Abstract PO-012: Acceptance and refusal among multi-lingual safety net patients to participate in a trial comparing genetic counseling delivery modes
Authors: Lee Robin , Frick Miya , Kaplan Celia , Joseph Galen , Tsoh Janice , Flores Selina , Dixit Niharika , Cedermaz Heather , Wang Lly , Khoury Amal , Campbell Brittany , Pasick Rena , Guerra Claudia S. , Stewart Susan L. 
Published: December 2020

Abstract
Introduction While still low, diversity among clinical trial participants has improved in recent years due to efforts to eliminate health disparities. Here we present and endeavor to explain participation rates in our multicenter partially randomized preference noninferiority trial comparing the effectiveness of phone, video, and in person genetic counseling among high-risk English-, Spanish-, and Chinese-speaking patients. Methods High-risk patients were identified using a family history screener in clinics and via physician referrals. After reviewing forms received, bilingual/bicultural clinical research coordinators (CRC) called patients considered eligible in their preferred language (English, Spanish or Cantonese, Mandarin or Toisanese). Patients were informed that their hospital was conducting the study in conjunction with an academic institution. The CRC went over each patient’s family history of cancer to confirm eligibility and to explain the study components, including free genetic counseling. Because previous research had significant refusals due to patients’ preferences for a single mode, our consented patients were asked if they would accept random assignment to phone, video, or in person counseling or if they had a strong preference. Patients who declined were asked their reasons. Results Out of 1,403 patients reached (70% English-, 26% Spanish-, and 3% Chinese- speaking), 86% agreed to participate. The highest acceptance rate was among Spanish-speakers (94%), followed by English-speakers (83%) and Chinese-speakers (67%). Among the 201 patients who declined, 49% did so upon contact, while 51% declined after eligibility was confirmed. Reasons for declining are available for 71% of decliners as follows: 22% not interested; 19% no time; 10% cited no benefit them or family members; 7% did not want to talk about cancer; 7% had too many other medical issues; and 6% provided a range of other reasons. Discussion and Conclusions We believe that our study’s high initial participation rate for patients contacted was due to the purpose which was particularly meaningful to those with a family history of cancer. Also, patients trusted their own hospitals which co- sponsored the study. It was helpful that providers in the 3 public hospitals strongly supported the research which provided much needed genetic counseling and pursued questions important to access to genetic services. Importantly, our study design addressed significant known barriers to minority and low SES participation in clinical trials through the use of bilingual/bicultural investigators, multi-language study materials, and strong, positive working relationships with gatekeeper medical and clinic support staff. Reasons given for declining may indicate the existence of a socio-economic structural ceiling for participation due to patient vulnerabilities and societal burdens, causes outside the investigative scope of our study that are likely to continue to hamper efforts to improve participation if not addressed.
Citation Format: Robin Lee, Miya Frick, Celia Kaplan, Galen Joseph, Janice Tsoh, Selina Flores, Niharika Dixit, Heather Cedermaz, Lly Wang, Amal Khoury, Brittany Campbell, Rena Pasick, Claudia S. Guerra, Susan L. Stewart. Acceptance and refusal among multi-lingual safety net patients to participate in a trial comparing genetic counseling delivery modes [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-012.