ACRIN Fall meeting 10-2009 Minority Recruitment in the NLST Catherine Duda, MPHIrene Mahon, RN, MPH Mei Hsiu Chen, PhDBradley Snyder, MS Richard Barr,

ACRIN Fall meeting 10-2009 Minority Recruitment in the NLST Catherine Duda, MPHIrene Mahon, RN, MPH Mei Hsiu Chen, PhDBradley Snyder, MS Richard Barr, MD PhDCaroline Chiles, MD Robert Falk, MDElliott Fishman, MD David Gemmel, PhDJonathan G. Goldin, MD PhD Reginald Munden, MDKay Vydaryny, MD Kathy Brown, MDDenise R. Aberle, MD ACRIN Fall meeting 10-2009

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

ACRIN Fall meeting 10-2009 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

ACRIN Fall meeting 10-2009 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

ACRIN Fall meeting 10-2009 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

ACRIN Fall meeting 10-2009 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)

InstitutionLocationPopulation of Interest Emory UniversityAtlanta, GAAfrican American Jewish Heart and LungLouisville, KYAfrican American Johns Hopkins UniversityBaltimore, MDAfrican American M.D. Anderson Cancer CenterHouston, TXHispanic St. Elizabeth’s Health System 1 Youngstown, OHAfrican American UCLA Jonsson Cancer CenterLos Angeles, CAAfrican American, Hispanic, Asian Wake Forest UniversityWinston-Salem, NCAfrican American 1 St. Elizabeth’s Health System was not initially an accruing NLST-ACRIN institution, but later submitted a plan. NLST-ACRIN minority institutions

Race | Ethnicity Minority Sites N (%) Remaining Sites N (%) Total N (%) African American895 (82%)193 (18%)1088 (100%) Asian81 (74%)29 (26%) 110 (100%) Hispanic / Latino163 (67%)82 (33%)245 (100%) > 1 race70 (71%)28 (29%)98 (100%) Total1209 (78%)332 (22%)1541 (100%) results: summary minority accrual

Emory Jewish Heart and Lung Johns Hopkins MDA St Elizabeth’s UCLA Wake Forest All Minority Sites All other Institutions Total Race N (%) AA 175 (14.3%) 87 (4.4%) 406 (24.3%) 56 (7.1%) 39 (3.7%) 99 (6.3%) 33 (3.0%) 895 (9.5%) 193 (2.0%) 1088 (5.8%) Asian 1 (0.1%) 5 (0.3%) 4 (0.5%) 5 (0.5%) 57 (3.6%) 4 (0.4%) 81 (0.9%) 29 (0.3%) 110 (0.6%) White 1048 (85.3%) 1876 (95.0%) 1253 (74.9%) 675 (86.0%) 988 (94.5%) 1349 (85.5%) 1061 (95.8%) 8250 (87.8%) 9157 (96.9%) 17407 (92.4%) > 1 Race 0 (0.0%) 2 (0.1%) 21 (2.7%) 7 (0.7%) 35 2.2%) 3 (0.3%) 70 (0.7%) 28 (0.3%) 98 (0.5%) Ethnicity 1 N (%) Hispanic 11 (0.9%) 10 (0.5%) 8 (0.5%) 40 (5.1%) 22 (2.1%) 67 (4.2%) 5 (0.5%) 163 (1.7%) 82 (0.9%) 245 (1.3%) Non Hispanic 1216 (99.0%) 1960 (99.3%) 1665 (99.5%) 744 (94.8%) 1022 (97.7%) 1483 (94.0%) 1102 (99.5%) 9192 (97.9%) 9357 (99.0%) 18549 (98.4%) Total 1228 (100%) 1974 (100%) 1673 (100%) 785 (100%) 1046 (100%) 1578 (100%) 1108 (100%) 9392 (100%) 9450 (100%) 18842 (100%) results: site-specific accruals

