Minority Recruitment in the NLST

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

9. results: summary minority accrual

10. results: site-specific accruals

11. results: racial | ethnic characteristics

12. results: age, smoking characteristics, sex

13. results: education | income

14. results: education | income

15. results: education | income

16. results: education | income

17. results: education | income

18. results: medical insurance

19. results: enrollment pre- & post implementation

20. results: enrollment pre- & post implementation

21. results: enrollment pre- & post implementation

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. results: minority recruitment strategies by site

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 • 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

35. 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

36. 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

37. 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