supporting its importance. We strongly recommend that this explanatory paper be used in conjunction with the SPIRIT Statement. A website of resources is also available (www.spirit-statement.org). The SPIRIT 2013 Explanation and Elaboration paper, together with the Statement, should help with the drafting of trial protocols. Complete documentation of key trial elements can facilitate transparency and protocol review for the benefit of all stakeholders.
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Affiliation(s)
- An-Wen Chan
- Women's College Research Institute at Women's College Hospital, Department of Medicine, University of Toronto, Toronto, Canada M5G 1N8
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Lamberti MJ, Mathias A, Myles JE, Howe D, Getz K. Evaluating the Impact of Patient Recruitment and Retention Practices. ACTA ACUST UNITED AC 2012. [DOI: 10.1177/0092861512453040] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ford M, Wahlquist A, Blake R, Green C, Streets J, Fuller E, Johnson E, Jefferson M, Etheredge J, Varner H, Johnson S, Glover S, Turner D, Garrett-Mayer E. Assessing an intervention to improve clinical trial perceptions among predominately African-American communities in South Carolina. Prog Community Health Partnersh 2012; 6:249-63. [PMID: 22982839 DOI: 10.1353/cpr.2012.0038] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND African Americans (AA) are not well-represented in cancer clinical trials despite having significantly higher cancer mortality rates than their European-American (EA) counterparts. OBJECTIVES The purpose of this study was to evaluate a program to improve perceptions of cancer clinical trials among AA. METHODS The program was conducted in a convenience sample of 195 participants (75.4% AA) who lived in counties with high racial disparities in cancer mortality rates and who were recruited by community partners. The 30-minute program, part of a larger 3.5-hour cancer education program, was developed by the National Institutes of Health (NIH)/National Cancer Institute (NCI). It was modified to include additional pictures of AA, AA-specific cancer mortality data, and information about the Tuskegee Syphilis Study and the resulting improved participant protection measures. MEASURES The seven-item Attitudes to Randomized Trial Questionnaire (ARTQ) was used to evaluate changes in trial perceptions from pre- to posttest. Additional survey items assessed general demographic characteristics. RESULTS Slightly more than half of the participants had at least a college diploma (54.4%), 45.1% were married/living as married, 53.3% were female, and 45.6% had an annual household income of less than $40,000. For each ARTQ item, most participants who had less favorable perceptions of trials at pretest changed to more positive perceptions at posttest (p < .001). CONCLUSIONS Providing cancer clinical trial information led to more positive perceptions of cancer clinical trials. In future studies, the program could be used to help potential trial participants make informed decisions about participation; trial enrollment rates could then be evaluated.
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Affiliation(s)
- Marvella Ford
- Medical University of South Carolina, Vorhees College, USA
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Graham AL, Fang Y, Moreno JL, Streiff SL, Villegas J, Muñoz RF, Tercyak KP, Mandelblatt JS, Vallone DM. Online advertising to reach and recruit Latino smokers to an internet cessation program: impact and costs. J Med Internet Res 2012; 14:e116. [PMID: 22954502 PMCID: PMC3510691 DOI: 10.2196/jmir.2162] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 07/17/2012] [Accepted: 07/23/2012] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Tobacco cessation among Latinos is a public health priority in the United States, particularly given the relatively high growth of this population segment. Although a substantial percentage of American Latinos use the Internet, they have not engaged in Web-based cessation programs as readily as other racial/ethnic subgroups. A lack of culturally specific advertising efforts may partly explain this disparity. OBJECTIVE Phase I of this study focused on the development of four Spanish-language online banner advertisements to promote a free Spanish-language smoking cessation website (es.BecomeAnEX.org). Phase II examined the relative effectiveness of the four banner ads in reaching and recruiting Latino smokers to the cessation website. METHODS In Phase I, 200 Spanish-speaking Latino smokers completed an online survey to indicate their preference for Spanish-language banner ads that incorporated either the cultural value of family (familismo) or fatalism (fatalismo). Ads included variations on message framing (gain vs loss) and depth of cultural targeting (surface vs deep). In Phase II, a Latin square design evaluated the effectiveness of the four preferred ads from Phase I. Ads were systematically rotated across four popular Latino websites (MySpace Latino, MSN Latino, MiGente, and Yahoo! en Español) over four months from August to November 2009. Tracking software recorded ad clicks and registrants on the cessation website. Negative binomial regression and general linear modeling examined the main and interacting effects of message framing and depth of cultural targeting for four outcomes: number of clicks, click-through rate, number of registrants, and cost per registrant. RESULTS In Phase I, smokers preferred the four ads featuring familismo. In Phase II, 24,829,007 impressions were placed, yielding 24,822 clicks, an overall click-through rate of 0.10%, and 500 registrants (2.77% conversion rate). Advertising costs totaled US $104,669.49, resulting in an overall cost per click of US $4.22 and cost per registrant of US $209.34. Website placement predicted all four outcomes (all P values < .01). Yahoo! en Español yielded the highest click-through rate (0.167%) and number of registrants (n = 267). The message framing and cultural targeting interaction was not significant. Contrary to hypotheses, loss-framed ads yielded a higher click-through rate than gain-framed ads (point estimate = 1.08, 95% CI 1.03 1.14, P = 0.004), and surface-targeted ads outperformed deep-targeted ads for clicks (point estimate = 1.20, 95% CI 1.13 1.28, P < .001), click-through rate (point estimate = 1.22, 95% CI 1.16 1.29, P < .001), and number of registrants (point estimate = 2.73, 95% CI 2.14 3.48, P < .001). CONCLUSIONS Online advertising can be an effective and cost-efficient strategy to reach and engage Spanish-speaking Latino smokers in an evidence-based Internet cessation program. Cultural targeting and smoking-relevant images may be important factors for banner ad design. Online advertising holds potential for Web-based cessation program implementation and research.
