Barriers and Facilitators to Recruitment to a Culturally Based Dietary Intervention Among Urban Hispanic Breast Cancer Survivors

Abstract

PURPOSE To understand factors related to recruitment to behavioral intervention trials among Spanish-speaking urban Hispanic breast cancer (BC) survivors. METHODS Potentially eligible Hispanic BC survivors were recruited from the Columbia University Breast Oncology Clinic, signed informed consent, and completed a screening interview on demographics, medical history, acculturation (Short Acculturation Scale for Hispanics), quality of life (QOL), and perceived benefits/risks of research participation. Trial eligibility criteria included stage 0-III BC, completion of adjuvant treatment, Hispanic, fluency in Spanish, willing to be randomized to active arm (9-session in-person culturally-based ¡Cocinar para su salud! dietary modification program) or control arm (written materials). We compared characteristics between eligible women who did and did not enroll in the trial. RESULTS 102 women completed the screening interview and were eligible to participate. Overall mean age was 57.3±9.5 years, mean time since diagnosis was 3.4±2.1 years, 71% reported annual household income <$15,000 and mean acculturation index score was 1.6±0.6 (scale 1–5, low-high). Of the 102 women, 70 enrolled and 32 declined participation. Reasons stated for non-participation included lack of interest in dietary change, illness, and work constraints. Compared to women who enrolled, women who did not enroll were less likely to be employed (P=0.03) and more likely to only read/speak Spanish (P=0.02). Compared to women who enrolled, non-enrollers were more likely to state that research is costly to participants (P=0.03). CONCLUSION Lower participation was associated with unemployment, monolingualism, and the perception that research is costly to participants. Future behavioral intervention trials among minority BC survivors need to account for these and other factors that may be related to trial participation.

Systematic review of barriers and facilitators to clinical trial enrollment among adolescents and young adults with cancer: Identifying opportunities for intervention

“…However, improving physicians' knowledge and awareness of trials does not alleviate patients' burdens. Studies assessing barriers to CCTs for older adults (65 years old or older) and racial/ethnic minority populations suggest that life constraints and the need to travel to the study site may substantially influence patient enrollment . These barriers may also affect AYA populations.…”

Applying a Conceptual Framework to Maximize the Participation of Diverse Populations in Cancer Clinical Trials

“…Sociodemographic factors such as age, income, and education also play a role; individuals who participate in cancer research are more likely to be better educated and to have higher income levels than non-participants (Bernard-Davila et al, 2015; Bussey-Jones et al, 2010; Kehl et al, 2014; Unger, Gralow, Albain, Ramsey, & Hershman, 2016). Furthermore, individuals with these characteristics have a higher likelihood of being offered opportunities to participate in cancer research compared with individuals who are less well educated and who have lower income levels (Bernard-Davila et al, 2015; Kehl et al, 2014; Unger et al, 2016).…”

“…Furthermore, individuals with these characteristics have a higher likelihood of being offered opportunities to participate in cancer research compared with individuals who are less well educated and who have lower income levels (Bernard-Davila et al, 2015; Kehl et al, 2014; Unger et al, 2016). Hence, individuals of a higher socioeconomic status may be more aware of cancer research, have more opportunities to participate, and face fewer economic and logistical barriers to participation than less educated and lower income individuals.…”

Psychosocial mediators of dietary change among Hispanic/Latina breast cancer survivors in a culturally tailored dietary intervention

“…First, the study enrolled a sample that was representative of the target population in the predominantly Spanish-speaking Dominican neighborhood in New York City. 40 Second, bootstrapping increased the power to detect a small indirect effect, because it does not rely on the normality assumption required by regression-based approach, such as the Sobel's test. 31 Additionally, the high retention rate helped overcome some of the limitations of the relatively small initial sample size.…”