Abstract A11: A disparity of words: A comparison of offers to participate in cancer clinical trials by patient race.
Authors: Eggly Susan , Barton Ellen , Winckles Andrew , Penner Louis A. , Albrecht Terrance L. 
Published: August 2014

Purpose: Oncologist-patient communication clearly influences patients' decisions about participating in clinical trials (Albrecht 2008; Eggly 2008). Black-White differences in the quality of patient-physician communication exist in oncology interactions (Eggly 2011), but no prior study has used real-time data from actual clinical interactions to investigate whether there are also Black-White differences in communication about clinical trials. The purpose of this study was to compare communication during offers to participate in cancer clinical trials in oncology visits with Black and with White patients.

Patients and Methods: Data were taken from an archive of 47 transcribed, video recorded oncology interactions that included the explicit offer of a cancer clinical trial (Albrecht 2008). All visits with Black patients (n=11) were identified and matched with a sample of visits with White patients (n=11). We used linguistic discourse analysis to analyze the visits (n=22) with specific focus on discussions of clinical trials and the five basic elements of consent (purpose, risks and benefits of the trial, alternatives to participating, and the voluntary nature of trial participation). We used word count as an objective measure of the amount of actual face-to-face discussion that occurred during the visits. We assessed Black-White differences in word count of the entire visits; the number of times clinical trials or any of the elements of consent were mentioned by oncologists, patients, or patients' companions; and word count of discussions during mentions of each of these topics.

Results: Mean word count of the entire visit was less for Black than White patients (m=4877.73Blacks vs. 7247.18Whites, d=.8740). Clinical trials were mentioned less frequently during visits with Black than White patients (M=2.73Blacks vs. 4.27Whites, d=1.2099). Mean word count during mentions of clinical trials was also less for Black patients (1089.64Blacks vs. 1867.09Whites, d=1.0618). Regarding the elements of consent, mean word count was less for Black patients during discussions of purpose (M=90.91 Blacks vs. 181.22 Whites, d=.9272) and risks (M=211.900Blacks vs. 390.27Whites, d=.6477). Risks were also mentioned less frequently for Black patients (M=1.91Blacks vs. 3.18Whites, d=.5782). However, voluntary participation was mentioned more frequently (M=2.18Blacks vs. 1.55Whites, d=.4139) for White than Black patients.

Conclusion: Black patients, as compared to White patients, may make decisions about clinical trial participation based on less overall discussion with oncologists and less discussion of the purpose and risks of participation. One possible explanation is a less active communication style of Black patients in medical visits, which has been shown in other research (Gordon 2006; Eggly 2011). Other possibilities include oncologist concerns about patient mistrust and/or nonconscious racial bias (van Ryn 2011). Possible communicative strategies to overcome these disparities include more conscious attention to mentioning and developing the topic of clinical trials with Black patients, with particular attention to the purpose and risks of trial participation.

Citation Format: Susan Eggly, Ellen Barton, Andrew Winckles, Louis A. Penner, Terrance L. Albrecht. A disparity of words: A comparison of offers to participate in cancer clinical trials by patient race. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A11.