FRAMM: Fair ranking with missing modalities for clinical trial site selection

Abstract

The underrepresentation of gender, racial, and ethnic minorities in clinical trials is a problem undermining the efficacy of treatments on minorities and preventing precise estimates of the effects within these subgroups. We propose , a deep reinforcement learning framework for fair trial site selection to help address this problem. We focus on two real-world challenges: the data modalities used to guide selection are often incomplete for many potential trial sites, and the site selection needs to simultaneously optimize for both enrollment and diversity. To address the missing data challenge, has a modality encoder with a masked cross-attention mechanism for bypassing missing data. To make efficient trade-offs, uses deep reinforcement learning with a reward function designed to simultaneously optimize for both enrollment and fairness. We evaluate using real-world historical clinical trials and show that it outperforms the leading baseline in enrollment-only settings while also greatly improving diversity.