Financial incentives to address representativeness in randomized clinical trials: A secondary analysis of the RETAIN randomized clinical trial

Enrolling participants in randomized clinical trials (RCTs) who reflect the patients to whom the results will be applied is crucial for promoting fairness, engendering trust, and augmenting generalizability. Yet enrollment disparities persist. In the Randomized Evaluation of Trial Acceptability by Incentive (RETAIN) study, financial incentives increased enrollment in 1 of 2 RCTs evaluated without acting as undue or unjust inducements in either. Recruitment took place from September 2017 to August 2019 for the smoking trial and January 2018 to May 2019 for the ambulation trial. Using data from RETAIN, we evaluated whether use of incentives was associated with narrowed enrollment gaps among subgroups of race and ethnicity, sex, educational level, and age.

In this secondary analysis of an embedded trial of financial incentives for trial enrollment, we found incentives were associated with reduced enrollment gaps between Black and White patients… These findings suggest the importance of just payment structures for clinical research representation, and that incentives may help alleviate barriers that may be more prevalent among Black participants.

National Heart, Lung, and Blood Institute
National Institutes of Health
NIH Medical Scientist Training Program

Jamie S Benson, Bhavik P Patel, Brian Bayes, Elizabeth Cooney-Zingman, Alisa J Stephens Shields, Scott D Halpern