Impact and costs of targeted recruitment of minorities to the National Lung Screening Trial

Abstract

Background To promote results in the National Lung Screening Trial (NLST) that are generalizable across the entire US population, a subset of NLST sites developed dedicated strategies for minority recruitment. Purpose To report the effects of targeted strategies on the accrual of underrepresented groups, to describe participant characteristics, and to estimate the costs of targeted enrollment. Methods The 2002–2004 Tobacco Use Supplement was used to estimate eligible proportions of racial and ethnic categories. Strategic planning included meetings/conferences with key stakeholders and minority organizations. Potential institutions were selected based upon regional racial/ethnic diversity and proven success in recruitment of underrepresented groups. Seven institutions submitted targeted recruitment strategies with budgets. Accrual by racial/ethnic category was tracked for each institution. Cost estimates were based on itemized receipts for minority strategies relative to minority accrual. Results Of 18,842 participants enrolled, 1576 (8.4%) were minority participants. The seven institutions with targeted recruitment strategies accounted for 1223 (77.6%) of all minority participants enrolled. While there was a significant increase in the rate of minority accrual pre-implementation to post-implementation for the institutions with targeted recruitment (9.3% vs. 15.2%, P<0.0001), there was no significant difference for the institutions without (3.5% vs. 3.8%, P=0.46). Minority enrollees at the seven institutions tended to have less than a high school education, be economically disadvantaged, and were more often uninsured. These socio-demographic differences persisted at the seven institutions even after adjusting for race and ethnicity. The success of different strategies varied by institution, and no one strategy was successful across all institutions. Costs for implementation were also highly variable, ranging from $146 to $749 per minority enrollee. Limitations Data on minority recruitment processes were not consistently kept at the individual institutions. In addition, participant responses via newspaper advertisements and the efforts of minority staff hired by the institutions could not be coded on Case Report Forms. Conclusions Strategic efforts were associated with significant increases in minority enrollment. The greatest successes require that a priori goals be established based on eligible racial/ethnic proportions; the historical performance of sites in minority accrual should factor into the selection of sites; recruitment planning must begin well in advance of trial launch; and there must be endorsement by prominent representatives of the racial groups of interest.

Barriers to Clinical Trial Enrollment in Racial and Ethnic Minority Patients with Cancer

“…32,79 One such intervention targeted minority recruitment using strategic planning, which included meetings and conferences with key stakeholders and minority organizations as a means to increase minority enrollment. 79 The authors examined institutions that employed these strategies and those that did not, and they found a significant increase in the rate of minority accrual in institutions that implemented strategic planning compared with those that did not. 79 This effort suggests that the mistrust of the medical system seen among minority patients might be addressed with culturally sensitive and open community engagement.…”

“…79 The authors examined institutions that employed these strategies and those that did not, and they found a significant increase in the rate of minority accrual in institutions that implemented strategic planning compared with those that did not. 79 This effort suggests that the mistrust of the medical system seen among minority patients might be addressed with culturally sensitive and open community engagement.…”

Uniting Postcolonial, Discourse, and Linguistic Theory to Explore Participation of African Americans in Cancer Research as an Effect of Social and Historical Race Relationships

“…1,[3][4][5][6][7] Despite the literature emphasizing these deficits, African Americans continue to be a disproportionately underrepresented population in cancer clinical trials. [12][13][14][15][16][17][18][19] Research studies often report health disparities as numerical values of cancer cases, cancer deaths, participation or nonparticipation in clinical trials, income level, education level, gender, and reported age groups. [12][13][14][15][16][17][18][19] These are meaningful data that need to be incorporated as part of 34 ADVANCES IN NURSING SCIENCE/JANUARY-MARCH 2014 a strategy to improve recruitment of African Americans to clinical trials.…”

Retaining traditionally hard to reach participants: Lessons learned from three childhood obesity studies

“…[8] Some of the identified barriers include transportation, childcare, cultural and language differences, inflexible work hours, communication barriers, [13] distrust in health-related research, and less reliable contact information. [8, 10; 14–17] …”