Background African-Americans are consistently underrepresented in cancer clinical trials. Minority under-enrollment may be, in part, due to differences in the way clinical trials are discussed in oncology visits with African-American versus White patients. Objective To investigate differences in oncologist-patient communication during offers to participate in clinical trials in oncology visits with African-American and White patients. Methods From an archive of video recorded oncology visits, we selected all visits with African-American patients that included a trial offer (n=11) and a matched sample of visits with demographically/medically comparable White patients (n=11). Using mixed qualitativequantitative methods, we assessed differences by patient race in (1) word count of entire visits and (2) frequency of mentions and word count of discussions of clinical trials and key elements of consent. Results Visits with African-American patients, compared to visits with White patients, were shorter overall and included fewer mentions of and less discussion of clinical trials. Also, visits with African-Americans included less discussion of the purpose and risks of trials offered, but more discussion of voluntary participation. Discussion and Conclusions African-American patients may make decisions about clinical trial participation based on less discussion with oncologists than do White patients, as shown by a discourse analysis of two interactions. Possible explanations include a less active communication style of African-Americans in medical visits, oncologists’ concerns about patient mistrust, and/or oncologist racial bias. Findings suggest oncologists should pay more conscious attention to developing the topic of clinical trials with African-American patients, particularly purpose and risks.
Clinical trials are the gold standard in medical research evaluating new treatments in cancer care; however, in the United States, too few patients enroll in trials, especially patients from minority groups. Offering patients the option of a clinical trial is an ethically-charged communicative event for oncologists. One particularly vexed ethical issue is the use of persuasion in trial offers. Based on a corpus of 22 oncology encounters with Caucasian-American (n = 11) and African-American (n = 11) patients, this discourse analysis describes oncologists' use of two persuasive strategies related to the linguistic structure of trial offers: topic placement and topic framing. Findings are presented in total and by patient race, and discussed in terms of whether these strategies may constitute ethical or unethical persuasion, particularly with respect to the ethical issue of undue influence and the social issue of underrepresentation of minorities in cancer clinical trials.
Recent research has suggested that altruism might play a role in patients’ decisions to participate in cancer clinical trials. Little is known, however, about oncologists’ use of appeals to altruism as a persuasive strategy in the face-to-face communication of offers to participate in clinical trials. Based on a corpus of 22 oncology encounters, this exploratory discourse analysis describes oncologists’ appeals to altruism in clinical trial offers and discusses the ethical status of such appeals. Oncologists make appeals to altruism (1) in discussions of trial benefits and (2) in research stories about the progress of medical science through clinical trials. But these appeals were made only rarely in the corpus, indicating that oncologists may not regard appeals to altruism as a persuasive strategy, perhaps because they regard these appeals as ineffective in recruiting patients to participate in clinical trials.
Purpose: Oncologist-patient communication clearly influences patients' decisions about participating in clinical trials (Albrecht 2008; Eggly 2008). Black-White differences in the quality of patient-physician communication exist in oncology interactions (Eggly 2011), but no prior study has used real-time data from actual clinical interactions to investigate whether there are also Black-White differences in communication about clinical trials. The purpose of this study was to compare communication during offers to participate in cancer clinical trials in oncology visits with Black and with White patients. Patients and Methods: Data were taken from an archive of 47 transcribed, video recorded oncology interactions that included the explicit offer of a cancer clinical trial (Albrecht 2008). All visits with Black patients (n=11) were identified and matched with a sample of visits with White patients (n=11). We used linguistic discourse analysis to analyze the visits (n=22) with specific focus on discussions of clinical trials and the five basic elements of consent (purpose, risks and benefits of the trial, alternatives to participating, and the voluntary nature of trial participation). We used word count as an objective measure of the amount of actual face-to-face discussion that occurred during the visits. We assessed Black-White differences in word count of the entire visits; the number of times clinical trials or any of the elements of consent were mentioned by oncologists, patients, or patients' companions; and word count of discussions during mentions of each of these topics. Results: Mean word count of the entire visit was less for Black than White patients (m=4877.73Blacks vs. 7247.18Whites, d=.8740). Clinical trials were mentioned less frequently during visits with Black than White patients (M=2.73Blacks vs. 4.27Whites, d=1.2099). Mean word count during mentions of clinical trials was also less for Black patients (1089.64Blacks vs. 1867.09Whites, d=1.0618). Regarding the elements of consent, mean word count was less for Black patients during discussions of purpose (M=90.91 Blacks vs. 181.22 Whites, d=.9272) and risks (M=211.900Blacks vs. 390.27Whites, d=.6477). Risks were also mentioned less frequently for Black patients (M=1.91Blacks vs. 3.18Whites, d=.5782). However, voluntary participation was mentioned more frequently (M=2.18Blacks vs. 1.55Whites, d=.4139) for White than Black patients. Conclusion: Black patients, as compared to White patients, may make decisions about clinical trial participation based on less overall discussion with oncologists and less discussion of the purpose and risks of participation. One possible explanation is a less active communication style of Black patients in medical visits, which has been shown in other research (Gordon 2006; Eggly 2011). Other possibilities include oncologist concerns about patient mistrust and/or nonconscious racial bias (van Ryn 2011). Possible communicative strategies to overcome these disparities include more conscious attention to mentioning and developing the topic of clinical trials with Black patients, with particular attention to the purpose and risks of trial participation. Citation Format: Susan Eggly, Ellen Barton, Andrew Winckles, Louis A. Penner, Terrance L. Albrecht. A disparity of words: A comparison of offers to participate in cancer clinical trials by patient race. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A11.
Eighteenth-Century Women’s Writing and the Methodist Media Revolution argues that Methodism in the eighteenth century was a media event that uniquely combined and utilized different types of media to reach a vast and diverse audience. Specifically, it traces specific cases of how evangelical and Methodist discourse practices interacted with major cultural and literary events during the long eighteenth-century, from the rise of the novel to the Revolution controversy of the 1790’s to the shifting ground for women writers leading up to the Reform era in the 1830’s. The book maps the religious discourse patterns of Methodism onto works by authors like Samuel Richardson, Mary Wollstonecraft, Hannah More, Elizabeth Hamilton, Mary Tighe, and Felicia Hemans. This not only provides a better sense of the religious nuances of these authors’ better-known works, but also provides a fuller consideration of the wide variety of genres women were writing in during the period, many of which continue to be read as ‘non-literary’. The scope of the book leads the reader from the establishment of evangelical forms of discourse in the 1730’s to the natural ends of these discourse structures during the era of reform, all the while pointing to ways in which women—Methodist and otherwise—modified these discourse patterns as acts of resistance or subversion.
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