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Minority Recruitment in the NLST

Minority Recruitment in the NLST. Catherine Duda, MPH Irene Mahon, RN, MPH Mei Hsiu Chen, PhD Bradley Snyder, MS Richard Barr, MD PhD Caroline Chiles, MD Robert Falk, MD Elliott Fishman, MD David Gemmel , PhD Jonathan G. Goldin, MD PhD Reginald Munden , MD Kay Vydaryny , MD

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Minority Recruitment in the NLST

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  1. Minority Recruitment in the NLST Catherine Duda, MPH Irene Mahon, RN, MPH Mei Hsiu Chen, PhD Bradley Snyder, MS Richard Barr, MD PhD Caroline Chiles, MD Robert Falk, MD Elliott Fishman, MD David Gemmel, PhD Jonathan G. Goldin, MD PhD Reginald Munden, MD Kay Vydaryny, MD Kathy Brown, MD Denise R. Aberle, MD ACRIN Fall meeting 10-2009

  2. the problem • Limited minority participation in prevention research • Impact: • Generalizability | health care delivery • Equitably distribute risks and benefits of clinical trials • Barriers • Lack of awareness of clinical trials • Lack of opportunity • Barriers of opportunity

  3. NLST ACRIN objectives • Measure effects of targeted strategies on accruing underrepresented groups • Characterize participant characteristics as result of strategies • Estimate the costs of targeted enrollment

  4. methods • Estimate proportions of racial/ethnic categories • Tobacco Use Supplement of the 1998-99 population survey • Proportions: 91.7% White, 6.3% African American,1.0% Asian, 1.0% American Indian/Alaskan native, 3.4% Hispanic

  5. methods • Estimate proportions of racial/ethnic categories • Tobacco Use Supplement of the 1998-99 population survey • Proportions: 91.7% White, 6.3% African American,1.0% Asian, 1.0% American Indian/Alaskan native, 3.4% Hispanic • Site selection criteria • Situated in cultural diverse settings: UC Census Bureau • Target recruitment strategies already implemented • Proven success in accruing minority populations

  6. methods - planning • Strategic planning began March 2003 (month 7) • Initial meeting: ACS, NCI, NCI OC, ACRIN leadership • NLST ACRIN trial-wide conference calls • Introduce the minority recruitment plan • Review barriers | potential solutions • Sites asked to submit recruitment plan with budget • Supplemental funding was requested, not guaranteed • 6 sites (1 site later participated)

  7. NLST-ACRIN minority institutions

  8. results: summary minority accrual

  9. results: site-specific accruals

  10. results: racial | ethnic characteristics

  11. results: age, smoking characteristics, sex

  12. results: education | income

  13. results: education | income

  14. results: education | income

  15. results: education | income

  16. results: education | income

  17. results: medical insurance

  18. results: enrollment pre- & post implementation

  19. results: enrollment pre- & post implementation

  20. results: enrollment pre- & post implementation

  21. results: minority recruitment strategies by site

  22. results: minority recruitment strategies by site

  23. results: minority recruitment strategies by site

  24. results: minority recruitment strategies by site

  25. results: minority recruitment strategies by site

  26. results: minority recruitment strategies by site

  27. results: minority recruitment strategies by site

  28. results: minority recruitment strategies by site

  29. discussion: strategic approaches • A priori accrual goals based on racial/ethnic proportions • Minority enrollment a factor in site selection • Recruitment planning well in advance • Flexibility in eligibility1 • Endorsement by prominent representatives of the racial groups of interest1 1: SELECT: Phase III chemoprevention trial for prostate cancer: N = 35,53422% minorities: 15% AA | 6% Hispanic | 1% Asian

  30. discussion: strategic approaches • A priori accrual goals based on racial/ethnic proportions • Minority enrollment a factor in site selection • Recruitment planning well in advance • Flexibility in eligibility1 • Endorsement by prominent representatives of the racial groups of interest1 1: SELECT: Phase III chemoprevention trial for prostate cancer: N = 35,53422% minorities: 15% AA | 6% Hispanic | 1% Asian

  31. discussion: strategic approaches • A priori accrual goals based on racial/ethnic proportions • Minority enrollment a factor in site selection • Recruitment planning well in advance • Flexibility in eligibility1 • Endorsement by prominent representatives of the racial groups of interest1 1: SELECT: Phase III chemoprevention trial for prostate cancer: N = 35,53422% minorities: 15% AA | 6% Hispanic | 1% Asian

  32. discussion: strategic approaches • A priori accrual goals based on racial/ethnic proportions • Minority enrollment a factor in site selection • Recruitment planning well in advance • Flexibility in eligibility1 • Endorsement by prominent representatives of the racial groups of interest1 1: SELECT: Phase III chemoprevention trial for prostate cancer: N = 35,53422% minorities: 15% AA | 6% Hispanic | 1% Asian

  33. discussion: strategic approaches • A priori accrual goals based on racial/ethnic proportions • Minority enrollment a factor in site selection • Recruitment planning well in advance • Flexibility in eligibility1 • Endorsement by prominent representatives of the racial groups of interest1 1: SELECT: Phase III chemoprevention trial for prostate cancer: N = 35,53422% minorities: 15% AA | 6% Hispanic | 1% Asian

  34. discussion: strategic approaches • Awareness • Grass roots education: Churches, clinics/providers, trial champions • Targeted advertising & mailing • Opportunity • Access: Site hours | transportation | reimburse time & travel • Insurance status: site diagnostic testing | clinic referrals • Trial requirements and duration • Individual beliefs: barriers of perspective

  35. limitations • No standard documentation of reasons for non-participation • Incomplete description of recruitment methods • “Other” and “word of mouth” incorporates • Grass roots efforts • Dedicated minority staff • Media ads: newspaper ads • Site experience and organizational structure

  36. conclusions • Targeted strategies increase racial/ethnic representation • Sites with targeted strategies accounted for 80% of all minorities enrolled • Dominated minority accrual pre-implementation • 60% increase in minority accrual post-implementation • No single strategy effective across all sites • Costs associated with targeted accrual | highly variable

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