Barriers to the participation of African-American patients with cancer in clinical trials - A pilot study
Barriers to the participation of African-American patients with cancer in clinical trials - A pilot study
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DOI：
10.1002/cncr.11213
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发表时间：
2003-03-15
期刊：
影响因子：
6.2
通讯作者：
Gautier, M
中科院分区：
文献类型：
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作者：
Advani, AS;Atkeson, B;Gautier, M
背景资料。在肿瘤学临床试验中，非裔美国人患者的代表性一直不足。更好地了解非裔美国人参与的障碍可能有助于增加非裔美国人患者参加临床试验的收益。方法：218名恶性疾病患者(72名非裔美国人患者和146名白人患者)从杜克癌症诊所和杜克肿瘤外展诊所(DOORS)招募。患者使用标准化调查进行采访。问题包括患者对癌症的知识、宗教/精神信仰、对医疗服务的满意度、临床试验的知识、参加或拒绝参加临床试验的原因、经济/交通问题以及年龄和教育等人口统计因素。对非裔美国人患者和白人患者以及在杜克癌症诊所接受治疗的患者和在DOORS诊所接受治疗的患者之间的群体差异进行态度和信念的数据分析。结果：参加临床试验的意愿取决于种族和临床地点。45%的白人患者愿意参加临床试验，而非洲裔患者的这一比例为31%(P=0.05)。在杜克癌症诊所接受治疗的白人和非裔美国患者比在DOORS诊所接受治疗的同龄人更愿意参加试验(分别为47%和37%；P=0.09)。不同群体(非裔美国人患者与白人患者以及杜克癌症诊所患者与DOORS患者)之间最大的差异是教育和收入：非裔美国患者和DOORS患者中未完成高中学业且年收入为15,000美元的比例要高得多。此外，更多的非洲裔美国患者比白人患者相信上帝会决定他们是会被治愈还是会死于他们的疾病。在多变量分析中，教育、收入和相信上帝将决定患者的结果也与参与临床试验的意愿降低相关。结论：与宗教、教育和收入相关的因素，而不是种族，可能是参与临床试验的主要障碍。针对教育和收入的干预措施可能会增加非洲裔美国人肿瘤学患者参加临床试验的人数。(C)2003年美国癌症协会。
BACKGROUND. African-American patients have been under-represented in oncology clinical trials. Better understanding barriers to African-American participation may help increase the accrual of African-American patients onto clinical trials.METHODS. Two hundred eighteen patients with malignant disease (72 African-American patients and 146 white patients) were recruited from the Duke Cancer Clinic and from Duke Oncology Outreach Clinics (DOORS). Patients were interviewed using a standardized survey. Questions included patients' knowledge of cancer, religious/spiritual beliefs, satisfaction with medical care, knowledge of clinical trials, reasons for participating or refusing to participate in a clinical trial, financial/transportation issues, and demographic factors, such as age and education. Data on attitudes and belief were analyzed for group differences between African-American patients and white patients as well as between patients who were treated at the Duke Cancer Clinic and patients who were treated at DOORS clinics.RESULTS. Willingness to participate in a clinical trial depended on both race and clinic site. Forty-five percent of white patients, compared with 31% of African-American patients, were willing to participate in a clinical trial (P = 0.05). white and African-American patients who were treated at the Duke Cancer Clinic were more willing to participate in a trial compared with their counterparts who were treated at DOORS clinics (47% vs. 37%, respectively; P = 0.09). The greatest differences between groups (African-American patients vs. white patients and Duke Cancer Clinic patients vs. DOORS patients) were education and income: Much greater percentages of African-American patients and DOORS patients did not complete high school and had annual incomes < $15,000. In addition, more African-American patients than white patients believed that God would determine whether they would be cured or would die from their disease. In a multivariate analysis, education, income, and belief that God would determine the patient's outcome also were correlated with a decreased willingness to participate in clinical trials.CONCLUSIONS. Factors associated with religion, education, and income, rather than race, may be major barriers to clinical trial participation. Interventions that target education and income may increase the recruitment of African-American oncology patients onto clinical trials. (C) 2003 American Cancer Society.