Abstract 4982: A randomized controlled trial of financial incentives to improve electronic health record (EHR)-driven recruitment among underrepresented communities
Authors: Mark Aaron Fiala, Wasihun Gema, Andrew Davis, Foluso Ademuyiwa
Journal: Cancer Research (2025)

Abstract Background: Disparities in EHR portal use have been documented based on age, race, ethnicity, and other factors. Thus, EHR-driven research recruitment may worsen representation of these groups. Monetary incentives can increase response rates, but their impact on improving inclusivity in research is unknown. In this study, we aimed to determine if a financial incentive improves response rates to recruitment messages in an equitable fashion. Patients and Methods: A random sample of 1, 200 patients with diagnoses of either breast, colorectal, prostate, or lung cancer treated at Washington University in St. Louis received a recruitment message for a fictitious cross-sectional survey study “The Social Aspects of Cancer Care” via their EHR portal. Two strata of patients were sampled, those who identify as non-Hispanic White (n = 600) and those who identify as another race or ethnicity (n = 600). Participants were randomized to receive an offer of a $20 monetary incentive (n=400) or no incentive (n=800) for their enrollment. Patients were debriefed following their participation, and all participants received the incentive regardless of randomization assignment. The primary endpoints include the comparison of response rates by 1) race and 2) financial incentive. Results: The sample consisted of 1200 patients with a history of breast (31%), prostate (28%), lung (25%), and colorectal cancer (16%). The mean age was 65.7 years (SD 12.3) and 46% were male. Fifty percent identified non-Hispanic White, 38% African American or Black, and 12% as another race or ethnicity. Overall, 39% of participants viewed the recruitment message and 13% responded that they were interested. Incentives did not improve response rates to a statistically significant degree. The response rate for the incentive cohort was 15% compared to 12% for no incentive (p = 0.206). Response rates were higher (p &amp;lt; 0.001) among non-Hispanic White patients (18%) than for African American or Black (7%) and members of other racial/ethnic groups (13%). This was true for patients who did not receive an offer of an incentive (18% compared to 9% and 10%; p &amp;lt;0.001) and for those that did (19% compared to 9% and 20%; p = 0.028). There was a trend for greater improvement in response rate for patients of racial and ethnic minorities, but it was not statistically significant (p = 0.129). We performed a secondary analysis of the 471 patients who viewed the message and found similar results regarding the differences in response rates based on race and ethnicity and the lack of impact of incentives. Conclusions: People with cancer who identify as a racial and ethnic minority are less likely to view and respond to recruitment messages for research studies through their EHR patient portal. The impact of a $20 financial incentive was modest, if any, but may be greater on people who identify as a racial and ethnic minority. Citation Format: Mark Aaron Fiala, Wasihun Gema, Andrew Davis, Foluso Ademuyiwa. A randomized controlled trial of financial incentives to improve electronic health record (EHR)-driven recruitment among underrepresented communities [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 4982.