A study comparing how physicians discuss clinical trials during clinical interactions with black patients versus white patients further confirms racial disparities in the quality of communication between physicians and patients.
Oncologists provided black patients with less information overall about cancer clinical trials compared with white patients, according to data presented at the Fifth AACR Conference on The Science of Cancer Health Disparities, held here Oct. 27-30, 2012.
“Minority patients tend to receive less information, which could, in part, explain under-enrollment by minorities in clinical cancer trials,” said Susan Eggly, Ph.D., associate professor of oncology in the Population Studies and Disparities Program at Wayne State University School of Medicine and the Barbara Ann Karmanos Cancer Institute in Detroit, Mich. “These disparities could also lead to minority patients being enrolled in trials without fully understanding the purpose of the trial and the potential risks of participation.”
Eggly and colleagues examined 22 video-recorded interactions between oncologists and patients during which a clinical trial was offered. Patients were matched by cancer type and sociodemographic characteristics. Half of the video-recorded interactions were with black patients and the other half were with white patients. Researchers used linguistic discourse analytical methods to examine several aspects of the interactions, including overall discussion of clinical trials and the five basic elements of consent: purpose, risks, benefits, alternatives to participating and the voluntary nature of trial participation.
Data revealed that clinical trial interactions with black patients were shorter overall and included less discussion of clinical trials compared with interactions with white patients. Key aspects of consent were also discussed less with black patients than with white patients, especially the purpose of the trial and risks of participation. However, the researchers found that oncologists spoke more about voluntary participation with black patients than with white patients.
Previous research by Eggly and colleagues showed that black patients tended to ask fewer questions and they trusted their doctors less than white patients did. In addition, physician biases affected the quality of communication, which Eggly believes may also account for the differences found in this study.
“Taking a close look at interactions and the language used can help us to identify patterns of behavior and make the necessary improvements that may ultimately lead to decisions that are in the best interest of each patient,” she said.
A disparity of words: A comparison of offers to participate in cancer clinical trials by patient race
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.
Susan Eggly1, Ellen Barton2, Andrew Winckles2, Louis A. Penner1, Terrance L. Albrecht1. 1Wayne State University/Karmanos Cancer Institute, Detroit, MI, 2Wayne State University, Detroit, MI.
American Association for Cancer Research