Factors Impacting Recruitment & Factors Impacting Recruitment & Retention of African American Retention of African American

Women in Breast Cancer Women in Breast Cancer Intervention StudyIntervention Study

Presented by Connie L. Jacobs, LMSWPresented by Connie L. Jacobs, LMSW

ObjectivesObjectives

Increase minority participation in clinical trialsIncrease minority participation in clinical trials

Explore culturally competent approaches to recruit Explore culturally competent approaches to recruit and retain African American women in clinical and retain African American women in clinical trialstrials

Analyze factors impacting low retention rateAnalyze factors impacting low retention rate

Address implications for future researchAddress implications for future research

Overview of A Nu-Life StudyOverview of A Nu-Life Study

Nutrition intervention studyNutrition intervention study

Designed to examine effect of low fat, high Designed to examine effect of low fat, high

fiber diet on breast cancer preventionfiber diet on breast cancer prevention

Focused on young pre-menopausal African Focused on young pre-menopausal African American womenAmerican women

Eligibility CriteriaEligibility Criteria African American women between 25 to 45 years oldAfrican American women between 25 to 45 years old

Reside in Houston Metropolitan areaReside in Houston Metropolitan area

Not pregnant or taking birth control or hormonal therapyNot pregnant or taking birth control or hormonal therapy

Have regular monthly menstrual cycleHave regular monthly menstrual cycle

Have not undergone menopause Have not undergone menopause

No personal history of diabetes or heart disease and no No personal history of diabetes or heart disease and no cancer diagnosiscancer diagnosis

Breast Cancer DataBreast Cancer Data

Breast CancerBreast Cancer African AmericanAfrican American CaucasianCaucasian

Incident Incident 118 per 100,000118 per 100,000 134 per 100,000134 per 100,000

MortalityMortality

(1 in 3 women will die)(1 in 3 women will die)

34.3 deaths 34.3 deaths

per 100,000per 100,000

25.3 deaths 25.3 deaths

per 100,000per 100,000

5 Year Survival Rate5 Year Survival Rate 77%77% 90%90%

Lifetime RiskLifetime Risk 1 in 10 women1 in 10 women 1 in 8 women1 in 8 women

References: American Cancer Society Cancer Facts & Figures for African Americans 2007-2008.

Importance of Nu-Life StudyImportance of Nu-Life Study

Breast cancer is the second leading cause Breast cancer is the second leading cause of death among African American womenof death among African American women

Pre-menopausal African American women Pre-menopausal African American women have a higher incidence and death rate from have a higher incidence and death rate from breast cancer than women from any other breast cancer than women from any other ethnic groupethnic group

Study Design of Nu-LifeStudy Design of Nu-Life

Focus Groups – Recruitment materials and Focus Groups – Recruitment materials and nutrition perceptionsnutrition perceptions

Study Recruitment – involved 3 phasesStudy Recruitment – involved 3 phases Study Randomization – (164 AA women)Study Randomization – (164 AA women)

– Intervention Group – 27 nutrition classes (eating Intervention Group – 27 nutrition classes (eating habits & cooking)habits & cooking)

– Control Group – 5 nutrition classes (ACS Control Group – 5 nutrition classes (ACS guidelines for cancer prevention)guidelines for cancer prevention)

– Baseline, 6 & 12 month blood samples and Baseline, 6 & 12 month blood samples and body measurements taken on all participantsbody measurements taken on all participants

Benefits to ParticipantsBenefits to Participants

Increased knowledge about health, breast cancer Increased knowledge about health, breast cancer awareness and detectionawareness and detection

Free nutrition classes for one yearFree nutrition classes for one year

Accessibility to mammogram and pap smear as deemed Accessibility to mammogram and pap smear as deemed medically appropriatemedically appropriate

Informed of clinical trialsInformed of clinical trials

Monetary incentive upon completionMonetary incentive upon completion

A Nu-Life Recruitment FliersA Nu-Life Recruitment Fliers

Community Support of Community Support of Recruitment EffortsRecruitment Efforts

ChurchesChurches Health FairsHealth Fairs Sororities Sororities Civic Club MeetingsCivic Club Meetings Local Cancer OrganizationsLocal Cancer Organizations Sister’s NetworkSister’s Network Minority Physicians’ GroupsMinority Physicians’ Groups Minority Owned BusinessesMinority Owned Businesses Local Colleges/UniversitiesLocal Colleges/Universities

