Minorities Still A Minority in Clinical Trials

Roxanne Nelson

February 10, 2009

February 10, 2009 (Carefree, Arizona) — Health disparities persist among various racial, ethnic, and socioeconomic groups, but racial and ethnic minorities continue to be underrepresented in clinical trials. According to data presented here at the American Association for Cancer Research Science of Cancer Health Disparities Conference, a lack of incentives and support are preventing the successful recruitment of minorities into clinical trials.

The recruitment of minorities has not been well supported in any setting, explained study author Daniel Dohan, PhD, associate professor of health policy and social medicine at the University of California, San Francisco. "In both academic and private-practice settings, there weren't any good incentives to reach out and make the extra effort," he said.

Although the culture in academic and private-practice settings supports the recruitment of minorities, incentives to do so were lacking. And although providers were motivated by a sense of justice to enroll minorities in the public setting, the organizational structure needed was not available.

"In 1993, Congress passed the NIH Revitalization Act to reach out to women and minorities and bring them into clinical trials," said Dr. Dohan. "There has been a lot of interest on the clinical and provider side about how to bring them into trials."

However, the recruitment of minorities to cancer therapeutic trials remains problematic, and a number of barriers to enrolment have been documented, including a lack of trust in biomedical research. Although community-focused outreach and intervention strategies have attempted to address these barriers, less research has been conducted on the role of cancer clinics in minority recruitment. In this qualitative research study, the researchers evaluated how provider and organizational factors affect minority recruitment.

"We looked at different healthcare settings and we spent time observing what happens on a day-to-day basis," he said. "We observed how they spoke with patients and how the recruitment process unfolded. None of the settings we observed had an effective program."

Minority Recruitment Not Well Supported

Dr. Dohan and his colleague, Galen Joseph, PhD, also from University of California, San Francisco, studied minority recruitment in 10 oncology clinics in academic medical centers, community-based private practices, and public safety-net clinics. They gathered and analyzed data using ethnography, and directly observed hundreds of interactions between providers and patients over a period of more than 3 years. Indepth interviews with providers working in each of the 3 types of settings were also conducted.

Overall, they found that minority recruitment was not well supported in any of the settings that were studied, and providers had few incentives to seek out and recruit minority patients. The result was that few attempts were made to recruit minority patients to clinical trials and, according to Dr. Dohan, this observation was consistent with what providers relayed in interviews.

In the safety-net setting, which consisted primarily of county and public health facilities, providers were very focused on getting clinical care to patients who needed access to care. "There are language barriers and difficulty explaining health issues to persons with low health literacy," he explained. "In the safety-net setting, we really need good translators who understand all of the technical and cultural issues."

Clinicians are often rewarded for recruiting patients into clinical trials, but there is no special incentive for recruiting a patient from a minority background, Dr. Dohan pointed out. "In academic settings, there wasn't any sort of acknowledgement about the kind of patient recruited, just about numbers," he said. "There are issues of equity and justice in how we choose who to recruit, butit might be possible to recognize the extra effort — and at least within the organization — that the provider is trying to do the right thing and reaching out to minorities."

This was a fairly small qualitative study," Dr. Dohan said, "So we need to see how generalizeable our findings are in a larger study."

American Association for Cancer Research Conference on the Science of Cancer Health Disparities: Abstract PR-6. Presented February 4, 2009.

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