Challenges and opportunities using online portals to recruit diverse patients to behavioral trials

• Published in: Journal of the American Medical Informatics Association : JAMIA Vol. 26; no. 12; pp. 1637 - 1644
• Main Authors: Tabriz, Amir Alishahi, Fleming, Patrice Jordan, Shin, Yongyun, Resnicow, Ken, Jones, Resa M, Flocke, Susan A, Shires, Deirdre A, Hawley, Sarah T, Willens, David, Lafata, Jennifer Elston
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.12.2019
• Subjects: Aged; Case Report; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - ethnology; Continental Population Groups - statistics & numerical data; Early Detection of Cancer; Electronic Health Records - statistics & numerical data; Female; Health Status Disparities; Humans; Logistic Models; Male; Middle Aged; Patient Acceptance of Health Care - ethnology; Patient Portals - statistics & numerical data; Patient Selection; Pragmatic Clinical Trials as Topic; Primary Health Care; Selection Bias; Surveys and Questionnaires; colorectal cancer screening; health disparities; patient portal; electronic health record; pragmatic clinical trial
• ISSN: 1527-974X; 1067-5027; 1527-974X
• DOI: 10.1093/jamia/ocz157

We describe the use of an online patient portal to recruit and enroll primary care patients in a randomized trial testing the effectiveness of a colorectal cancer (CRC) screening decision support program. We use multiple logistic regression to identify patient characteristics associated with trial recruitment, enrollment, and engagement. We found that compared to Whites, Blacks had lower odds of viewing the portal message (OR = 0.46, 95% CI = 0.37-0.57), opening the attached link containing the study material (OR = 0.75, 95% CI = 0.62-0.92), and consenting to participate in the trial (OR = 0.85, 95% CI = 0.67-0.93). We also found that compared to Whites, Asians had lower odds of viewing the portal message (OR = 0.53, 95% CI = 0.33-0.64), opening the attached link containing the study material (OR = 0.76, 95% CI = 0.54-0.97), consenting to participate in the trial (OR = 0.68, 95% CI = 0.53-0.95), and completing the trial's baseline questionnaire (OR = 0.59, 95% CI = 0.36-0.90). While portals offer an opportunity to mitigate human bias in trial invitations, because of racial disparities-not only in who has a portal account, but in how they interact with trial recruitment and enrollment material within the portal-using portals alone for trial recruitment may generate study samples that are not racially diverse.