JMIR Publications

ABSTRACT

Background:

Out-of-pocket costs pose a significant barrier to participating in cancer clinical trials (CCTs). Financial reimbursement programs (FRPs) that reduce the burden of out-of-pocket costs can support participation in CCTs if the information is readily available to participants at the time of enrollment. Prior studies have shown the important and impact of FRPs, but despite improvements, significant barriers still remain.

Objective:

This study was designed to explore the feasibility and acceptability of automated texts designed to offer, screen, and enroll CCT participants in a FRP for out-of-pocket travel and lodging related clinical trial costs.

Methods:

This study employed a mixed methods approach. Eligible participants were those that consented to a breast, leukemia, or CAR-T trial at an NCI comprehensive cancer center. Quantitative data was collected through engagement metrics, including text response rates and enrollment rates, as well as patient-reported satisfaction scores. Program enrollment rates were used to determine feasibility, whereas the engagement metrics were used to measure acceptability of the program. Semi-structured interviews were conducted with a subsample of patients who responded to at least one of the FRP texts and agreed to be interviewed to determine the barriers and facilitators of enrolling in the IMPACT program via text, perceived advantages and disadvantages of the text messaging program compared to a phone call, and overall feedback on the acceptability of the automated text messaging program.

Results:

Among the 77 patients consented to CCTs across the three trial teams, only 51 were referred to the IMPACT team (n=26 not referred for unknown reasons). Quantitative data including engagement with texts, FRP eligibility screening and enrollment rates were collected from all participants who successfully received a text (n=51) and qualitative data from a subsample of participants who agreed to participate in a semi-structured interview (n=28) about the text-based program. Participants’ mean age was 58 (s.d. 12), approximately 64% of participants were female, 21% of participants were Black, and 4% of participants were Hispanic or Latino. There was high engagement with texts (96.1%), screening for FRP eligibility (51.0%), overall FRP enrollment rates (62.5%), and high satisfaction (Net Promoter Score=51). The text-based platform streamlined the enrollment process, allowing one-third of patients to complete enrollment independently, without assistance from the FRP coordinator. Reported facilitators for completion of the text conversation included support from the coordinator and introduction of the FRP by CCT teams. Barriers were a lack of communication from CCT teams, patient skepticism about legitimacy of the texts, and limited program information via text.

Conclusions:

Despite the small sample size and single study site, these findings suggest that automated text messaging can be an effective, low-cost and scalable strategy to increase awareness and streamline enrollment in FRPs.