Patient-Related Issues

The Wednesday AccrualNet Post (7-11-12) You've Got Mail: Evidence-based strategy for reaching racial and ethnic minorities

Last Updated: Aug 30, 2012

Originally posted by: Linda Parreco, AccrualNet Co-Moderator, on the former AccrualNet site on Jul 11, 2012.

We all appreciate the importance of adequate representation of minority populations in randomized clinical trials--and we acknowledge that there are many challenges associated with successfully reaching racial and ethnic minorities.  Numerous strategies have been described, but many are resource intensive and/or lack evidence to support their efficacy. We were happy to recently receive an interesting original research article from lead author Susan Brown, PhD of Kaiser Permanente Northern California. Dr. Brown's study, "Minority recruitments into clinical trials: experimental findings and practical implications" looked at the use of a direct mail strategy and compared letters that included either an ethnically targeted statement or personalization to recruit minority women to a behavioral weight management trial. The ethnically targeted statement noted ethnic-specific information about health risks of obesity. Personalized letters included recipients' names/addresses in the salutation and a handwritten signature on high-quality letterhead. Women who were sent the ethnically targeted statement were more likely to respond than were women sent letters with the generic statement. Women sent personalized letters were no more likely to respond than were women sent nonpersonalized letters. The simple modification of adding ethnic-specific information had a meaningful impact on minority reach and recruitment rates. 


Have you used direct mail as a recruitment method? How did you personalize the letters? What are your thoughts on adding ethnic-specific information to a recruitment letter?


AccrualNet Team

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Originally posted by: Anonymous on the former AccrualNet site on Jul 17, 2012.

Hi- i think this strategy may be useful for non-cancer related trials or perhaps prevention studies but evidence suggests poor utility for cancer treatment.

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Originally posted by: linda on the former AccrualNet site on Jul 17, 2012.

Thanks for your comment. This particular study used direct mail for a behavioral study--and as you suggest, this tailored direct mail approach may also be useful in prevention studies. Agree that the mechanisms for identifying patients for cancer treatment trials are different and that the direct mail approach is not as relevant for that group. We invite you to share any literature or references that you've found on this topic that AccrualNet readers would find helpful.

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Originally posted by: Anonymous on the former AccrualNet site on Jul 17, 2012.

Thank you to NCI AccuralNet and its users for your interest in our study. We found that a minor change to direct mail letters--a single sentence about health disparities--resulted in a significant increase in response rates. I agree that direct mail may not be the best recruitment method for every trial. However, our modification was simple and incurred no additional cost, and could be incorporated into alternative recruitment methods (e.g., flyers, websites, etc.). Future research is needed to test the effectiveness of adding ethnically-targeted content to alternative modalities.

Of note, many existing reports about recruitment strategies are descriptive rather than experimental. Randomized experiments nested within larger trials, as this one was, may be an efficient approach to conducting research in this area. More experimental research is certainly needed to answer critical questions about patient engagement across all types of clinical trials.
- Susan Brown (study co-author)

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