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Affiliation(s)
- Amanda L Graham
- Schroeder Institute for Tobacco Research & Policy Studies, American Legacy Foundation, Washington, DC, USA.
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A Pilot Study of a Culturally Targeted Video Intervention to Increase Participation of African American Patients in Cancer Clinical Trials. Oncologist 2012. [DOI: 10.1634/theoncologist.2012-0454] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Green BB, Bogart A, Chubak J, Vernon SW, Morales LS, Meenan RT, Laing SS, Fuller S, Ko C, Wang CY. Nonparticipation in a population-based trial to increase colorectal cancer screening. Am J Prev Med 2012; 42:390-7. [PMID: 22424252 PMCID: PMC3549634 DOI: 10.1016/j.amepre.2011.11.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 11/04/2011] [Accepted: 11/30/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many trials have tested different strategies to increase colorectal cancer (CRC) screening. Few describe whether participants are representative of the population from which they are recruited. PURPOSE To determine risk factors related to nonparticipation among patients enrolled in an integrated health plan and not up to date for CRC testing, in a trial to increase screening rates. METHODS Between July 2008 and October 2009, a total of 15,000 adults aged 50-74 years from 21 clinics in Washington State who were due for CRC screening were contacted. Nonparticipants were defined as English-speaking patients who did not engage in the call or refused participation while still potentially eligible. Log-binomial regression models were used to estimate the relative risk of nonparticipation. Analyses were completed between October 2010 and June 2011. RESULTS Patients who were nonwhite, had less education, used tobacco, had less continuity of care, and had lower rates of preventive care and cancer screening were more likely to be nonparticipants. Patients reporting never having received any type of CRC testing or screening were also more likely not to participate (62% of nonparticipants vs 46% of participants; adjusted RR=1.58, 95% CI=1.47, 1.70). Reasons for refusal included costs, risks of procedures, and not wanting their medical records reviewed. CONCLUSIONS Patients eligible for but not participating in the trial were more likely to be from minority socioeconomic and racial groups and had behaviors that can negatively affect cancer outcomes. Additional efforts are needed to recruit patients who need CRC screening the most. TRIAL REGISTRATION This trial is registered at clinicaltrials.gov NCT 00697047.
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Affiliation(s)
- Beverly B Green
- Group Health Permanente, University of Washington Medical School, Seattle, USA.
