Challenges and solutions to recruiting diverse populations to oncology clinical trials: A mixed-methods study of clinical research coordinators.

Abstract

1619 Background: Multiple barriers limit the enrollment of diverse populations in oncology clinical trials (CTs). A review of our institutional CTs recruitment dashboard identified underrepresentation of Black and Latinx adults among thoracic and gastrointestinal (GI) oncology CTs participants compared to demographics of our catchment area and patient population. We conducted a mixed-methods study to identify barriers and potential solutions to the enrollment of diverse populations in oncology CTs in our institution. Methods: We conducted a mixed methods study enrolling clinical investigators and clinical research coordinators’ (CRCs) at an NCI-designated CCC in Northern California. Data from CRCs is presented. All CRCs supporting CTs in the thoracic and GI medical oncology were invited to participate in qualitative, one-on-one, semi-structured interviews. Participants completed 60-90 minutes interview and a short survey. Data were analyzed using a thematic inductive approach. Results: Of 14 CRCs, the majority were female (78.6%), with primary focus on thoracic (50.0%) and GI (35.7%) oncology CTs. 64.3% of CRCs reported >80% of their work was dedicated to coordinating and managing therapeutic cancer CTs. In survey responses CRCs identified inability to take time away from work/family (64.3%), inadequate insurance coverage (42.9%), lack of transportation (35.7%), and language barriers (35.7%) as major barriers to enrollment of diverse patients in CTs. In qualitative interviews CRCs expressed the need of culturally and language appropriate materials for CT recruitment, establishing a sense of connection between clinical research staff/PI and patients, accommodating socioeconomic concerns, and resources to respond to potential participants’ mistrust of medical research. Main obstacles faced by CRCs during patient enrollment in CTs included lack of time, low patient awareness, resistance from colleagues, lack of multilingual staff, and inadequate logistical support. CRCs identified in-person interpretation as beneficial and identified a strong rapport between the clinical provider and the potential participant as the most important component to boost recruitment of minorities. Lastly, CRCs highlighted that institutional efforts are needed to increase CT participation among all populations. Conclusions: Lack of representation of diverse populations in CTs remains a complex challenge. Our study of CRCs’ perceptions highlights access to in-person translators, culturally and language concordant materials, education resources, and increased rapport as key areas for intervention to facilitate patient enrollment of diverse populations. Analysis into practice-specific patterns within our cancer centers can help identify areas for interventions to support the recruitment and enrollment of diverse populations in oncology CTs.