Question asking by black and white patients and companions during clinical trial offers

B16 Background: Disproportionately low rates of accrual to clinical trials by minority patients may in part be attributable to oncologist-patient communication during clinical interactions in which trials are offered. One aspect of communication, patient/companion question asking, has been associated with positive patient outcomes, including patient-centeredness, active participation by patients, and information provided by physicians. Purpose: To observe and analyze question asking by Black and White patients/companions during oncology interactions in which clinical trials are offered to patients. Method: Video recordings of outpatient interactions were taken from a larger study of oncologist-patient communication (N=235) at two cancer centers. For the current study, a sample of 50 interactions was randomly selected from those in which a) the oncologist explicitly offered a clinical trial (CT, n=25) or clinical trials were never discussed (non-CT, n=25); and b) patients were either Black or White. Subsequently, 4 interactions were added to the CT group to increase representation by Black patients. Questions were defined as verbal attempts by patients or companions to gain information from the oncologist. Two observers independently identified and transcribed all questions during the 54 interactions. Results: Most patients were male (57%, n=31), married (61%, n=31), White (67%, n=36), and accompanied by at least one person (76%, n=41). Mean age was 60.4 (SD =12.43). 50% completed some college; median annual family income was between $40-60K. No significant differences were found between CT and non-CT patients with regard to their demographic characteristics. Blacks and Whites only differed on income, χ2=14.52, p=.013. Whites were also more likely than Blacks to have a companion present, χ2=8.67, p=.003. Across all interactions, 1712 patient/companion questions were asked (M=31.7, SD 24.45), 53% by patients (M=16.74, SD=13.9). No differences were found in the number of questions asked by Black and White patients; however, more total patient/companion questions were asked in interactions with White versus Black patients, t(49)=3.07, p=.004. In comparing CT to non-CT visits, significantly more questions were asked in CT than non-CT visits, t(52) =-2.09, p=.04. An ANOVA showed no interaction between race and visit type (CT/non-CT) on question frequency. However, main effects analysis found that while there were no Black/White differences in questions asked in the non-CT visits, significantly more questions were asked in CT interactions with White patients (M=47.12) than in CT visits with Black patients (M=17.55), t(26)=3.59, p=.001. Discussion: Although there was no difference in the number of questions asked by Black and White patients, White patients were more likely to bring a companion to the visit, likely resulting in an increase of total questions asked on their behalf. Because increased question asking has been associated with positive patient outcomes, these findings may reveal some causes of racial health disparities. To maximize the effectiveness of oncology interactions and possibly to increase accrual to clinical trials among Black patients, further research should investigate why Black patients are less likely to bring companions.