Cancer trial communications

Doctor with patient

Clinical trials have resulted in enormous strides in cancer patient treatment in the past 30 years, leading to advanced care and — even better —more cancer survivors.

Despite the successes, a troubling omission remains: “Very few African-American cancer patients enroll in therapeutic clinical trials. That disparity must be addressed in order to improve care and survival rates,” says Richard Brown, Ph.D., an assistant professor in the department of Health Behavior and Policy at Virginia Commonwealth University.

Brown is the principal investigator of “African-American Cancer Clinical Trial Decisions: Testing Tailored Messages,” a four-year study that focuses on physician-patient communication about clinical trials. Ineffective communication is a significant barrier when it comes to recruiting African-American cancer patients for clinical trials, Brown says, and leads to less-informed medical decisions and patient distrust of their doctors.

This study is the first to involve both patients and physicians in the intervention process by giving patients brochures with messages about cancer clinical trials that are tailored to addressing each individual patient’s preferences and concerns, and, in some cases, sharing that messaging with their doctors prior to consultation appointments.

Brown says that less than 10 percent of African-American patients join clinical trials, partly because they don’t clearly understand what clinical trials entail. His goal is to eliminate poor communication as a barrier to enrollment.

The research, funded by a grant from the American Cancer Society, will enroll 357 African-American cancer patients from VCU’s Massey Cancer Center and affiliated sites. Patients will receive varying degrees of tailored messages before their consultation:

  • Some patients will receive brochures based on information from their medical files
  • Some patients will receive brochures based on their medical files and responses to a survey about their preferences and concerns regarding clinical trials

For half of all patients, doctors will review the brochures before the consultation.

The goal is to test what degree of message customization is needed for patients to be more engaged in the discussion with their doctor about clinical trials. The study also tests how helpful it is for a doctor to review information about the patient’s preferences or concerns before a consultation.

“If the physician knows a patient is worried about ethics in clinical trials, he or she might spend time explaining why ethical violations are less likely to occur than ever before,” Brown says.

To gather comprehensive data, the research team will survey patients; provide tailored messages to them and, in some cases, their doctors; audio-record the conversation about trial participation; and follow up to see what decision patients made about enrolling in a clinical trial and why.

Next, the research team will analyze the results: Did the patient being equipped with tailored information about clinical trials lead to a more involved discussion about treatment options? Did the doctor knowing about a patient’s concerns before the consultation lead to a better conversation?

“Hopefully, the patients will be more actively engaged in discussions with their oncologists in terms of asking more questions, expressing their concerns and making more assertive statements,” Brown says. “Our goal is to help African American cancer patients make more informed decisions about joining a clinical trial.”

 

* Richard Brown, Ph.D. is supported by a Research Scholar Grant, RSG-14-227-01-CPPB, from the American Cancer Society. For complete details about the study, view our current projects.