The Mount Sinai journal of medicine, New York
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Comparative Study
The success of recruiting minorities, women, and elderly into a randomized controlled effectiveness trial.
Heart failure, a leading cause of hospitalization among elderly people, disproportionately afflicts African-American and other non-White populations. Studies of health care interventions often do not include these groups in proportion to numbers in the patient population. Our objective was to assess whether a randomized controlled effectiveness trial enrolled patients by ethnicity/race, gender, and age in proportion to those eligible. ⋯ The recruitment strategy successfully enrolled patients by ethnicity/race, gender, and age through 74 years, but not those > or = 75 years. Registries of patients who refuse to enroll in trials could provide guidance for clinical and public policy.
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Effective adjuvant treatments proven to prolong survival for breast cancer exist, yet many women, particularly minority women, do not receive them. Little work has focused on improving the quality of, and reducing racial disparities in, cancer treatment. We describe the application of a conceptual model to direct, design, and implement trials to reduce underuse of effective adjuvant breast cancer treatments. ⋯ Identifying reasons for underuse by interviewing patients, physicians, physician office staff, and allied care providers about episodes in which needed care failed to occur helps engage key individuals, and can inform the design and implementation of interventions targeting barriers to delivering high quality breast cancer care to all.