Increasing Diversity in Clinical Trials: Overcoming Critical Barriers

Curr Probl Cardiol. 2019 May;44(5):148-172. doi: 10.1016/j.cpcardiol.2018.11.002. Epub 2018 Nov 9.


Clinical trial results provide the critical evidence base for evaluating the safety and efficacy of new medicines and medical products. Efficacy and safety may differ among population subgroups depending on intrinsic/extrinsic factors, including sex, age, race, ethnicity, lifestyle, and genetic background. Racial and ethnic minorities continue to be underrepresented in cardiovascular and other clinical trials. Although barriers to diversity in trials are well recognized, sustainable solutions for overcoming them have proved elusive. We investigated barriers impacting minority patients' willingness to participate in trials and-based on literature review and evaluation, and input from key stakeholders, including minority patients, referring physicians, investigators who were minority-serving physicians, and trial coordinators-formulated potential solutions and tested them across stakeholder groups. We identified key themes from solutions that resonated with stakeholders using a transtheoretical model of behavior change and created a communications message map to support a multistakeholder approach for overcoming critical participant barriers.

Publication types

  • Review

MeSH terms

  • Cardiovascular Diseases / ethnology*
  • Cardiovascular Diseases / therapy
  • Clinical Trials as Topic / organization & administration*
  • Continental Population Groups*
  • Ethnic Groups*
  • Global Health
  • Health Services Accessibility
  • Healthcare Disparities / ethnology*
  • Humans
  • Minority Groups / statistics & numerical data*
  • Patient Selection*
  • Surveys and Questionnaires