ideasIdea
Community health workers and trusted local organisations paid to recruit for trials
People join trials when someone they trust explains them. Paying community health workers, churches and local groups to inform and refer people would reach communities that hospitals do not.
Trial sponsors and networks contract community health workers and community organisations for outreach, education and referral in under-represented communities, with training in trial literacy and payment per activity rather than per enrolment (to avoid coercion). Evaluated in a cluster-randomised design against standard site-based recruitment.
Hypothesis
Communities with paid CHW outreach will contribute at least twice the enrolment of minority and low-income participants compared with matched communities without it, and enrolled participants will have retention equal to others.
Rationale
CHW models raised vaccination, screening and HIV testing uptake in similar communities; trial participation shares the same trust and information barriers.
What would test it
Cluster-randomise 20 community areas around trial sites to CHW outreach or none for 18 months, with enrolment by demographic as the primary outcome.
Maturity
early clinical
Who has to act
philanthropy
Cost to try
Medium ($1M to $50M)
Years to first evidence
2
Bottlenecks it attacks
- Trials do not represent the people who get cancer · Older, Black, Hispanic, Asian, rural, poor and multimorbid patients are under-represented, so results may not apply to them.
- Trials enrol too few, too slowly · Fewer than one in ten adults with cancer joins a trial. Trials close for lack of patients, not lack of ideas.