Key result
In the ENABLE CHF-PC trial, African American patients with heart failure were more likely to consent to palliative care trial enrollment than Caucasians (55%; P=0.001).
Why the study?
Palliative care trial recruitment of African Americans is a formidable research challenge.
RCT (n=415)
Targeted strategies such as community-based partnerships and recruiter racial concordance can successfully achieve high recruitment rates of African Americans in heart failure palliative care trials.
Supports targeted strategies for African American enrollment in HF palliative care trials; leaves open generalizability to other settings or interventions.
Background: Palliative care trial recruitment of African Americans (AAs) is a formidable research challenge. Objectives: Examine AA clinical trial recruitment and enrollment in a palliative care randomized controlled trial (RCT) for heart failure (HF) patients and compare patient baseline characteristics to other HF palliative care RCTs. Methods: This is a descriptive analysis the ENABLE CHF-PC (Educate, Nurture, Advise, Before Life Ends: Comprehensive Heartcare for Patients and Caregivers) RCT using bivariate statistics to compare racial and patient characteristics and differences through recruitment stages. We then compared the baseline sample characteristics among three palliative HF trials. Results: Of 785 patients screened, 566 eligible patients with NYHA classification III-IV were approached; 461 were enrolled and 415 randomized (AA = 226). African Americans were more likely to consent than Caucasians (55%; P FDR = .001), were younger (62.7 + 8; P FDR = .03), had a lower ejection fraction (39.1 + 15.4; P FDR = .03), were more likely to be single ( P FDR = .001), and lack an advanced directive (16.4%; P FDR < .001). AAs reported higher goal setting (3.3 + 1.3; P FDR = .007), care coordination (2.8 + 1.3; P FDR = .001) and used more “denial” coping strategies (0.8 + 1; P FDR = .001). Compared to two recent HF RCTs, the ENABLE CHF-PC sample had a higher proportion of AAs and higher baseline KCCQ clinical summary scores. Conclusion: ENABLE CHF-PC has the highest reported recruitment rate and proportion of AAs in a palliative clinical trial to date. Community-based recruitment partnerships, recruiter training, ongoing communication with recruiters and clinician co-investigators, and recruiter racial concordance likely contributed to successful recruitment of AAs. These important insights provide guidance for design of future HF palliative RCTs. Trial Registration: ClinicalTrials.gov Identifier: NCT02505425
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Stockdill et al. (2020) conducted an RCT in Heart failure (n=415). ENABLE CHF-PC palliative care trial enrollment (African American race) vs. Caucasian race was evaluated on Consent rate (p=0.001). In the ENABLE CHF-PC trial, African American patients with heart failure were more likely to consent to palliative care trial enrollment than Caucasians (55%; P=0.001).
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