Factors that influence Spanish‐ and English‐speaking participants' decision to enroll in cancer randomized clinical trials

Abstract

Cancer randomized clinical trial (RCT) participation is low, particularly among ethnic and racial minorities. Hispanic enrollment is far below their representation in the US population, yet their cancer burden is higher. Little is known from the patient perspective about factors which influence the decision to enroll in RCTs. We asked Spanish- and English-speaking individuals what factors influence decisions about cancer RCT participation. Eight focus groups were conducted with 55 participants (25 Spanish and 30 English-speaking). The groups were taped, transcribed, and analyzed for themes. Six major themes emerged: patient-provider communication, personal relationship with provider, involvement of significant others in decision making, role of faith, need for information, and impact of discrimination on decision making. Both similarities (e.g. need for comprehensive information) and differences (e.g. need for provider acknowledgement of emotional and spiritual concerns) were found between Spanish- and English-speaking participants. Among Spanish-speaking participants, level of education was differentially related to decision-making themes. Implications for providers are discussed.

Influence of Culture and Discrimination on Care-Seeking Behavior of Elderly African Americans: A Qualitative Study

“…ATLAS-ti is a qualitative data management software (Pugh Computers Ltd., 2002) that can assist the researcher in coding narrative data, searching the data along a number of dimensions, and systematically identifying themes in the data (Barry, 1998). ATLAS-ti has been used in conducting similar studies dealing with health disparities among Hispanics (Ellington, Wahab, Sahami, Field, & Mooney, 2006) and Iranian immigrants (Martin, 2009). …”

Provider roles in the recruitment of underrepresented populations to cancer clinical trials

“…Eleven studies found provider attitudes as a barrier to enrollment 13,[15][16][17]19,20,[22][23][24][25]27 (Fig. 3), whereas 3 studies found provider attitudes to be a promoter of patient accrual.…”

“…Five studies 10,13,15,17,18 found that provider communication or method of presentation were barriers to patient enrollment, whereas 1 study found it to be a promoter of trial enrollment. 18 In focus groups of Latino/Hispanic patients, Ellington et al 15 reported that physician level barriers involved showing a lack of compassion and respect toward their patients as well as being rushed, defensive, or patronizing.…”

“…18 In focus groups of Latino/Hispanic patients, Ellington et al 15 reported that physician level barriers involved showing a lack of compassion and respect toward their patients as well as being rushed, defensive, or patronizing. Benson et al 10 found that 55% of physicians surveyed reported that they were uncomfortable discussing clinical trials as a treatment option with their patients.…”

“…Of the 18 studies eligible for review, 3 were published before 1993, 10-12 2 were published between 1993 and 1999, 13,14 and 13 were published in 2000 or later (Table 1). [15][16][17][18][19][20][21][22][23][24][25][26][27] The study designs included a randomized controlled trial (n ¼ 1), concurrent controlled trial (n ¼ 1), casecontrol (n ¼ 1), and descriptive (n ¼ 15), with 4 of the studies also using qualitative techniques to facilitate in-depth assessments of physician attitudes and perceptions. Fourteen studies reported recruitment into treatment trials only [10][11][12][13][15][16][17][18][19][20][21][22]24,26 ; 3 studies reported recruitment into both prevention and treatment trials 14,25,27 ; and 1 study reported recruitment to a prevention trial (Table 1).…”