Physician Perceptions of the Use of Social Media for Recruitment of Patients in Cancer Clinical Trials

Enhancing Efficiency and Reach Using Facebook to Recruit Breast Cancer Survivors for a Telephone-Based Supportive Care Randomized Trial During the COVID-19 Pandemic

PURPOSE

Evidence supporting social media-based recruitment of cancer survivors is limited. This paper describes how we used Facebook during the COVID-19 pandemic to augment our recruitment of breast cancer survivors for our two-site telephone-based randomized clinical trial (RCT) at Dartmouth-Hitchcock Medical Center and the University of Alabama at Birmingham.

METHODS

Originally a two-site RCT of a telephone-delivered breast cancer survivorship intervention, we extended our clinic-based recruitment to Facebook. Participant characteristics, geographic reach, and baseline outcomes were compared across recruitment sources (ie, two clinics and Facebook) using descriptive statistics and effect sizes.

RESULTS

Enrollment rates (20%-29%) were comparable across recruitment sources. The 21-month Facebook marketing campaign accounted for 59% (n = 179/303) of our total sample and had the greatest geographic reach, recruiting women from 24 states. The Facebook campaign reached a total of 51,787 unique individuals and cost $88.44 in US dollars (USD) per enrolled participant. Clinic samples had a greater proportion of women who were widowed (8% v 1%; P = .03) and Facebook had a higher proportion of women with a household income over $40,000 USD (83% v 71%; P = .02). There were no statistically significant differences between Facebook and the two clinics on baseline survey scores.

CONCLUSION

Augmenting traditional recruitment with Facebook increased our RCT's geographic and sociodemographic reach and supported meeting recruitment goals in a timely way. In the wake of the COVID-19 pandemic, cancer survivorship researchers should consider using social media as a recruitment strategy while weighing the advantages and potential biases introduced through such strategies.

Methods and perceptions of success for patient recruitment in decentralized clinical studies

Patient recruitment, diversity, and retention continue to impede successful and representative clinical studies. This systematic review aims to assess the impact of decentralized methods on recruitment, retention, and diversity in recent clinical studies. A systematic search of literature reporting on recruitment in decentralized clinical studies was performed. Studies were reviewed for those reporting the primary outcome of recruitment in decentralized clinical trials, observational studies, or those covering the topic of clinical trials. Secondary outcomes included retention, participant diversity, and participant satisfaction. This systematic search returned 13 studies highlighting the role of decentralized methods impacting participant recruitment, retention, and diversity in clinical studies. Eleven reported improved recruitment using decentralized methods. Seven of these reported improvements directly compared to traditional methods. Seven studies reported positive retention outcomes, with four directly comparing decentralized methods with traditional methods. Six studies were reported to have trended toward increased diversity in the demographics of the sample population, including race or geographic location. Related reviews have stated a lack of published comparable data to determine if decentralized clinical methods improved recruitment and retention. Results suggest this review addresses such a gap, providing data on how decentralized methods such as virtual visits can positively impact recruitment and retention.

Challenges to Recruiting Men on Active Surveillance for Prostate Cancer in Clinical Chemoprevention Trials

Clinical trials play a critical role in evidence-based medicine, when rigorous scientific methodology is utilized to discover and test the effectiveness and safety of new drugs to prevent or cure diseases, including cancer. Participation in clinical trials thus becomes key to successful completion of these trials. Although it is estimated that >70% of Americans are inclined to participate in clinical trials, less than 5% of adult cancer patients participate in clinical trials. There is thus a large gap between those inclined to participate in clinical trials and actual participation in clinical trials. As with trials targeting men with prostate cancer (PCa) on active surveillance (AS), where the target population is mostly over 50 years of age, others have observed several challenges with recruitment and accrual in clinical trials. The participation rate is currently unavailable for men on primary and secondary chemoprevention trials. Additionally, with unanticipated environmental factors such as a pandemic or other natural emergencies that may severely impact the economy, personal property, travel and person-to person contact for study-related procedures, there is a need to continuously identify these challenges and determine solutions to recruitment barriers in chemoprevention trials to ensure timely completion of early phase trials. Recent studies regarding the impact of the pandemic on clinical trial recruitment have shown that cancer prevention trials were relatively more negatively impacted compared to cancer treatment trials. The goal of this manuscript is to review our experience in continuously evaluating the protocol and patient level challenges to recruiting subjects on AS for PCa in this cancer chemoprevention trial conducted at the Comprehensive Cancer Center (CCC) and report the contemporary strategies that we are utilizing to continue to recruit subjects in this trial. We provide data from our current trial as an example while discussing future strategies to improve overall clinical trial recruitment. These strategies can inform future design of contemporary cancer chemoprevention trials and, additionally, better select, focus and invest in strategies that are the most productive and efficient for recruiting target populations.