Emory Jewish Heart and Lung Johns Hopkins MDA St Elizabeth’s UCLA Wake Forest All Minority Sites All other Institutions Total Race N (%) AA 175 (14.3%) 87 (4.4%) 406 (24.3%) 56 (7.1%) 39 (3.7%) 99 (6.3%) 33 (3.0%) 895 (9.5%) 193 (2.0%) 1088 (5.8%) Asian 1 (0.1%) 5 (0.3%) 4 (0.5%) 5 (0.5%) 57 (3.6%) 4 (0.4%) 81 (0.9%) 29 (0.3%) 110 (0.6%) White 1048 (85.3%) 1876 (95.0%) 1253 (74.9%) 675 (86.0%) 988 (94.5%) 1349 (85.5%) 1061 (95.8%) 8250 (87.8%) 9157 (96.9%) 17407 (92.4%) > 1 Race 0 (0.0%) 2 (0.1%) 21 (2.7%) 7 (0.7%) 35 2.2%) 3 (0.3%) 70 (0.7%) 28 (0.3%) 98 (0.5%) Ethnicity 1 N (%) Hispanic 11 (0.9%) 10 (0.5%) 8 (0.5%) 40 (5.1%) 22 (2.1%) 67 (4.2%) 5 (0.5%) 163 (1.7%) 82 (0.9%) 245 (1.3%) Non Hispanic 1216 (99.0%) 1960 (99.3%) 1665 (99.5%) 744 (94.8%) 1022 (97.7%) 1483 (94.0%) 1102 (99.5%) 9192 (97.9%) 9357 (99.0%) 18549 (98.4%) Total 1228 (100%) 1974 (100%) 1673 (100%) 785 (100%) 1046 (100%) 1578 (100%) 1108 (100%) 9392 (100%) 9450 (100%) 18842 (100%) results: racial | ethnic characteristics

Feature Minority Institution Non-Minority Institution Total Age at study consent Median61 Range 1 (55 - 74) Smoking Status Current smokers (%)5052 (53.8%)4463 (47.2%)9515 (50.5%) Former smokers (%)4340 (46.2%)4987 (52.8%)9327 (49.5%) Sex Female4020 (42.8%)4417 (46.7%)8437 (44.8%) Male5372 (57.2%)5033 (53.3%) 1 10405 (55.2%) 1 P < 0.001 results: age, smoking characteristics, sex

Minority Sites (N = 7)Other Sites (N = 16) Minority White Non- Hispanic 1 TotalMinority White Non- Hispanic 1 Total Education N (%) Less than high school 217 (17.8%)567 (6.9%)784 (8.3%)42 (11.9%)423 (4.7%)465 (4.9%) High school graduate or GED 313 (25.6%)1855 (22.7%)2169 (23.1%)71 (20.1%)2106 (23.2%)2178 (23.0%) Post-high school: technology school, associate degree, some college 389 (31.8%)2804 (34.4%)3194 (34.0%)121 (34.2%)3141 (34.5%)3264 (34.5%) Bachelor’s degree 136 (11.1%)1446 (17.7%)1584 (16.9%)43 (12.1%)1565 (17.2%)1608 (17.0%) Graduate or professional school 133 (10.9%)1277 (15.6%)1412 (15.0%)66 (18.6%)1601 (17.6%)1667 (17.6%) Household income N (%) < $15,000 363 (29.7%)776 (9.5%)1139 (12.1%)59 (16.7%)621 (6.8%)680 (7.2%) $15,000 – $34,999 293 (24.0%)1768 (21.7%)2062 (22.0%)84 (23.7%)1917 (21.1%)2001 (21.2%) $35,000 - $64,999 223 (18.2%)2268 (27.8%)2492 (26.5%)89 (25.1%)2737 (30.1%)2828 (29.9%) $65,000 - $100,000 122 (10.0%)1396 (17.1%)1518 (16.2%)42 (11.9%)1700 (18.7%)1742 (18.4%) > $100,000 64 (5.2%)892 (10.9%)958 (10.2%)28 (7.9%)1001 (11.0%)1029 (10.9%) results: education | income

