Recruiting Rural Patients for Clinical Research: Lessons From a Colorectal Cancer Screening Trial.

PURPOSE: The Colonoscopy Outreach for Rural Communities (CORC) study is a randomized controlled trial testing the effectiveness of a remotely-delivered patient navigation program to increase colonoscopy completion for colorectal cancer (CRC) screening among rural and underserved patients. This study assesses CORC's success in recruiting rural patients and outlines approaches for including rural residents in clinical research.

METHODS

We conducted descriptive analyses of rurality designations for enrolled patients based on their ZIP code using the Federal Office of Rural Health Policy (FORHP) definition and Rural-Urban Commuting Area (RUCA) codes. The primary care organization (PCO) partnership was based on Rural-Urban Continuum Codes (RUCCs). To recruit patients, CORC partnered with two PCOs in urban counties (RUCC = 3) and four PCOs in rural counties (RUCC >3).

FINDINGS: Of 527 participants, 75% (n = 394) lived in rural areas overall; 43.3% resided in large rural areas, 38.3% in small rural areas, and 18.4% in isolated rural areas. Nearly all (97.3%) participants recruited from the four PCOs located in rural counties lived in FORHP-designated rural areas, whereas urban PCOs contributed both rural (53.3%) and urban participants.

CONCLUSIONS

Partnering with rural PCOs in a pragmatic clinical trial led to successful recruitment of rural patients. Working with PCOs in urban counties also contributed to successful rural patient recruitment. Several key approaches included partnering with primary care to reach patients in their communities, using multiple strategies to understand PCO's populations served, and tailoring recruitment to rural patients' unique needs. These strategies may help researchers increase the representation of rural populations in clinical research.