Abstract A50: Educating women about cancer clinical trials: The impact of a community health educator intervention in a primary care clinic
Authors: Gunn Christine M. , Bak Sharon K. , Battaglia Tracy A. 
Published: May 2015

Clinical trials information is often presented to patients at the time of diagnosis or during the course of treatment when patients have many barriers to acquiring new information, including stress on emotional, social, family, and/or functional well-being. We hypothesized that engaging the community about the importance of clinical trials is critical in order to increase enrollment when patients are faced with a diagnosis. We implemented an educational program based on the premise that general education about cancer clinical trials should begin independent of a cancer diagnosis in order to maximize message retention and acceptability. This pilot program aimed to educate low income, racially-diverse patients about clinical trials and evaluate acceptance and attitudes of incorporating these messages during a primary care visit.

A Community Health Educator (CHE) funded through the NCI National Outreach Network was hired to work within a women's health primary care clinic in an urban safety net hospital to target women in need of cancer screening. The CHE identified women ages 50-69 more than 18 months overdue for routine breast cancer screening, scheduled mammograms, and educated these women about clinical trials to promote awareness about research. All women who met the criteria for overdue screening were provided with NCI-adapted educational materials and participated in discussions with the CHE about clinical trials. Women were invited to participate in follow up qualitative interviews about the educational materials until the evaluation sampling goal of 20 was reached. The evaluation interview consisted of both close- and open-ended questions. Likert and dichotomous responses were summarized using descriptive statistics. Qualitative responses were coded by the primary author and reviewed with two senior authors.

The CHE identified 1,703 women eligible for mammograms in the clinic, of which 460 (27%) were overdue for screening. Through one-on-one interactions with these women, the CHE scheduled 324 mammograms to reduce the rate of overdue breast cancer screening to 8% over a one year period. The CHE delivered educational materials to 190 of these women. Of the twenty women in the evaluation sample, most were racial/ethnic minorities (65%), on public insurance (55%), and only half had education above a high school diploma. While all (100%) respondents agreed that clinical trials help find ways to prevent cancer, fewer (55%) women reported they would be willing to participate themselves. Compared to those who were willing to participate in a future clinical trial, participants who were unwilling were more likely to be non-white (45% vs. 89%; p=0.04). Qualitative responses indicated that most women recalled receiving the educational materials and topics discussed, but when probed regarding specific details about clinical trials, little information was retained. Women who were able to recall specifics typically related their knowledge to salient life circumstances such as a personal or family experience with cancer.

This program demonstrates the viability of incorporating clinical trials messages into primary care encounters involving cancer screening discussions in a safety net population. Our use of a CHE was successful in engaging a diverse group of women and resulted in more than half reporting a willingness to consider clinical trial enrollment in the future. Although message retention was a challenge, using narratives to increase salience may be one way to overcome this barrier, especially for minority populations.

Citation Format: Christine M. Gunn, Sharon K. Bak, Tracy A. Battaglia. Educating women about cancer clinical trials: The impact of a community health educator intervention in a primary care clinic. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A50. doi:10.1158/1538-7755.DISP13-A50