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Dowling NM, Olson N, Mish T, Kaprakattu P, Gleason C. A model for the design and implementation of a participant recruitment registry for clinical studies of older adults. Clin Trials 2012; 9:204-14. [PMID: 22273586 DOI: 10.1177/1740774511432555] [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 The identification and enlistment of suitable participants into clinical studies is often challenging, requiring a large commitment of time and staff resources. The recruitment and retention of populations typically underrepresented in research present additional challenges to enrollment of sufficient numbers of participants in clinical studies. Inadequate participation may undermine the pace and direction of new treatment discoveries. PURPOSE Registries of potential research participants are powerful tools to support research by providing a framework to streamline screening and recruitment and to maintain a communication history with potential research participants. The authors present a model for the development and implementation of a web-based database system to support recruitment, enrollment, and retention of potential study participants in close alignment with the goals of the Wisconsin Alzheimer's Disease Research Center (ADRC). METHODS The required data elements and major information domains for the registry were identified using a structured problem-solving and system design approach and the collaboration of a multidisciplinary team of stakeholders. The system performance, utility, and usability were assessed through multiple iterations with the users. RESULTS The process-oriented approach culminated in a multifaceted tool that combined contact management and potential research participant registration to assist with the challenges of recruitment and retention in clinical research. A unique feature of the registry design model was its contact management capabilities for efficient tracking of all contacts with registrants. LIMITATIONS We have focused on the development and implementation of a system for the recruitment of older adults with specific cognitive and medical characteristics. However, our procedures for identifying data needs and database system utility and functionality can be transferred easily to other populations and settings. As with any multipurpose registry database system, careful management and training are essential to optimize efficiency. CONCLUSION Adding a contact management element to the registry design significantly improved the efficiency of communication between clinical study coordinators and potential research participants, as well as the communication among coordinators.
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Affiliation(s)
- N Maritza Dowling
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53792-4675, USA.
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Douglas A, Bhopal RS, Bhopal R, Forbes JF, Gill JMR, Lawton J, McKnight J, Murray G, Sattar N, Sharma A, Tuomilehto J, Wallia S, Wild SH, Sheikh A. Recruiting South Asians to a lifestyle intervention trial: experiences and lessons from PODOSA (Prevention of Diabetes & Obesity in South Asians). Trials 2011; 12:220. [PMID: 21978409 PMCID: PMC3201899 DOI: 10.1186/1745-6215-12-220] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 10/06/2011] [Indexed: 11/23/2022] Open
Abstract
Background Despite the growing emphasis on the inclusion of ethnic minority patients in research, there is little published on the recruitment of these populations especially to randomised, community based, lifestyle intervention trials in the UK. Methods We share our experience of recruitment to screening in the PODOSA (Prevention of Diabetes and Obesity in South Asians) trial, which screened 1319 recruits (target 1800) for trial eligibility. A multi-pronged recruitment approach was used. Enrolment via the National Health Service included direct referrals from health care professionals and written invitations via general practices. Recruitment within the community was carried out by both the research team and through our partnerships with local South Asian groups and organisations. Participants were encouraged to refer friends and family throughout the recruitment period. Results Health care professionals referred only 55 potential participants. The response to written invitations via general practitioners was 5.2%, lower than reported in other general populations. Community orientated, personal approaches for recruitment were comparatively effective yielding 1728 referrals (82%) to the screening stage. Conclusions The PODOSA experience shows that a community orientated, personal approach for recruiting South Asian ethnic minority populations can be successful in a trial setting. We recommend that consideration is given to cover recruitment costs associated with community engagement and other personalised approaches. Researchers should consider prioritising approaches that minimise interference with professionals' work and, particularly in the current economic climate, keep costs to a minimum. The lessons learned in PODOSA should contribute to future community based trials in South Asians. Trial Registration Current Controlled Trials ISRCTN25729565
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Affiliation(s)
- Anne Douglas
- Centre for Population Health Sciences, The University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, UK.
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James AS, Daley CM, Engelman K, Greiner KA, Ellerbeck E. Process evaluation of recruitment for a cancer screening trial in primary care. Health Promot Pract 2011; 12:696-703. [PMID: 21471439 PMCID: PMC3319739 DOI: 10.1177/1524839910366402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Many cancer screening studies are conducted in primary care settings, yet few systematically analyze recruitment challenges found at these sites. During a randomized trial promoting colorectal cancer screening, we implemented a process evaluation of recruitment. Recruiters maintained logs that registered the numbers of patients entering the clinic, approached by recruiters, declining to participate, and reasons for nonapproach and nonparticipation. One half of age-eligible patients were approached (n = 1,489), and half of those who met basic eligibility requirements agreed to engage further (n = 527). A small proportion of patients (n = 98) completed the 15-min assessment before their appointment. Major reasons for nonapproach included previous approach, patients called to the exam room, and appearing ill. The major reason for nonparticipation was "not interested"; a few patients did not want to share contact information. Some participants exited the assessment midway because of further ineligibility or time limitations. Best-practice recommendations for recruitment in primary care are discussed.
