Recruiting Black and White patients to a behavioral oncology clinical trial: Lessons from the DISCO trial.
Authors: Hamel Lauren M. , Tadesse Eyouab , Grossi Roman , Mabunda Lorna , Austin Teneisha , Dougherty David W. , Angers Keri , Tutuska Karis , Daigle Mai , Eggly Susan 
Published: May 2024

e13684 Background: Clinical trials are often terminated due to insufficient accrual, with only about 6% of patients enrolling into a trial. Trial enrollment rates are even lower for Black patients. In 2021, we began recruitment for a clinic-based behavioral trial testing the effectiveness of a health equity communication intervention designed to address patient cancer treatment cost concerns. This study involves patients and providers completing surveys before and after a video-recorded clinical interaction. We are implementing this study at a NCI-designated comprehensive cancer center in Detroit, Michigan, a city with a majority Black population. Based on findings that most patients agree to participate in a trial if they are eligible and invited, we set a sample goal of 50% Black and 50% White patients. We used evidence-based strategies and lessons from our previous work, including having a diverse staff and building trusting relationships with provider and patient participants. As we begin the final year of recruitment, we consider what suggestions we can offer teams seeking to recruit a diverse patient sample to trials. Methods: We based our strategies on evidence that racially concordant (same racial group) clinical dyads have better communication quality than racially discordant (different racial group) dyads, and that medical mistrust is greater among Black patients than among White patients. First, we hired and trained a team that includes Black and White members, and encouraged them to take leadership roles. Second, we built trust with providers, staff, and patients. Procedures involve discussing the study with providers and their staff, recruiting providers as participants, and screening patients for eligibility. We 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 achieved a consent rate of 52% across 4 clinics; our sample includes 86 (61%) Black patients and 55 (39%) White patients, which reflects the demographics of our patient population. We attribute our success to critical aspects of our protocol. First, recruitment of providers as participants helps capture the attention of and builds trust with patients. Second, we have a flexible recruitment approach. Once potential participants are screened, we can approach them in person or by phone. Third, our team composition reflects the patient population we hope to recruit. Last, we have the support of a diverse group of medical student team members in terms of race, gender, and age who provide additional recruitment support. Conclusions: Our strategies, based on scientific 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 .