Minority Sites (N = 7)Other Sites (N = 16) Minority Participants White | Non- Hispanic 1 Total Minority Participants White | Non- Hispanic 1 Total Insurance Status N (%) Private insurance and/or Medicare 859 (70.3%)7158 (87.7%)8024 (85.4%)278 (78.5%)8218 (90.4%)8499 (89.9%) Medicaid 38 (3.1%)42 (0.5%)80 (0.9%)10 (2.8%)77 (0.8%)87 (0.9%) Medicaid and Medicare 35 (2.9%)54 (0.7%)89 (0.9%)13 (3.7%)83 (0.9%)96 (1.0%) Military or Veteran’s Administration 68 (5.6%)278 (3.4%)346 (3.7%)17 (4.8%)227 (2.5%)244 (2.6%) No insurance 191 (15.6%)514 (6.3%)706 (7.5%)26 (7.3%)341 (3.8%)367 (3.9%) Total 1222 (100%)8162 (100%)9392 (100%)354 (100%)9092 (100%)9450 (100%) results: medical insurance

results: enrollment pre- & post implementation Type of InstitutionTime Period 1 Minority participant N (%) White/Non- Hispanic N (%) Total Institutions with Targeted Recruitment Strategies Pre-Implementation322 (9.3%)3153 (90.6%)3479 Post-Implementation900 (15.2%)5009 (84.7%)5913 Other Institutions Pre-Implementation113 (3.6%)3058 (96.3%)3174 Post-Implementation241 (3.8%)6034 (96.1%)6276 Total1576 (8.4%)17254 (91.6%)18842 1 Pre-implementation refers to the period on or prior to 5/31/2003

results: enrollment pre- & post implementation Type of InstitutionTime Period 1 Minority participant White/Non- Hispanic participant 2 Total Institutions with Targeted Recruitment Strategies Pre-Implementation322 (9.3%)3153 (90.6%)3479 Post-Implementation900 (15.2%)5009 (84.7%)5913 Other Institutions Pre-Implementation113 (3.6%)3058 (96.3%)3174 Post-Implementation241 (3.8%)6034 (96.1%)6276 Total1576 (8.4%)17254 (91.6%)18842 1 Pre-implementation refers to the period on or prior to 5/31/2003

results: minority recruitment strategies by site Strategy InstitutionsN (% minority) Total EmoryJewishJHMDASt. E’sUCLAWF Local | National Radio 15 (7.9%)1 (0.9%)59 (13.8%)1 (0.9%)3 (3.9%)109 (41.8%)1 (2.0%)189 (15.5%) Local | National TV 119 (62.6%)29 (27.1%)117 (27.5%)19 (17.1%)9 (11.7%)18 (6.9%)13 (26.0%)324 (26.5%) Physician | Clinic 10 (5.3%)3 (2.8%)2 (0.5%)0 (0.0%)4 (5.2%)4 (1.5%)2 (4.0%)25 (2.0%) Word of mouth 9 (4.7%)10 (9.3%)125 (29.3%)8 (7.2%)20 (26.0%)18 (6.9%)4 (8.0%)194 (15.9%) Targeted mailing 12 (6.3%)51 (47.7%)76 (17.8%)51 (45.9%)14 (18.2%)39 (14.9%)15 (30.0%)258 (21.1%) Other effort 1 25 (13.2%)13 (12.1%)47 (11.0%)32 (28.8%)27 (35.1%)73 (28.0%)15 (30.0%)232 (19.0%) Total 190 (100%)107 (100%)426 (100%)111 (100%)77 (100%)261 (100%)50 (100%)1222 (100%) Total Accrual (% minority) 1228 (15.5%) 1974 (5.5%) 1673 (25.5%) 785 (14.1%) 1046 (7.4%) 1578 (16.5%) 1108 (4.5%) 9392 (13.0%) Total institutional cost $27,726$37,854$126,600NA$4,796$99,331$37,468$333,775 3 Total cost per minority participant $146$354$297NA$62$381$749$300 3 1 Other recruitment effort includes newspaper ads, job/health fairs and minority recruiters.