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Affiliation(s)
- Aimee S James
- Department of Surgery, Washington University in Saint Louis, School of Medicine, Saint Louis, MO 63110, U.S.A
| | - Christine M Daley
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS 66160, U.S.A
| | - Kimberly Engelman
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS 66160, U.S.A
| | - K. Allen Greiner
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS 66160, U.S.A
| | - Edward Ellerbeck
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS 66160, U.S.A
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Ejiogu N, Norbeck JH, Mason MA, Cromwell BC, Zonderman AB, Evans MK. Recruitment and retention strategies for minority or poor clinical research participants: lessons from the Healthy Aging in Neighborhoods of Diversity across the Life Span study. THE GERONTOLOGIST 2011; 51 Suppl 1:S33-45. [PMID: 21565817 PMCID: PMC3092978 DOI: 10.1093/geront/gnr027] [Citation(s) in RCA: 195] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose of the study: Investigating health disparities requires studies designed to recruit and retain racially and socioeconomically diverse cohorts. It is critical to address the barriers that disproportionately affect participation in clinical research by minorities and the socioeconomically disadvantaged. This study sought to identify and rectify these barriers to recruit and retain a biracial (African American and non-Hispanic White) and socioeconomically diverse cohort for a longitudinal study. Design and Method: The Healthy Aging in Neighborhoods of Diversity across the Life Span study is a 20-year longitudinal examination of how race and socioeconomic status influence the development of age-related health disparities. One goal was to create a multifactorial recruitment and retention strategy. The recruitment paradigm targeted known barriers and identified those unique to the study's urban environment. The retention paradigm mirrored the recruitment plan but was based on specifically developed approaches. Results: This cohort recruitment required attention to developing community partnerships, designing the research study to meet the study hypotheses and to provide benefit to participants, providing a safe community-based site for the research and creating didactics to develop staff cultural proficiency. These efforts facilitated study implementation and enhanced recruitment resulting in accrual of a biracial and socioeconomically diverse cohort of 3,722 participants. Implications: Recruiting and retaining minority or poor research participants is challenging but possible. The essential facets include clear communication of the research hypothesis, focus on providing a direct benefit for participants, and selection of a hypothesis that is directly relevant to the community studied
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Affiliation(s)
- Ngozi Ejiogu
- Health Disparities Research Section, Clinical Research Branch, National Institute on Aging, National Institutes of Health, NIH Biomedical Research Center, 251 Bayview Blvd, Suite 100 Room 4C-222, Baltimore, MD 21224, USA
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Nápoles AM, Chadiha LA. Advancing the science of recruitment and retention of ethnically diverse populations. THE GERONTOLOGIST 2011; 51 Suppl 1:S142-6. [PMID: 21565815 DOI: 10.1093/geront/gnr019] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We highlight several critical challenges that must be addressed to accelerate the advancement of the science on recruitment and retention of ethnically diverse older adults into health research. These include the relative lack of attention by researchers to methodological issues related to recruitment and retention of ethnically diverse populations and the inadequacy of funding to advance systematically this field. We describe strategies used by the Resource Centers on Minority Aging Research and other National Institute of Aging-funded programs to advance the science of recruitment of ethnically diverse older adults. Finally, we propose a set of broad recommendations designed to generate a body of evidence on successful methods of recruitment and retention of ethnically diverse populations in health research. To eliminate health disparities and better understand aging processes in ethnically diverse populations, much more research is needed on effective strategies for increasing minority enrollment in health research. Comparative effectiveness research on more intensive recruitment and retention methods, which are often needed for including diverse populations, will require dedicated funding and concerted efforts by investigators.
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Affiliation(s)
- Anna M Nápoles
- Division of General Internal Medicine, University of California San Francisco 94118-1944, USA.
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Stineman MG, Strumpf N, Kurichi JE, Charles J, Grisso JA, Jayadevappa R. Attempts to reach the oldest and frailest: recruitment, adherence, and retention of urban elderly persons to a falls reduction exercise program. THE GERONTOLOGIST 2011; 51 Suppl 1:S59-72. [PMID: 21565820 PMCID: PMC3092973 DOI: 10.1093/geront/gnr012] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 02/01/2011] [Indexed: 11/12/2022] Open
Abstract
PURPOSE OF THE STUDY To assess the recruitment, adherence, and retention of urban elderly, predominantly African Americans to a falls reduction exercise program. DESIGN AND METHODS The randomized controlled trial was designed as an intervention development pilot study. The goal was to develop a culturally sensitive intervention for elderly persons who suffered a fall and visited an emergency department (ED). Participants were taught exercises during 4 on-site group classes and encouraged to continue exercising at home for 12 weeks and attend additional on-site monthly classes. The protocol included a specifically designed intervention for increasing retention through trained community interventionists drawn from the participants' neighborhoods. RESULTS The screening of 1,521 ED records after falling yielded the recruitment of 204 patients aged 65 years and older. Half were randomized into the falls prevention program. Of the 102 people in the intervention group, 92 completed the final 6-month assessment, 68 attended all on-site sessions, but only 1 reported exercising at home all 12 weeks. Those who lived alone were more likely (p = .03) and those with symptoms of depression were less likely (p = .05) to attend all on-site exercise classes. The final recruitment rate was estimated as 31.8%. The final retention rates were 90.2% and 87.3% for the intervention and control groups, respectively. IMPLICATIONS Recruitment of frail elderly African American patients is resource intensive. Adherence to the on-site exercise classes was better than to the home-based component of the program. These findings have implications for the design of future community-based exercise programs and trials.
