Division of Geriatric Medicine, Department of Family Medicine, University of California, Irvine School of Medicine, Irvine, CA, USA.
Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, CA, USA.
J Gen Intern Med. 2023 Jun;38(8):1848-1853. doi: 10.1007/s11606-022-08000-7. Epub 2023 Jan 30.
Patients experiencing systemic patterns of disadvantage, such as racial/ethnic minorities and those with limited English proficiency, are underrepresented in research. This is particularly true for large pragmatic trials of potentially sensitive research topics, such as advance care planning (ACP). It is unclear how phone outreach may affect research participation by underrepresented individuals.
To assess the effect of phone outreach, in addition to standard mail survey recruitment, in a population-based ACP pragmatic trial at three academic health systems in California.
Retrospective cohort study PATIENTS: Primary care patients with serious illness were mailed a survey in their preferred language. Patients who did not initially respond by mail received up to three reminder phone calls with the option of survey completion by phone.
Effect of phone outreach on survey response rate associated with respondent demographic characteristics (e.g., Social Vulnerability Index [SVI], range 0 (low) to 1 (high)).
Across the health systems, 5998 seriously ill patients were mailed surveys. We obtained completed surveys from 1215 patients (20% response rate); 787 (65%) responded after mail alone and 428 (35%) participated only after phone outreach. Patients recruited after phone outreach compared to mail alone were more socially vulnerable (SVI 0.41 v 0.35, P < 0.001), were more likely to report being a racial/ethnic minority (35% v 28%, P = 0.006), and non-English speaking (16% v 10%, P = 0.005). Age and gender did not differ significantly. The inclusion of phone outreach resulted in a sample that better represented the baseline population than mail alone in racial/ethnic minority (28% mail alone, 30% including phone outreach, 36% baseline population), non-English language preference (10%, 12%, 15%, respectively), and SVI (0.35, 0.37, 0.38, respectively).
Phone outreach for a population-based survey in a pragmatic trial concerning a potentially sensitive topic significantly enhanced recruitment of underrepresented seriously ill patients.
在研究中，系统地处于劣势的患者（如少数族裔和英语水平有限的患者）代表性不足。对于潜在敏感研究主题（如预先护理计划（ACP））的大型实用试验，这种情况尤其如此。尚不清楚电话外展如何影响代表性不足的个人的研究参与度。
评估在加利福尼亚州的三个学术医疗系统中进行的基于人群的 ACP 实用试验中，除了标准邮件调查招募外，电话外展的效果。
回顾性队列研究
将调查邮寄给有严重疾病的初级保健患者，并使用他们首选的语言。那些最初没有通过邮件回复的患者会收到多达三个提醒电话，并且可以选择通过电话完成调查。
电话外展对调查响应率的影响与受访者人口统计学特征相关（例如，社会脆弱性指数（SVI），范围为 0（低）到 1（高））。
在三个医疗系统中，共向 5998 名重病患者邮寄了调查。我们从 1215 名患者中获得了完整的调查结果（20%的响应率）；787 名（65%）仅通过邮件回复，428 名（35%）仅在电话外展后参与。与仅通过邮件招募的患者相比，通过电话外展招募的患者的社会脆弱性更高（SVI 0.41 比 0.35，P < 0.001），更有可能报告自己是少数族裔（35%比 28%，P = 0.006）和非英语语言（16%比 10%，P = 0.005）。年龄和性别没有显著差异。与仅通过邮件相比，电话外展的纳入使样本在种族/族裔（28%仅通过邮件，30%包括电话外展，36%为基线人群）、非英语语言偏好（10%、12%、15%）和 SVI（0.35、0.37、0.38）方面更好地代表了基线人群。
针对潜在敏感主题的实用试验中，针对人群的调查的电话外展显著增强了代表性不足的重病患者的招募。