results: minority recruitment strategies by site Strategy InstitutionsN (% minority) Total EmoryJewishJHMDASt. E’sUCLAWF Local | National Radio 15 (7.9%)1 (0.9%)59 (13.8%)1 (0.9%)3 (3.9%)109 (41.8%)1 (2.0%)189 (15.5%) Local | National TV 119 (62.6%)29 (27.1%)117 (27.5%)19 (17.1%)9 (11.7%)18 (6.9%)13 (26.0%)324 (26.5%) Physician | Clinic 10 (5.3%)3 (2.8%)2 (0.5%)0 (0.0%)4 (5.2%)4 (1.5%)2 (4.0%)25 (2.0%) Word of mouth 9 (4.7%)10 (9.3%)125 (29.3%)8 (7.2%)20 (26.0%)18 (6.9%)4 (8.0%)194 (15.9%) Targeted mailing 12 (6.3%)51 (47.7%)76 (17.8%)51 (45.9%)14 (18.2%)39 (14.9%)15 (30.0%)258 (21.1%) Other effort 1 25 (13.2%)13 (12.1%)47 (11.0%)32 (28.8%)27 (35.1%)73 (28.0%)15 (30.0%)232 (19.0%) Total 190 (100%)107 (100%)426 (100%)111 (100%)77 (100%)261 (100%)50 (100%)1222 (100%) Total Accrual (% minority) 1228 (15.5%) 1974 (5.5%) 1673 (25.5%) 785 (14.1%) 1046 (7.4%) 1578 (16.5%) 1108 (4.5%) 9392 (13.0%) Total institutional cost $27,726$37,854$126,600NA$4,796$99,331$37,468$333,775 3 Total cost per minority participant $146$354$297NA$62$381$749$300 3 1 Other recruitment effort includes newspaper ads, minority recruiters, and job/health fairs.

ACRIN Fall meeting 10-2009 A priori accrual goals based on racial/ethnic proportions Minority enrollment a factor in site selection Recruitment planning well in advance Flexibility in eligibility 1 Endorsement by prominent representatives of the racial groups of interest 1 1: SELECT: Phase III chemoprevention trial for prostate cancer: N = 35,534 22% minorities: 15% AA | 6% Hispanic | 1% Asian discussion: strategic approaches

ACRIN Fall meeting 10-2009 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 discussion: strategic approaches

ACRIN Fall meeting 10-2009 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

ACRIN Fall meeting 10-2009 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

ACRIN Fall meeting 10-2009 Minority Recruitment in the NLST Catherine Duda, MPHIrene Mahon, RN, MPH Mei Hsiu Chen, PhDBradley Snyder, MS Richard Barr,

Similar presentations

Presentation on theme: "ACRIN Fall meeting 10-2009 Minority Recruitment in the NLST Catherine Duda, MPHIrene Mahon, RN, MPH Mei Hsiu Chen, PhDBradley Snyder, MS Richard Barr,"— Presentation transcript:

Similar presentations

About project

Feedback

Log in

Auth with social network:

ACRIN Fall meeting 10-2009 Minority Recruitment in the NLST Catherine Duda, MPHIrene Mahon, RN, MPH Mei Hsiu Chen, PhDBradley Snyder, MS Richard Barr,

Similar presentations

Presentation on theme: "ACRIN Fall meeting 10-2009 Minority Recruitment in the NLST Catherine Duda, MPHIrene Mahon, RN, MPH Mei Hsiu Chen, PhDBradley Snyder, MS Richard Barr,"— Presentation transcript:

Similar presentations

About project

Feedback