AACR: Communication Differences May Explain Minority Under-Enrollment in Clinical Trials

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(ChemotherapyAdvisor) – Racial disparities exist in the quality of communication between physicians and patients in discussing clinical trial participation, a study presented at the Fifth AACR Conference on The Science of Cancer Health Disparities, San Diego, CA, reported.

“Minority patients tend to receive less information, which could, in part, explain under-enrollment by minorities in clinical cancer trials,” said Susan Eggly, PhD, associate professor of oncology in the Population Studies and Disparities Program at Wayne State University School of Medicine and the Barbara Ann Karmanos Cancer Institute, Detroit, MI. “These disparities could also lead to minority patients being enrolled in trials without fully understanding the purpose of the trial and the potential risks of participation.”

In their study, “A Disparity of Words: A Comparison of Offers to Participate in Cancer Clinical Trials by Patient Race,” Dr. Eggly and colleagues compared data taken from an archive of transcribed, video recorded oncology interactions that “included the explicit offer of a cancer clinical trial.”

The black patients (n=11) were matched with white patients (n=11) by cancer type and sociodemographic characteristics. Researchers used linguistic discourse analytical methods to examine several aspects of interactions of the 22 visits, including overall discussion of clinical trials and the five basic elements of consent: purpose, risks, benefits, alternatives to participating and the voluntary nature of trial participation. “Word count” was used as an objective measure of actual face-to-face discussion.

Data revealed that clinical trial interactions with black patients were shorter overall: mean word count of the entire visit was less for black than white patients (m=4877.73 vs 7247.18, d=0.8740), and clinical trials were mentioned less frequently (M=2.73 vs 4.27, d=1.2099). Mean word count during mentions of clinical trials was also less for black patients, including during discussions of purpose and risks, and risks were mentioned less frequently for black patients. Voluntary participation was mentioned more frequently for white than black patients.

Previous research by Eggly et al has found black patients tend to ask fewer questions and trust their doctors less than white patients. In addition, physician biases may affect quality of communication, which Eggly believes may also account for the differences found in this study.

“Taking a close look at interactions and the language used can help us to identify patterns of behavior and make the necessary improvements that may ultimately lead to decisions that are in the best interest of each patient,” she said.

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