Barriers to Trial Accrual Can Be Overcome With Communication and Education

DURHAM, North Carolina-There are specific communicationsand education strategies that mayhelp overcome the fears, suspicions,and misperceptions that keep elderlycancer patients from participating inclinical trials, according to Judith K.Payne, PhD, RN, AOCN.Recruitment of elderly cancer patientsinto clinical trials is low, estimatedat even less than the 2% to 4%participation rate of all adult patientswith cancer. Dr. Payne described practicalways that doctors, nurses, andother health care providers could increaseenrollment-not only by dispellingmyths involving clinical trialsbut also through promoting benefits,such as excellent follow-up care.Changing the Mindset"I'm suggesting that we need todevelop a new attitude about recruitment,"said Dr. Payne, assistant professorin the School of Nursing at DukeUniversity Medical Center, Durham,North Carolina. "We really need tochange the community's mindset ofwhat clinical trials are all about, anddispel some of the apprehensions thatolder people feel."Apprehension of the unknown arisesfrom patients misunderstandingabout what a clinical trial entails. "Peopledon't always understand even whatrandomization means, and, if they do,often want to be assured that they willreceive a treatment arm-and researchdoesn't work that way," Dr. Paynesaid. "We need to take the time toexplain what the process is. We usethese reseearch terms readily and yetmy experience has been that manypatients, especially the elderly, do nottruly understand the process."Overcoming BarriersTo overcome this, she said, it isnecessary to explain the purpose ofresearch and why randomization isimportant. Moreover, clinicians canstress the benefits patients derive fromresearch, such as access to the newestand most innovative treatment andbest-quality follow-up care. The researchcenter, it should be stressed, isa "special" place with a team personallycommitted to help facilitate the patient'scare at every stage of the trial.The elderly community at largeshould also hear the message that clinicaltrials offer safe, innovative, state ofthe art care. Creating public awarenessin a local area can be accomplishedthrough a variety of means.For example, institutions that offerclinical trials can create an awarenessat community events frequented bythe elderly."Communication skills will helpus build trust. Not every one out therein our communities trusts the healthcare system-especially regarding researchtrials," Dr. Payne said. "It's upto us to make sure that happens ...becausemost of the time, knowledgedispels apprehension."Dr. Payne also recommended honingcommunications skills to accommodatethe elderly, some of whommay be hard of hearing or have poorvision. Information should be presentedto most patients at a 6th to 8thgrade level, because much of it is complicatedand of a technical nature, evenfor the younger adult. However, careshould be taken not to present informationin a manner that anyone, andespecially the elderly patient, may interpretas condescending.Ultimately, when faced with a patient,a clinician may have no morethan 5 to 10 minutes to help the patientform an opinion as to whether ornot to participate in a trial. Therefore,the clinician explaining the trial shouldwork on presenting relevant informationin a succinct and organized way."Pay attention to details...," Dr.Payne said. "You have to know yourjob and the clinical trial...nothing isworse than presenting research in adisorganized manner."