Recruitment MethodsRecruitment Methods

0

5

10

15

20

25

30

35

40

45

Recruitment

Mass Media(newspapers/radio/tv)

Flyers/Brochures

Presentations

Community Events

44%

24%

17%15%

Correlation of Recruitment Method Correlation of Recruitment Method versus Age of Participantversus Age of Participant

Recruitment efforts utilizing mass media were the Recruitment efforts utilizing mass media were the most effective method regardless of age of most effective method regardless of age of participantparticipant

Distribution of flyers/brochures was an equally Distribution of flyers/brochures was an equally effective recruitment method among all effective recruitment method among all participantsparticipants

Community events were slightly more appealing to Community events were slightly more appealing to participants over 36 years of ageparticipants over 36 years of age

Correlation of Recruitment Method Correlation of Recruitment Method versus Education of Participantversus Education of Participant

Mass media was most effective recruitment Mass media was most effective recruitment method for participants regardless of educational method for participants regardless of educational levellevel

Community events were more effective with Community events were more effective with participants with high school educationparticipants with high school education

Flyer/brochure distribution was slightly more Flyer/brochure distribution was slightly more effective than community events with participants effective than community events with participants with more than high school educationwith more than high school education

Correlation of Recruitment Methods Correlation of Recruitment Methods versus Income of Participantversus Income of Participant

Mass media was most effective method regardless Mass media was most effective method regardless of income of participantof income of participant

Flyer/brochure distribution was slightly more Flyer/brochure distribution was slightly more effective for participants with income of less than effective for participants with income of less than 50K50K

Community events were equally effective as Community events were equally effective as flyer/brochure distribution for participants with flyer/brochure distribution for participants with income greater than 50kincome greater than 50k

Factors Contributing to Low Factors Contributing to Low Retention RateRetention Rate

PregnancyPregnancy Financial issuesFinancial issues Multiple responsibilities related to family and Multiple responsibilities related to family and

work demandswork demands Physical and emotional fatiguePhysical and emotional fatigue ForgetfulnessForgetfulness Inclement weather conditionsInclement weather conditions

Challenges of A Nu-LifeChallenges of A Nu-Life

Recruitment and RetentionRecruitment and Retention

Study PopulationStudy Population

Requirement of Blood SamplesRequirement of Blood Samples

DiscussionDiscussion

Despite incorporating culturally competent Despite incorporating culturally competent approaches, creating trusting environment, approaches, creating trusting environment, incentives, flexible scheduling and frequent incentives, flexible scheduling and frequent follow-up, study retention was lower (54%) follow-up, study retention was lower (54%) than expected (75%)than expected (75%)

Implications for Future ResearchImplications for Future Research Consider multiple factors impacting recruitment and retention and how Consider multiple factors impacting recruitment and retention and how

this may affect participants remaining in studythis may affect participants remaining in study

Increase monitoring of recruitment and retentionIncrease monitoring of recruitment and retention

Importance of training all staff on anticipating potential factors Importance of training all staff on anticipating potential factors impacting recruitment and retention so these concerns can be impacting recruitment and retention so these concerns can be proactively addressedproactively addressed

Evaluate the use of procedures that increase participants’ burden Evaluate the use of procedures that increase participants’ burden

Increase participants’ attachment to the studyIncrease participants’ attachment to the study

AcknowledgementsAcknowledgements

Lovell Jones, PhDLovell Jones, PhDAbenaa Brewster, MDAbenaa Brewster, MDTanya Stephens, MDTanya Stephens, MD

Denae King, PhDDenae King, PhDRichard Hajek, PhDRichard Hajek, PhDBeverly Gor, EdDBeverly Gor, EdDKelly Hodges, MSKelly Hodges, MSErica Givens, BSErica Givens, BS

American Cancer SocietyAmerican Cancer Society