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Affiliation(s)
- Margaret G Stineman
- Physical Medicine and Rehabilitation and Epidemiology, University of Pennsylvania, 904 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA.
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Borgida AE, Ashamalla S, Al-Sukhni W, Rothenmund H, Urbach D, Moore M, Cotterchio M, Gallinger S. Management of pancreatic adenocarcinoma in Ontario, Canada: a population-based study using novel case ascertainment. Can J Surg 2011; 54:54-60. [PMID: 21251433 DOI: 10.1503/cjs.026409] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Pancreatic adenocarcinoma (PA) is largely incurable, although recent progress has been made in the safety of surgery for PA and in adjuvant and palliative chemotherapy. The purpose of this study was to describe the management of PA in Ontario, Canada. METHODS The Pathology Information Management System (PIMS), which uses electronic pathology reporting (E-path), was used to rapidly identify and recruit patients based on a pathologic diagnosis of PA between 2003 and 2006. Patients were mailed questionnaires for additional data. RESULTS The patient participation rate was 26% (351 of 1325). Nonresponders were more likely to be older than 70 years (43% v. 28%, p < 0.001) and to have received treatment in nonacademic centres (53% v. 34%, p < 0.001). Fifty-four percent of responders underwent a potentially curative operation, and most (77%) were 70 years or younger (p = 0.03). Completed resections were documented in 83% of patients who underwent exploratory surgery with curative intent; 17% of patients had unresectable and/or metastatic disease at laparotomy. Of the completed resections, 24% were performed in nonacademic centres with a 32% positive margin rate; 76% were performed in academic centres with a 29% positive margin rate (p = 0.84). Resections with curative intent were less frequently aborted in academic centres (10% v. 33%, p < 0.001). Of the patients who responded to our questionnaire, 43% received chemotherapy and 7% participated in clinical trials. CONCLUSION Despite using PIMS and E-path, the response rate for this study was low (< 30%). Nonresponders were older and more commonly treated in nonacademic centres. Patients undergoing surgery in academic centres had higher resection rates. The rate of adjuvant and palliative chemotherapy was stage-dependent and low.
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Affiliation(s)
- Ayelet Eppel Borgida
- Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex, 69 Murray Street, Toronto, Ontario.
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Mordukhovich I, Reiter PL, Backes DM, Family L, McCullough LE, O'Brien KM, Razzaghi H, Olshan AF. A review of African American-white differences in risk factors for cancer: prostate cancer. Cancer Causes Control 2010; 22:341-57. [PMID: 21184263 DOI: 10.1007/s10552-010-9712-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2010] [Accepted: 12/04/2010] [Indexed: 01/01/2023]
Abstract
OBJECTIVE African American men have higher prostate cancer incidence rates than White men, for reasons not completely understood. This review summarizes the existing literature of race-specific associations between risk factors and prostate cancer in order to examine whether associations differ. METHODS We reviewed epidemiologic studies published between January 1970 and December 2008 that reported race-specific effect estimates. We focused mainly on modifiable risk factors related to lifestyle and health. A total of 37 articles from 21 study populations met our inclusion criteria. RESULTS We found no evidence of racial differences in associations between prostate cancer and alcohol intake, tobacco use, and family history of prostate cancer. Research suggests that a modest positive association may exist between height and prostate cancer risk (all prostate cancer and advanced prostate cancer) among Whites only. No clear patterns were observed for associations with physical activity, weight/body mass index, dietary factors, occupational history, sexual behavior, sexually transmissible infections, and other health conditions. DISCUSSION Our results suggest few differences in prostate cancer risk factors exist between racial groups and underscore areas where additional research is needed. Future studies should enroll higher numbers of African American participants and report results for advanced prostate cancer.
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Affiliation(s)
- Irina Mordukhovich
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, CB #7435, McGavran-Greenberg Hall, Chapel Hill, NC, USA
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