African American Recruitment in Early Heart Failure Palliative Care Trials: Outcomes and Comparison With the ENABLE CHF-PC Randomized Trial
Open accessAbstract
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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A total of 12 included articles were assessed with an MMAT score below 3, including two RCTs, three non-randomised studies, six quantitative descriptive studies and one mixed methods study.
“A total of 12 articles were assessed with a score of below 3. This included two RCTs [61, 66], three non-randomised studies [15, 46, 64], six quantitative descriptive studies [9, 37, 38, 40, 57, 58] and one mixed methods study [60].”
From Enablers and barriers of clinical trial participation in adult patients from minority ethnic groups: a systematic review (2025) · cites this paper as [64]
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References 46 · Cited by 11
- Authors
- Stockdill, M. L., Dionne-Odom, J. N., Wells, R., Ejem, D., Azuero, A., Keebler, K., Sockwell, E., Tims, S., Burgio, K. L., Engler, S., Durant, R., Pamboukian, S. V., Tallaj, J., Swetz, K. M., Kvale, E., Tucker, R., & Bakitas, M.
- Affiliations
- University of Alabama at Birmingham (US)
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
- The University of Texas at Austin (US)
- Corresponding author
- Stockdill, Macy L.
- ORCID
- Venue
- Journal of Palliative Care
- Publisher
- SAGE Publications
- Published
- 2020-12-01
- Volume
- 38
- Issue
- 1
- Pages
- 52-61
- ISSN
- 0825-8597 (ISSN-L)
- 2369-5293
- PMC
- PMC8314978
- OpenAlex
- W3107653601
- Cited by
- 11
- References
- 46
- Citations by year
- 2025: 7 · 2024: 1 · 2023: 1 · 2022: 1 · 2021: 1
- FWCI
- 0.56
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Palliative Care (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Nursing Research (R01NR013665)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics in Clinical Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Keywords
- African American patients, clinical trial recruitment, heart failure, palliative care, racial diversity in clinical trials, community-based recruitment, recruiter training, advance directives, goal setting, coping strategies, Kansas City Cardiomyopathy Questionnaire, NYHA functional class
- MeSH terms
- Black or African American, Heart Failure, Humans, Palliative Care, Quality of Life, Hospice and Palliative Care Nursing
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