The use of social media has been explored as a potential strategy to improve enrollment in cancer clinical trials. However, significant barriers to implementation of this recruitment approach remain, including investigator reluctance to use social media for patient recruitment.1,2 We conducted a survey study to assess the prevalence of and attitudes toward the use of social media in clinical trial recruitment among cancer investigators.
In the Southwest Oncology Group Cancer Research Network, 1 of 4 adult National Cancer Institute–sponsored clinical trials groups, we surveyed 220 principal or coprincipal investigators of National Cancer Institute–funded clinical protocols between October 21 and December 30, 2019. Eligible participants included investigators of study protocols from January 1, 2013, to October 14, 2019. The survey instrument was constructed on the basis of prior qualitative work,3 reviewed by methodologists and clinical experts, and pilot tested (eAppendix 1 in the Supplement). The study followed the American Association of Public Opinion Research (AAPOR) reporting guideline4 and was approved by the City of Hope institutional review board. The survey was administered online using Research Electronic Data Capture (REDCap) software. Eligible participants were sent an invitation via email with a brief explanation of the purpose of the research and a URL link for online survey. By following the link, participants were provided with a statement of research on the title page of the survey, which included all the elements of informed consent, prior to commencement of the survey.
We measured the prevalence of social media use for trial recruitment as the proportion of respondents (termed users) who reported any use (other than “never”) to the item, “How often do you use social media to recruit for your research studies?” We measured attitudes and concerns by dichotomizing responses to survey items as “agree or strongly agree” vs “neutral, disagree, or strongly disagree” and “not at all concerned or slightly concerned” vs “somewhat, moderately, or extremely concerned.”
Demographic and practice characteristics were summarized using descriptive statistics (Table). For each measure, we calculated proportions and 95% CIs. The χ2 and Fisher exact tests were used to compare differences between users and nonusers. Logistic regression was used to examine the association between social media use for recruitment and investigator attitudes adjusted for age and protected research time. Analyses were conducted using SAS, version 9.4 software (SAS Institute Inc). The level of statistical significance was set at 2-sided P < .05.
The survey response rate was 45% (92 of 220 surveys were returned) (eAppendix 2 in the Supplement). Twenty of 92 participants (22%; 95% CI, 14%-32%) reported that they use social media platforms to recruit patients (users). Compared with nonusers, users were more likely to be younger (<45 years, 8 of 20 [40%] vs 15 of 72 [21%]; P = .08), and had 30% or more professional time dedicated to research (16 of 20 [80%] vs 41 of 72 [57%]; P = .07).
The majority of the 92 participants agreed that social media can help increase awareness of cancer trials (79 [86%; 95% CI, 77%-92%]), education about cancer trials (75 [82%; 95% CI, 72%-89%]), and patient access to cancer trials (69 [75%; 95% CI, 65%-83%]) (Figure, A). Most participants were concerned about the risk of misinformation (55 [60%; 95% CI, 49%-70%]) and misinterpretation (53 [58%; 95% CI, 47%-68%]) of the trial information, and 54 participants (59%; 95% CI, 48%-69%) believed that trained moderator monitoring is needed. Compared with users, nonusers were more concerned about misinformation (49 of 72 participants [68%] vs 6 of 20 [30%], P = .004), misinterpretation (48 [67%] vs 5 [25%], P = .002), undisclosed conflicts of interest (32 [44%] vs 3 [15%], P = .02), and violations of patient privacy (27 [38%] vs 1 [5%], P = .005) (Figure, B). Adjustment for age and protected research time did not change these associations.
Nearly 1 in 4 cancer investigators in the Southwest Oncology Group reported that they used social media to recruit patients for trials. Although most investigators were optimistic about social media use for this purpose, many barriers to use remain. This exploratory study was limited to investigators of a single National Cancer Institute network group.
With more than 2.9 billion individuals worldwide using social media platforms regularly, their use has created an ability to disseminate health information with unprecedented speed, reach, and penetration.5 Use of such platforms has become increasingly important amid the coronavirus disease 2019 pandemic,5 prompting discussions in the scientific literature and popular press about the potential application of these widely used platforms to improve patient recruitment for trials.6 If investigator resistance is overcome, social media may emerge as an essential tool for promoting accrual to clinical trials.
Accepted for Publication: October 30, 2020.
Published: December 28, 2020. doi:10.1001/jamanetworkopen.2020.31202
Correction: This article was corrected on March 18, 2021, to fix the key in the Figure and to correct the absolute percentages for data from the nonusers group in part B of the Figure.
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Sedrak MS et al. JAMA Network Open.
Corresponding Author: Mina S. Sedrak, MD, MS, Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Care Center, 1500 E Duarte Rd, Duarte, CA 91010 (msedrak@coh.org).
Author Contributions: Drs Dale and Dizon served as co–senior authors and contributed equally to the work. Dr Sedrak had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Sedrak, Dale, Dizon.
Acquisition, analysis, or interpretation of data: Sedrak, Sun, Hershman, Unger, Liu, Dizon.
Drafting of the manuscript: Sedrak, Sun, Dizon.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Sun.
Obtained funding: Sedrak.
Administrative, technical, or material support: Liu, Dale, Dizon.
Supervision: Sedrak, Hershman, Dale, Dizon.
Conflict of Interest Disclosures: None reported.
Funding/Support: This work was supported by the Hope Foundation for Cancer Research Dr Charles A. Coltman Jr Career Development Award (Dr Sedrak), grant K12CA001727 from the National Cancer Institute, the Phase One Foundation, and the Center for Cancer and Aging. Dr Sedrak is supported by grant R03AG064377 from the National Institute on Aging, the Waisman Breast Cancer Innovation Fund, and City of Hope Circle 1500. Dr Dale is supported by grant K24AG055693 from the National Institute of Aging.
Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.
Additional Contributions: We thank our colleagues Sumanta Pal, MD, and Howard (Jack) West, MD (City of Hope); Michael J. Fisch, MD (MD Anderson Cancer Center); and Michael A. Thompson, MD (Aurora Cancer Care), for their review of this manuscript. We also thank Heeyoung Kim, MSc, for her assistance with the analysis. None of these individuals were financially compensated for their contributions.
4.American Association for Public Opinion Research. Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys. 9th ed. AAPOR; 2016.