In this lesson, we'll discuss the importance of engaging community healthcare providers to increase minority recruitment into clinical trials. Engaging physicians and other community healthcare providers is really important in minority recruitment. We know that racial and ethnic minorities are more likely to trust their own physicians, even if they don't trust the healthcare system or researchers in general. So, they look to have the endorsement of their own physicians when, they're thinking about participating in clinical trials. When you're engaging clinicians in the community, it's important to recognize that they are concerned about being sure that their patients have the opportunity to participate in clinical trials, but they're also concerned about making sure that their patients are protected and not harmed. Another concern is that helping you recruit for your study could disrupt their workflow. So, it's important to begin to build relationships with clinical providers, to build trust, but also understand their needs and preferences, as it relates to being engaged in clinical trials. So, we've just completed a study looking at the provider's preferences and needs around participating in clinical trials. What we've learned recently is that our approach to engaging providers tended to focus too much on what the researchers need and not what the providers need. So, the researchers typically went to the clinic or to the doctor, after the study is already designed, after they're recruiting sometimes, and just ask the provider to send referrals, give me your patients, I need them now. This hasn't worked so well, and part of that is we haven't developed trusting relationships with the providers, we haven't considered how our clinical trials disrupt their workflow, and we also aren't sharing anything back with them. So, if we want the clinicians to leverage the trust that they've built with their patients in order to get them to participate in any clinical trials, we really have to change our approach to engaging them. If we fail to engage the clinicians early on, we shouldn't be surprised when they don't actually refer their patients to us. We need to understand how referring impacts their workflow, we need to consider what they need in order to get the buy-in from their patients. We also need to return information back to them, so that they feel that they were a part and they learn something from this process. So, when you're considering which providers to engage, it can be challenging if you don't already know where minority patients are more likely to get their care. One new tool to consider is electronic health records. At times, we can actually use these to identify providers or areas that have a higher proportion of minority patients. So you want to look for providers that have at least a third of their patient population minorities if you're going to target specific providers. You might also consider community health centers, safety net clinics, providers in rural areas, and VA clinics, where they often have a higher percentage of racial and ethnic minorities. You might also consider engaging minority physicians and clinicians who often care for patients more likely to be racial and ethnic minorities. But be careful, you don't want to make presumptions, and you certainly don't want to underestimate the resources required for them to be involved in your studies. Let's consider some strategies to effectively engage providers early on. First, recognize that you will often have very little time. So you don't want to show up with your hour long PowerPoint presentation looking to tell them everything about the clinical trial. You want to spend your time telling them why the trial is relevant to them and why it's important to have patients like theirs in the study, especially racial and ethnic minorities. You might consider building this into an educational session whether or not that's an opportunity to provide CME for them or to add it onto a meeting that's already occurring, such as a staff meeting at the hospital or in the community, but make it brief and be sure to include information that makes it relevant to them. When engaging providers, it's important to remember that many of them don't participate in clinical trials on a regular basis. So, it's important to remind them of the state of the science and how this is important to improve clinical care. You should consider with them whether or not returning information to them would be helpful, and discuss barriers to them referring. One thing we hear is that providers don't want to get reports or test results that they don't understand from clinical trials, and have their patients come to them looking for advice or guidance. So you need to think about how you'll address that proactively to prevent any excess burden to them. Just as with patients and potential participants, you have to build trust and you have to recognize that for many of them, especially those who are practicing in the community, they see researchers as elite or elitist, and not interested in their needs are priorities. So, you have to spend some time getting to know them and understanding what they'd like to see move forward. So, if you really want clinicians to refer to the clinical trials, you have to make it easy for them. That means, making sure that they are aware of trials, which trials are currently recruiting, and specifically, witch trials may be of interest to them. That requires that you take some time to understand, again, their priorities if they treat patients with specific conditions more often, and make it relevant to them. You should consider encouraging them to be opinion leaders and sharing information with fellow providers is an opportunity to engage them in ways that recognize them as leaders. If you want to motivate and inspire clinicians to be involved and refer their patients, you have to think about ways that indicate you value them and appreciate what they bring to the table. One of the most important things you can do when developing and maintaining a relationship is to make sure that you are not stealing their patients. Now, that might seem obvious to you, but when you're bringing in their patients to a clinical trial, they often feel as if they've lost control, and the patients also experience a different type of interaction in the clinical trial, that may be confusing or may lead them to think that perhaps the care they are receiving already isn't optimal. So, you should prepare in advance how you will address any concerns about their patients no longer coming back to them. That you will make sure that you're sharing information especially if lab results are available that you're going to share them with them, but also, that you have a plan that will allow them to maintain their relationship with their patients and answer their questions and not feel completely disconnected in the process. You will also need to ensure the providers that you will treat their patients with respect, that you have staff who are culturally sensitive and have cultural humility, and will be able to provide the information to their patients in ways that are respectful of their literacy level, their language preferences, and really allow them to feel comfortable. It's important to think about ways to develop and maintain relationships with community providers. A key piece of developing and maintaining relationships with community providers is being clear that it is a partnership, and you intend to return their patients to their physicians care. Providing ongoing education is an opportunity to engage providers in ways that they already need or could add value to them. That can be in the form of grand rounds at their local medical society, opportunities to visit their practices with a "lunch and learn", as well as innovative strategies such as, bringing the providers in for a tour of the clinical research facilities or participating in programs that they have with their patients in the community. Now we'll take a minute to do a video activity. Look, I understand you need people to participate in your trials, and I do treat many of my patients for hypertension, but I don't see why I should refer my patients. I know my patients wouldn't be interested in participating, I treat mostly minority patients. Besides, my patients are uninsured and already have problems paying for treatment, let alone participating in a trial. Look, it's too much work to send referrals to trials. I've sent patients to your site before and I never hear about what happens with my patients on the study. Besides, it's too hard for my staff to deal with all the paperwork you need.