of cancer). Concern about the loss of sexual function and other quality-of-life issues was also a significant barrier. Another significant impediment was distrust: many African-American men sampled believed that they might be abused as medical subjects in large health care institutions. After identifying potential barriers, the DEED program recruited subjects via African-American churches and related networks. Researchers found that when the church minister and other leaders were recruited for testing, participation among church members increased two- to threefold. In addition, a group of prostate cancer survivors assisted in recruitment by discussing their experiences. DEED program researchers reported high levels of success in recruiting and retaining African-American men in the in the longitudinal project.

Working with Communities: A Key to Success

Noel Chavez described several efforts that are needed for health education and research outreach in medically underserved communities. Chavez stressed the need for assessment of community norms and beliefs, to find out who in the community is entrusted with leadership positions, and how the community relates to the larger social environment. In addition, researchers need to find ways to help communities gain ''ownership" of research programs, including involvement in project planning and development, recruitment, and protocol design. Finally, researchers need to be prepared to assist communities in solving problems rather than assuming that work that can be done for or with a community. The development of trust and support within the community requires time, effort, flexibility, and resources, but the relationships built in this process will improve the likelihood of success.

General recommendations of this panel included the following:

  • There is a need for active involvement of minority physicians in the community as well as community members.
  • Researchers should factor in the time and cost of recruitment of minority and underserved populations in research budgets.

Implementation Strategies

Alternative strategies for recruitment of ethnic minorities into clinical trials have not been evaluated in most settings. Roshan Bastani describes the experience of the University of California at Los Angeles (UCLA) in improving recruitment of ethnic minorities into clinical trials. An important consideration in this effort is the difficulty that some individuals have with the written informed-consent process. An appeal was made to the UCLA IRB to allow verbal consent in place of written consent,

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