Use of Semi-Structured Interviews to Explore Competing Demands in a Prostate Cancer Prevention Intervention Clinical Trial (PCPICT)

In this paper we report on findings from the first known study using qualitative methods to explore factors influencing physicians' participation in an ongoing federally-funded prostate cancer chemoprevention clinical trial. We sought to identify ways to improve collaboration between researchers and physicians and enhance the success of future projects and employed purposive sampling to recruit physician/investigators who were involved or invited to participate in the trial. Using the data from open-ended semi-structured interviews, we examined patterns in their languaging and created themes. We found that individual and structural factors served as barriers and facilitators to participation. Willingness and desire to participate in the trial (individual factors) were not always enough to result in actual participation due to practice environment (structural) constraints. Our research provides a better understanding of the complex intersection of factors in this setting and through our findings we extend the theory of competing demands into the arena of prostate cancer prevention clinical trials, moving the science towards solutions to current challenges in recruitment to this type of trial. Keywords: Competing Demands, Barriers and Facilitators, Cancer, Screening and Prevention, Access to Participants, Open-Ended Semi-Structured InterviewsI, Dr. Crocker, conducted this research in partial fulfillment of the requirements for my doctorate in Applied Anthropology. During my doctoral program, I was uniquely situated, also working as a project director for a federally funded, multi-site, prostate cancer prevention intervention clinical trial (PCPICT). This resulted in the creation of a liminal space, often requiring navigation between the "rules" and languages of two very disparate worlds, biomedicine and anthropology, that seemed would never intersect. As the project director, I became increasingly aware of the challenges inherent in the design, implementation, and daily work of conducting a prostate cancer prevention trial. Simultaneously, through the requirements of the doctoral program, I experienced an increased skill set in which I acquired new perspectives and an expanded toolkit with which to examine the world. The overarching aim of my dissertation research was to show how the two worlds could merge, with each informing the other.As project director, I had observed recruitment below goal at most sites participating in the PCPICT. Upon review of detailed screening logs, our team was able to delineate patient, protocol and infrastructure related barriers that were contributing (Kumar et ah, 2012). Similar challenges to recruitment in chemoprevention clinical trials had been welldocumented by others (Chlebowski, Menon, Chaisanguanthum, & Jackson, 2010; Ruffin & Baron, 2000). What we also recognized as an important influence in recruitment was the support of committed physicians (Kumar et ah, 2012). Referring physicians had been recognized in other arenas for the major role they play in getting patients involved in clinical trials (Ford et ak, 2003; Miller, Crabtree, McDaniel, & Stange, 1998). In fact, physician involvement is considered essential for the provision of much of today's healthcare, and physicians serve as a critical link in the chain of events leading to the delivery of preventative services including cancer screening (Jaen et al., 2001; Nutting et al., 2001). What had not been explored using qualitative methods, and was the driving force behind this project was the role of physicians as the "link" to participation in prostate cancer prevention intervention trials (as PCPICT gatekeepers). Stange and Nutting (1994) used the theory of competing demands to describe the multiple factors competing for the provision and delivery of preventative services by primary care physicians. The main components (physician, patient, and practice environment) are thought to be influenced by factors such as attitudes, knowledge, expectations, practice organization, and alternative demands. …