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Health disparities and clinical trial patient recruitment

Monday, December 11, 2017

The Pulse on Patient Recruitment by Ashley Tointon

Despite remarkable improvements in the number of people with healthcare coverage and the vast improvements in many healthcare technologies, not everyone in the nation has benefited equally. Individuals who are low-income, a racial/ethnic minority or who are disadvantaged or disabled typically do not get involved in cutting-edge medical research. 

Clinical trial participation is one way to elevate the care of those largely underserved. Although there are certainly risks with participating in any type of clinical trial, enrolled participants are one of the most legally protected group classifications. Why are clinical trials not positioned to people who are characteristically underserved? Regardless of whether the investigational medication is found to be effective, the extra care and attention given to people participating in clinical research can ease the gap between care and no care for those who need it most. 

One of the most egregious examples of the underserved is the elderly. There is a large knowledge gap in evidence-based treatment options for people 65 and older. It is strange that although the older populations use prescription medicines the most frequently, they are the most underrepresented group in the testing of those medications. An evaluation published by The British Medical Journal revealed elderly patients were part of the exclusion criteria for nearly a third of trial protocols. Elderly patients make up more than a third of the population that ultimately would benefit from the use of those drugs in practice.

The elderly represent only one example of underserved populations. Inequalities related to race and gender exist at every stage of clinical trials. Researchers have an obligation to remedy these inequalities, both for the sake of women and minorities who deserve to benefit from the research burdens they bear and in order to better contribute to generalizable knowledge. The potential to target particular populations through social media is a tool that can help researchers fulfill this obligation. Done in an ethically sensitive manner, social media can aid recruitment efforts in order to involve a truly representative sample of the population they aim to investigate. 

Social media is not the only way to ensure greater representation of the underserved groups in clinical trials, but it has an enormous potential for balancing out unfair sampling within clinical trials. A recent statistic reveals that 18 to 24-year-olds are two times more likely to use social media for health-related discussions. In some instances, social media may not be the best way to help bridge the gap, specifically with the elderly population. However, with 86% of Americans online and four-fifths of them using the internet to look for health information, the reach is vast, offering researchers an opportunity to access potential participants with unprecedented precision. 

Still, despite some success, little clinical trial recruitment is being done through social media. A recent article in the Journal of the American Medical Association Oncology reported that analyzation of 1,500 tweets containing the words “lung cancer,” nearly 18% of those related to clinical trials, but virtually none of these linked to recruitment sites. 

When I asked Splash about how receptive researchers are to the online methods, they admitted that receptiveness definitely varies, but to reach diverse populations it is much easier to use digital advertising despite researcher reservations. They cited an article called “Health disparities and clinical trial recruitment: Is there a duty to tweet?” from the National Center for Biotechnology Information (NCBI) and revealed the following. While 79% of internet users have Facebook accounts, expanding recruitment efforts to Twitter and Instagram is likely to make diverse sampling even easier. While 28% of black and Hispanic internet users have Twitter, only 20% of white people do. The rates are even higher on Instagram, with 47% of black internet users, 38% of Hispanic internet users and only 21% of their white equivalents having an account. Each of these sites offers the possibility of paid, targeted advertisements, as well as free accounts from which researchers can post recruitment notices, answer questions and communicate with potential participants. Research teams have utilized both Facebook and Craigslist to recruit young female cancer survivors, despite this being a traditionally difficult population to recruit. Several other researchers have also reported successful experiences recruiting and retaining diverse, hard-to-reach and minority populations through social media

Despite a few limitations, social media can positively impact the health disparities that currently exist today. Using social media, underserved populations can be targeted to increase their awareness of their options by illustrating statistics, comparing hospitals in the area and providing a network that would allow them to feel more comfortable in these new situations. Social media provides not only a means of distributing information, but also a means for people receiving the information to discuss it and communicate.

It is possible for health disparities to be reduced, if the people being affected by these disparities are made aware of the resources available to them. Using social media, we can see a decrease in health disparities and an increase in the health of the nation. 


Ashley Tointon has more than 20 years of patient recruitment and project management experience supporting clinical trials and the pharmaceutical industry. Currently she provides recruitment expertise, strategy and leadership as Principal Consultant of Accelerate Clinical Enrollment LLC. Email tointon@icloud.com or tweet @AshleyTointon.

This article was reprinted from CWWeekly, a leading clinical research industry newsletter providing expanded analysis on breaking news, study leads, trial results and more. Subscribe »

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