Increasing patient participation in oncology clinical trials

AIM

Timely recruitment of eligible participants is essential for the success of clinical trials, with insufficient accrual being the leading cause for premature termination of both oncology and non-oncology trials.

METHODS

In this paper we further elaborate on the challenges for patient participation in oncology trials from physician, patient, healthcare system, and some trial-related perspectives.

RESULTS

We present strategies such as use of digital healthcare technologies, real-world data and real-world evidence, decentralized clinical trials, pragmatic trial designs, and supportive services to increase patient participation.

CONCLUSIONS

Multifaceted measures are necessary to increase patient participation, especially for those who are under-represented in cancer trials.

Innovative Social Media Summit: Providing a Path for Physicians on Social Media

PROBLEM

Physicians' voices are valued in society and should be present in mainstream social media where they can provide valuable public health messaging and patient education as well as increase opportunities for medical education, mentoring, and collaboration. However, lack of formal education on effective use of social media prevents many physicians from using it.

APPROACH

The authors developed a physician-led social media training program to address the need for formal instruction on social media use. The program was presented to medical students, trainees, and faculty at an academic medical institution in August and September 2020. The virtual format included 5 hour-long sessions with presentations by peer experts in social media. Peer physicians with experience using social media presented on a range of topics, including introductions to platforms, how to reach and grow audiences, and use of social media to advance patient education, medical education, and advocacy.

OUTCOMES

There were 425 cumulative registrations for the 5 sessions of the Social Media Summit. The number of registrants increased for each session, suggesting that interest increased over time. Qualitative and quantitative participant feedback was collected via a brief, voluntary survey. All of the participants who completed the survey (n = 24) reported they were "very satisfied" (58.3%) or "somewhat satisfied" (41.7%) with the Summit.

NEXT STEPS

Physician involvement in social media presents opportunities for public health knowledge, medical education, scientific collaboration, and career advancement. Physicians who have been successful in using social media for these purposes are excellent peer educators and can fill the medical education void in social media training. Future plans include building sustainability of the program, collecting additional quantitative and qualitative feedback to guide improvement, and encouraging reproducibility.

#ColonCancer: Social Media Discussions About Colorectal Cancer During the COVID-19 Pandemic

PURPOSE

Colorectal cancer (CRC) is the second leading cause of cancer-related mortality worldwide. Social media platforms such as Twitter are extensively used to communicate about cancer care, yet little is known about the role of these online platforms in promoting early detection or sharing the lived experiences of patients with CRC. This study tracked Twitter discussions about CRC and characterized participating users to better understand public communication and perceptions of CRC during the COVID-19 pandemic.

METHODS

Tweets containing references to CRC were collected from January 2020 to April 2021 using Twitter's Application Programming Interface. Account metadata was used to predict user demographic information and classify users as either organizations, individuals, clinicians, or influencers. We compared the number of impressions across users and analyzed the content of tweets using natural language processing models to identify prominent topics of discussion.

RESULTS

There were 72,229 unique CRC-related tweets by 31,170 users. Most users were male (66%) and older than 40 years (57%). Individuals accounted for most users (44%); organizations (35%); clinicians (19%); and influencers (2%). Influencers made the most median impressions (35,853). Organizations made the most overall impressions (1,067,189,613). Tweets contained the following topics: bereavement (20%), appeals for early detection (20%), research (17%), National Colorectal Cancer Awareness Month (15%), screening access (14%), and risk factors (14%).

