Recruiting Rural Patients for Clinical Research: Lessons From a Colorectal Cancer Screening Trial

Area of Science:

• Public Health
• Clinical Research
• Health Disparities

Background:

• Colorectal cancer (CRC) screening rates are often lower in rural and underserved populations.
• Effective recruitment strategies are crucial for including diverse populations in clinical research.
• The Colonoscopy Outreach for Rural Communities (CORC) study aimed to address these challenges.

Purpose of the Study:

• To test the effectiveness of a remotely-delivered patient navigation program for increasing colonoscopy completion in rural and underserved patients.
• To assess the success of the CORC study in recruiting rural participants.
• To outline approaches for improving rural resident inclusion in clinical research.

Main Methods:

• Descriptive analyses of patient rurality using Federal Office of Rural Health Policy (FORHP) and Rural-Urban Commuting Area (RUCA) codes.
• Partnerships with primary care organizations (PCOs) in both urban (RUCC=3) and rural (RUCC>3) counties.
• Recruitment of 527 participants for a randomized controlled trial.

Main Results:

• 75% (n=394) of participants resided in rural areas, with 43.3% in large rural, 38.3% in small rural, and 18.4% in isolated rural areas.
• PCOs in rural counties successfully recruited predominantly rural patients (97.3% in FORHP-designated rural areas).
• PCOs in urban counties also contributed significantly to rural patient recruitment (53.3%).

Conclusions:

• Collaborating with rural primary care organizations is effective for recruiting rural patients into pragmatic clinical trials.
• Partnerships with urban PCOs can also enhance rural patient recruitment.
• Tailored recruitment strategies, understanding community needs, and leveraging primary care partnerships are key to increasing rural representation in clinical research.