Recruiting a representative patient population in a busy Emergency Department - PowerPoint Presentation

Slide1

Recruiting a representative patient population in a busy Emergency Department

Lea H. Becker, MT(ASCP);

Elaine Dube, CCRP; Weitao

Wang, Kaitlyn Brill, Robert O’Connor, MDUniversity for Virginia Health System, Department of Emergency Medicine

Introduction

Problems

Conclusions

Next steps

A key requirement for completion of quality research is the recruitment of a representative patient population. Historically, minorities

have been under represented in clinical trials. Potential study participants must be identified without bias and ideally would consent to participate in a representative way. Factors that may impact research participation choices are study requirements, personal or social history, and current environment. Our team felt that the first step would be to work on the current environment , the clinical care team. Any reservations from the care team could negatively impact the attitude of the potential research participant, especially if that patient distrusts the medical system and researchers in general.

Results

Inform:

Post very brief study descriptions in multiple locationsEducate: Provide research focused continuing education at resident conferences, quarterly nursing meetings, shift change learning opportunities, and one on one.Include: Communicate face to face with all care team before inviting patient to become a research participant; ask about clinical schedule to avoid duplicating assessments and procedures for research purposesAffirm: Thank all persons who contribute! Send notes, copy supervisors, give small thank you gifts (if allowed by local ethics). Update team on study progress with Newsletters and e-mail announcements.

Solutions

Clinical care team is task saturated in fast paced environment

Clinical care team not accustomed to research activitiesHistoric inequities cause some groups to be less open to research participationDedicated research team has limited time to earn trust

Initially some staff were resistant to the research activities, but they very quickly accepted research as part of their culture and became supportive, providing assistance and referrals.

We selected several studies involving minimal risk and low time commitment to eliminate many reasons for declination. The research team tracked basic demographics and decisions to consent or not. Of the 627 patients approached for enrollment, 291 (42%) were women and 336 (58%) were men, and 488 (78%) were self-described as white. A total of 496 (79%) consented and 131 (21%) declined. The consent rate was 80% for women and 78% for men (p=0.49 ns). The consent rate was 83% for whites and 67% for non-whites (p<0.0001). The average age of consenting vs. declining patients were 57.8 and 60.7, respectively (p=0.92 ns). Within each race classification, there were no differences in rates of consent by age or gender.

Even though the clinical staff now supports research efforts, there are many in the general public who have reservations. Consistent with historical findings, minorities are less comfortable consenting to research. Our results show greater minority participation than reported by other academic institutions in the SE US. This indicates that unreserved support of research from the care team positively impacts patients willingness to become research participants. However additional attention is needed to promote representative participation in clinical trials.

Expand the inform, educate, include, affirm cycle to reach out to the community with brochures, videos, radio, and television spots. This may cause more potential research participants to arrive with a positive pre-disposition towards research. If we appropriately target our efforts, we may be able to further reduce the demographic gaps in clinical research.

Percent

of those approached for research who consented