Recruiting Black and White patients to a behavioral oncology clinical trial: Lessons from the DISCO trial.
Authors: Grossi Roman , Tadesse Eyouab , Mabunda Lorna , Austin Teneisha , Angers Keri , Tutuska Karis , Daigle Mai , Eggly Susan , Dougherty David W. , Hamel Lauren M. 
Published: October 2023

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Background: Data show that 55% of trials are terminated due to insufficient accrual, which is especially low for patients identifying as Black. In 2021, we initiated recruitment to a clinic-based behavioral oncology trial testing the effectiveness of a health equity communication intervention designed to address patient cost concerns. This study involves patients and clinicians completing surveys before and after a video-recorded clinical interaction. We are implementing this study at an NCI-designated comprehensive cancer center in Detroit, Michigan, a city comprised of a majority of Black residents (80%). Based on the aims and literature showing that most patients agree to participate in trials if they are eligible and invited, we set a sample goal of 50% Black and 50% White patients. We use strategies based on literature and our own experience, including having a diverse staff and building trusting relationships with participants. As we begin the third and final year of recruitment with about 2/3 of our required patient sample (N=180) recruited, we consider what suggestions we can offer teams seeking to efficiently recruit a diverse patient sample to clinical trials. Methods: We based our strategies on evidence that racially concordant (same racial group) clinical dyads have greater communication quality than racially discordant (different racial group) dyads, and that medical mistrust is greater among Black than among White patients. First, we hired and trained a team that includes both Black and White members, and encouraged them to take leadership roles in the team. Second, we built trust with clinic staff, clinicians and patients. Procedures involve discussing the study with clinicians and their staff, recruiting clinicians as participants, and screening their patients for eligibility. We then recruit patients in-person in the clinic or by phone. Patients who provide oral consent are later met in person to collect written consent. Results: We have achieved a consent rate of 52% across 4 clinics; our sample includes 74 (62%) Black patients and 45 (38%) White patients. We attribute this to critical aspects of our protocol. First, recruitment of clinicians as participants helps capture the attention of and build trust with patients. Second, we have a flexible recruitment approach. Once potential participants are screened, we decide whether to approach them in person or by phone. Third, our team is comprised of Black and White individuals to reflect the patient population we hope to recruit. Last, we have the support of a diverse group of medical student team members who assist in times of increased recruitment. Conclusions: Our strategies, based on social science literature, helped achieve our goal of recruiting a sample that reflects racial diversity in our patient population. These and similar strategies can be adapted for other trials with the goal of achieving clinical trial recruitment equity. Clinical trial information: NCT04766190 .