Lessons from the field: culturally grounded approaches to recruiting Chinese American immigrant cancer patients to psycho-oncology trials.

backgroundAsian Americans (AAs) are the only racial/ethnic group in the USA for whom cancer and not heart disease is the leading cause of death in men and women, and foreign-born immigrants are more likely to be diagnosed at an advanced stage than their native-born counterparts. While there is a growing literature on the development of culturally grounded interventions for AA and immigrant populations in cancer care, there is limited knowledge of researchers' experiences recruiting AAs to cancer research studies.

methodsBetween August 2023 and May 2025, trained bilingual research staff recruited eligible patients from an NCCN-designated cancer center in the Northeast to two trials piloting a counseling intervention adapted for Chinese Mandarin-speaking patients with advanced cancer. Research staff documented qualitative notes regarding contact with patients and family members in study contact logs. Contact logs of participants who declined to participate (n = 97), in addition to research reflections and amendments to the study protocol, were reviewed and coded to summarize main challenges in recruiting eligible patients to the study.

resultsThematic analysis yielded six main challenges encountered during the recruitment process: (1) family member involvement, (2) limited prognostic awareness, (3) mistrust and scam concerns, (4) uncertainty and unfamiliarity with counseling and psycho-oncology, (5) unmet health-related social needs, and (6) communication difficulties related to language/dialect. Details of how the recruitment processes were modified to address challenges and facilitate study participation are described.

conclusionSeveral recommendations are proposed for future research studies with Chinese immigrant cancer patients. During initial contact, research staff's approach with family caregivers is a major determinant of Chinese patients' willingness to participate. Social drivers of health (e.g., barriers to linguistically appropriate health care access, mistrust), health-related social needs (e.g., patients' and families' financial instability), and culturally rooted differences in prognosis sharing also affect patient engagement with research staff. Patient engagement processes should be flexible to respond to patient and caregiver needs. Culturally grounded recruitment strategies can improve rapport, build trust, and increase likelihood of recruitment and retention among Chinese immigrant cancer patients. Trial registration NCT02112188, registration date: August 30, 2023.