CONCLUSION

Discussions about CRC largely focused on bereavement and early detection. Online coverage of National Colorectal Cancer Awareness Month and personal experiences with CRC effectively stimulated goal-oriented tweets about early detection. Our findings suggest that although Twitter is commonly used for communicating about CRC, partnering with influencers may be an effective strategy for improving communication of future public health recommendations related to CRC.

A survey of patients with laryngotracheal stenosis on future clinical trial design

BACKGROUND/AIMS

Laryngotracheal stenosis is a rare but devastating proximal airway fibrosis that restricts a patient's ability to breathe. Treatment is primarily surgical and to date, there has never been a multi-institutional, randomized, prospective, and interventional clinical trial for a medical therapy to treat laryngotracheal stenosis. Therefore, we aimed to obtain patient feedback to guide successful trial design, recruitment, retention, and for identifying potential barriers to study participation.

METHODS

Over 1000 members of an international laryngotracheal stenosis online support community (the Living with Idiopathic Subglottic Stenosis Facebook group) were sent two questionnaires for a proposed interventional double-blinded, randomized, placebo-controlled clinical trial.

RESULTS

A total of 317 and 558 participants responded to the first and second surveys, respectively. The majority of participants (77%) were willing to consider enrollment, regardless of having a 50% chance of receiving placebo versus treatment (78%). The majority (84%) of participants were willing to travel 200 miles to participate for up to six in-person visits over 50 days. Specific side effects, including anemia/thrombocytopenia (72%) or risk of infection (69.3%) had the greatest impact on clinical trial participation with other side effects (peripheral edema (53%), oral ulcers (51%), and gastrointestinal side effects (41%)) having less impact.

CONCLUSION

Patients with laryngotracheal stenosis possess nuanced insight into their disease and treatment options. As a group, they are extremely motivated for better therapies. Future laryngotracheal stenosis clinical trials should focus on providing excellent side effect -related education and utilizing feedback from online advocacy groups to optimize recruitment and retention.

Social Media and Clinical Research in Dermatology

Purpose of Review

The immense growth of social media has afforded new opportunities in dermatology clinical research. This review serves to outline how social media has impacted clinical research and to explore future avenues for which social media can make a significant impact in dermatology clinical research.

Recent Findings

Recent clinical trials augmented by social media have demonstrated increased participant enrollment, shortened recruitment timelines, and decreased recruitment cost. The incorporation of social media into clinical research has also afforded greater access to teledermatology and the initiation of virtual clinical trials.

Summary

Clinical research serves as a primary source of evidence for refining healthcare practices by expanding the understanding of patient demographics, methods for improving patient care, and new therapeutic discoveries. Since its initiation, social media has played an integral and ever-expanding role in clinical research.

Perception of social media behaviour among medical students, residents and medical specialists

INTRODUCTION

Behaviour is visible in real-life events, but also on social media. While some national medical organizations have published social media guidelines, the number of studies on professional social media use in medical education is limited. This study aims to explore social media use among medical students, residents and medical specialists.

METHODS

An anonymous, online survey was sent to 3844 medical students at two Dutch medical schools, 828 residents and 426 medical specialists. Quantitative, descriptive data analysis regarding demographic data, yes/no questions and Likert scale questions were performed using SPSS. Qualitative data analysis was performed iteratively, independently by two researchers applying the principles of constant comparison, open and axial coding until consensus was reached.

RESULTS

Overall response rate was 24.8%. Facebook was most popular among medical students and residents; LinkedIn was most popular among medical specialists. Personal pictures and/or information about themselves on social media that were perceived as unprofessional were reported by 31.3% of students, 19.7% of residents and 4.1% of medical specialists. Information and pictures related to alcohol abuse, partying, clinical work or of a sexually suggestive character were considered inappropriate. Addressing colleagues about their unprofessional posts was perceived to be mainly dependent on the nature and hierarchy of the interprofessional relation.

