A disparity of words: racial differences in oncologist–patient communication about clinical trials

Abstract

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.

Barriers to Clinical Trial Enrollment in Racial and Ethnic Minority Patients with Cancer

“…45,63,92–95 Although few researchers have specifically focused on discussions with minority patients about enrolling in cancer trials, a single study of video-recorded interactions was undertaken in which oncologists discussed clinical trials with whites and African Americans. 96 Using linguistic analyses, the interactions with African Americans compared with whites were found to be shorter, the topic of clinical trials was less frequently mentioned, and, when clinical trials were mentioned, less time was spent discussing them. 96 Compared with whites, differences were observed in the discussion of some of the key aspects of clinical trials: Oncologists and African American patients spent less time discussing the purpose of the trial, its risks and benefits, and alternatives to participating in the trial; however, they spent more time discussing the voluntary nature of trials.…”

Do Patients and Oncologists Discuss the Cost of Cancer Treatment? An Observational Study of Clinical Interactions Between African American Patients and Their Oncologists

“…[31][32][33][34][35] In addition, most African American patients with cancer experience racially discordant clinical interactions (ie, nonAfrican American physician with African American patient), 36 and a significant body of research has found that relative to racially concordant interactions, patient-physician communication in racially discordant interactions is of poorer quality. [37][38][39][40][41][42][43] A secondary purpose of this study was to explore how certain patient characteristics affect cost discussions. Research has found that financial toxicity is an emotional stressor.…”

Discussing race-related limitations of genomic testing for colon cancer risk: Implications for education and counseling

“…Past research in health care communication has identified potential impediments to communication between health care providers and patients, including lack of provider engagement and misreading of patients’ non-verbal communication (Levine & Ambady, 2013). Recent research that explored physicians’ discussion of clinical trials for cancer treatment with African American and non-Hispanic white patients identified that physicians spent less time discussing potential trial risks and more time discussing the voluntary nature of participation with African Americans compared to non-Hispanic whites (Eggly, Barton, Winckles, Penner, & Albrecht, 2013). The conversations analyzed for the present study were part of tailored one-on-one discussions occurring before and after SNP testing.…”

“…This evidence contradicts the impression and individual studies that indicate minorities decline research at a greater rate than non-Hispanic whites and encourages a more nuanced or comprehensive explanation for lacking data among minorities (Wendler et al, 2006). As more evidence accumulates for the processes by which research participation is explained to individuals of different backgrounds, we may uncover specific strategies to help improve what and how much information is shared (Eggly et al, 2013). …”

“…Specific to genetic counselors and other genomic service providers, our results suggest that these clinicians should carefully consider communication processes of verbal dominance, immediacy and interactivity when communicating with a patient. Beyond genetics professionals, results highlight the potential benefit of attending to both how and how much information is conveyed in discussions with all patients, but particularly minority patients (Eggly et al, 2013; Hagiwara et al, 2013). With continued focus on patient-centered communication and care as potential drivers of improved health outcomes (Epstein & Street, 2007), examining how clinicians describe limitations to results from emerging technologies can contribute to the identification of potential education or intervention targets.…”