Clinical trials: a wider lens 2.

Social workers should be involved in the recruitment of patients into clinical trials. However, social workers must give consideration to the components and boundaries of the social work role in recruitment, the ethical problems in implementing the social work role, and the formal education necessary to provide services competently. The role of the social worker in recruiting patients into clinical trials is not defined explicitly. What does the task of recruitment include? Does the social worker implement a recruitment strategy that has already been developed, or is the worker responsible for the development of a strategy as well as its implementation (Freedman, 1998)? It has been suggested that social workers might be particularly effective in recruiting diverse populations. However, the development of effective recruitment strategies for these populations is likely to be time intensive and may involve developing positive relationships with community gatekeepers and leaders and with community institutions such as churches and fraternal and social organizations. In addition, language barriers or low literacy rates may require translation of study forms and informed consent statements (Lovato, Hill, Hertert, Hunninghake & Probstfield, 1997; Paskett, DeGraffinreid, Tatum, & Margitic, 1996; Swanson & Ward, 1995). Defining the parameters of the recruitment role is important in dictating the professional skills necessary for assuming the role. If recruitment involves the development of a strategy as well as its implementation, workers who assume this role should be generalist practitioners who have clinical skills, but they also should have skills in community organization and outreach; if the role is limited to recruiting patients, then a worker with clinical skills can provide services competently. Failure to define the parameters of the role and the professional skills required for role performance may interfere with successful patient recruitment and completion of the research. A second question with regard to the role of the social worker is whether successful recruitment also requires that the worker be available to assist the patient with adherence to the clinical protocol. Because the social worker may begin to develop a relationship or may already have a relationship with the patient, and because the worker is likely to have expertise in addressing both psychosocial and concrete service issues, it might be argued that the social worker should continue to be available to the patient on an on-call basis to facilitate the process of participation after the patient is recruited (Williams & Boykin, 1999). Social workers can be helpful in arranging transportation and child care, in retaining employer-covered health insurance, in applying for Medicaid coverage, and in addressing work-related problems and financial difficulties arising from the illness or the time commitment to the clinical trial (El Sadr & Capps, 1992; McCabe, Varricchio, & Padberg, 1994; Paskett et al., 1996; Swanso n & Ward, 1995; Williams & Boykin, 1999). Social workers also can assist patients with the anxiety arising from the feeling of being used as a "guinea pig" and with crises that arise during the research that may interfere with participation. In addition, social workers can provide referrals for patients who begin to exhibit underlying symptoms of pathology that were previously hidden but begin to be expressed as they respond to the stresses of clinical trial participation. Finally, social workers can work with the patient's support network to identify and address their concerns so that they can support the participation of the patient in the trial. Social workers who are actively integrated into the health care team can work with patients who are labeled as "noncompliant" and who are threatened with dismissal from the protocol to involve them in support groups or refer them for psychotherapy, thereby benefiting the patient and the researcher (Williams & Boykin, 1999). …