DISCUSSION

There is a widespread perception that the presence of unprofessional information on social media among the participants and their colleagues is a common occurrence. Medical educators should create awareness of the risks of unprofessional (online) behaviour among healthcare professionals, as well as the necessity and ways of addressing colleagues in case of such lapses.

Social Media in Heart Failure: A Mixed-Methods Systematic Review

BACKGROUND

Among social media (SoMe) platforms, Twitter and YouTube have gained popularity, facilitating communication between cardiovascular professionals and patients.

OBJECTIVE

This mixed-methods systematic review aimed to assess the source profile and content of Twitter and YouTube posts about heart failure (HF).

METHODS

We searched PubMed, Embase and Medline using the terms "cardiology," "social media," and "heart failure". We included full-text manuscripts published between January 1, 1999, and April 14, 2019. We searched Twitter and YouTube for posts using the hashtags "#heartfailure", "#HF", or "#CHF" on May 15, 2019 and July 6, 2019. We performed a descriptive analysis of the data.

RESULTS

Three publications met inclusion criteria, providing 677 tweets for source profile analysis; institutions (54.8%), health professionals (26.6%), and patients (19.4%) were the most common source profiles. The publications provided 1,194 tweets for content analysis: 83.3% were on education for professionals; 33.7% were on patient empowerment; and 22.3% were on research promotion. Our search on Twitter and YouTube generated 2,252 tweets and > 400 videos, of which we analyzed 260 tweets and 260 videos. Sources included institutions (53.5% Twitter, 64.2% You- Tube), health professionals (42.3%, 28.5%), and patients (4.2%, 7.3%). Content included education for professionals (39.2% Twitter, 62.3% YouTube), patient empowerment (20.4%, 21.9%), research promotion (28.8%, 13.1%), professional advocacy (5.8%, 2.7%), and research collaboration (5.8%, 0%).

CONCLUSION

Twitter and YouTube are platforms for knowledge translation in HF, with contributions from institutions, health professionals, and less commonly, from patients. Both focus largely on education for professionals and less commonly on patient empowerment. Twitter includes more research promotion, research collaboration, and professional advocacy than YouTube.

Social Media and Your Cancer Patient

In an increasingly connected world, healthcare is rapidly evolving to meet the needs of a growing patient population seeking information online. In the past few years, social media has erupted as a means of dissemination of health-related information between patients and healthcare providers alike. Patients online have access to communities and expert-opinion previously inaccessible. Cancer patients especially are empowered through online knowledge acquisition and interactions with support groups or advocacy groups. As patients continue seeking information online, social media has increasingly been recognized as an important potential physician-patient interface. Healthcare provider's presence on social media is growing to meet this need. Providers can utilize social media to easily reach patients to promote health-related information, guide important conversations like the importance of cancer screening and even improve health-related behaviors. Social media can also aid in conducting research through cultivation of networking, patient recruitment, and promotion of rapid dissemination of new results. Whether through "Tweet chats" or conference hashtags, the most up to date information is easily accessible and rapidly transmissible. Social media is positioned to bridge a gap of communication and accessibility between 21st century patients and physicians.

Investigator Use of Social Media for Recruitment of Patients for Cancer Clinical Trials

This survey study discusses the use of social media for recruitment of patients for cancer clinical trials and investigators’ concerns about this recruitment approach.

Internal Medicine Physicians and Social media: Knowledge, Skills, and Attitudes

Objective

Increasing adoption of social media have revolutionized communications between individuals, groups, and organizations This research study was designed to assess the knowledge, skills, and attitudes of internal medicine physicians’ awareness and engagement with social media (sometimes referred to as #SoMe) within the digital landscape of healthcare delivery.

Methods

An audience-response survey focused on social media “Social media in Healthcare: Physician Survey,” was administered during the “A Systematic Approach to Medically Unexplained Symptoms” continuing medical education conference. The Conference took place between August 22, 2019 and August 24, 2019. Data was collected on August 23, 2019. A range of 103 (59.5%) to 112 (64.7%) of the total 173 attendees participated in this cross-sectional audience-response survey, depending on the questions answered.

