Understanding strategies that promote minority participation in breast cancer clinical trials

Background: Despite the promising effectiveness of clinical trials on breast cancer prevention, treatment, and survival within communities of color, disparities in morbidity and/or mortality remain persistent. Improving minority participation in breast cancer clinical trials using culturally aligned strategies has the potential to improve cancer disparities for these communities. ^ Objectives and methods: This dissertation aims to identify key strategies that promote diversity in breast cancer clinical trial participation using two studies: (1) a systematic review of the evidence was undertaken with the goal of better understanding the state of the current literature on the recruitment of minorities to breast cancer clinical trials. This review replicated for the years 2004–2012 the search strategy from a prior systematic review; and (2) a qualitative case study of patients, healthcare providers, and clinical trial staff at a breast center in Houston, Texas. ^ Results: Study 1: The systematic review evaluated 34 studies: 20 studies examined methods for evaluating recruitment strategies; 9 studies examined effectiveness of recruitment strategies for improving minority participation in breast cancer clinical trials; and 5 studies examined the effect of provider attitudes on minority recruitment to breast cancer clinical trials. The included studies employed descriptive, qualitative, and quantitative study designs. Descriptive and qualitative studies looked at patients\u27 perspectives on methods for developing culturally tailored recruitment strategies and patients\u27 decision making processes related to trial participation. Studies that evaluated the effectiveness of recruitment strategies to promote minority participation in breast cancer clinical trials utilized comprehensive recruitment strategies that focused on education and outreach for patients and providers. Studies on the influence of providers\u27 attitudes and beliefs on minority recruitment focused on barriers and promoters of trial participation, and provider decision making in referring patients to clinical trials. Patient-Provider communication was the most common theme across all studies regardless of study design or population studied. For providers, lack awareness and time constraints were also influential factors in their decisions to refer minority patients to trials. ^ Study 2: The results from the qualitative study were consistent with the strategies identified in the literature. The providers noted that patients\u27 experience was an important factor in achieving a high rate of minority participation in breast cancer clinical trials. Similarly, patients\u27 identified clear patient-centered communication, compassion, and interpersonal relationships with providers as significant influences in their ultimate decision to participate in trials at the breast center.