Results

Most responders were between the ages of 35 and 65 years (79.6%) and female (60.2%). A majority of responders were aware of social media terminology (88.7%), and many had used it personally (46.7%), but only 12% knew how to use social media to search medical topics, 18% used it to network professionally and most (68.9%) had a distrust of social media when it came to the protection of their privacy or their patients’ privacy. Overall, about 29.6% indicated an interest in future continued medical education focused on social media (and 27.4% were neutral).

Conclusions

Approximately half of the responders used social media but far less engaged its platforms for professional use likely due to privacy related concerns. Distance from academic institutions, where professional social media use is more common likely, played a role in aversion. Awareness of social media’s role in healthcare has increased among physicians in practice, however their participation and knowledge of opportunities remains limited.

To be or not to be in the social media arena? The perspective of healthcare providers working within adolescent and young adult oncology in Switzerland

Background Given that social media is quickly penetrating clinical practice, it is essential to explore how these technologies can be used to improve patient-centered care. This is particularly important for healthcare professionals caring for adolescents and young adults (AYA), amid whom the use of social media is nearly universal and whose medical and psychosocial needs are often underestimated by the pediatric or adult oncology settings in which they are treated. Objectives To examine the perspectives of various medical professionals on the emerging role of social media in AYA oncology. Methods Three focus groups were performed with Swiss healthcare professionals involved in the care of AYA patients with cancer. The focus groups were analyzed using thematic coding. Results Healthcare professionals caring for AYA cancer patients in Switzerland are reluctant to step into the social media sphere because they find it difficult to navigate professional boundaries in an unfamiliar space where different contexts collapse. Nurses and younger healthcare professionals who tend to have a more intimate relationship with AYA, often lack virtual mentorship to know how to maintain online professionalism. Adolescents and young adults cancer-related social media presence was unknown to our participants which resulted in missed occasions to inform, educate and care for this often underserved population of cancer patients. Conclusions More practical guidance is needed to help healthcare professionals with how to integrate social media into clinical practice. Setting up fruitful collaborations between medical institutions and existing AYA support groups online might be the best way forward.

SOCIAL MEDIA FOR MEDICAL JOURNALS

Social networks are now an integrated part of life in most digitally connected societies. Bringing scientific papers of interest to a defined audience using the appropriate channel might substantially contribute to the impact of a scientific discovery. Various media and metrics have come to the fore in strategizing dissemination of scientific information. This opinion piece offers insights from the social-media experience of digital editors of peer-reviewed journals from non-Anglophone countries.

Barriers to Clinical Trial Accrual: Perspectives of Community-Based Providers

BACKGROUND

Only a small proportion of patients with cancer enroll onto clinical trials. Previous studies have explored patient-related barriers to trial participation; however, few studies have focused on the provider perspective. We aimed to describe referral practices and barriers to referrals of patients with breast cancer for clinical trials, including the utilization of web-based trial-matching tools.

MATERIALS AND METHODS

In 2016, we distributed 120 surveys to attendees of a breast oncology continuing medical education course. The survey addressed referral patterns, trial knowledge, and perceptions of web-based trial-matching tools. After survey completion, participants were provided a link to the Dana-Farber Cancer Institute trial-matching tool. Three months later, a follow-up survey was sent to assess their use of this tool. Descriptive statistics were used to summarize survey data.

RESULTS

Ninety-six (80%) participants completed the first survey; 5 respondents did not actively treat patients with breast cancer and were excluded. Respondents included medical (30%) and surgical (22%) oncologists, nurse practitioners/physician assistants (26%), and other (22%). Neoadjuvant and metastatic trials were deemed the highest priority. The primary reported barriers included perceived lack of patient interest, lack of trial awareness, and logistical barriers. Emailing trial investigators directly was the preferred method of trial referral. Although 80% indicated that web-based tools would increase trial referrals, our follow-up survey revealed that only 18% of respondents used our web-based tool.

CONCLUSION

Our respondents valued trial participation for their patients but found it difficult to manage. Further research is needed regarding how to increase the likelihood that patients are presented with appropriate trial options.