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Influence of Clinical Communication on Patients' Decision Making on Participation in Clinical Trials

Terrance L. Albrecht, Susan S. Eggly, Marci E.J. Gleason, Felicity W.K. Harper, Tanina S. Foster, Amy M. Peterson, Heather Orom, Louis A. Penner, John C. Ruckdeschel

From the Barbara Ann Karmanos Cancer Institute; Wayne State University School of Medicine, Detroit; and the Institute for Social Research, University of Michigan, Ann Arbor, MI

Corresponding author: Terrance L. Albrecht, PhD, Karmanos Cancer Institute 319 ROC, 4100 John R St, Detroit, MI 48201; e-mail: albrecht{at}karmanos.org

Purpose: To investigate how communication among physicians, patients, and family/companions influences patients' decision making about participation in clinical trials.

Patients and Methods: We video recorded 235 outpatient interactions occurring among oncologists, patients, and family/companions (if present) at two comprehensive cancer centers. We combined interaction analysis of the real-time video-recorded observations (collected at Time 1) with patient self-reports (Time 2) to determine how communication about trial offers influenced accrual decisions.

Results: Clinical trials were explicitly offered in 20% of the interactions. When offers were made and patients perceived they were offered a trial, 75% of patients assented. Observed messages (at Time 1) directly related to patients' self-reports regarding their decisions (2 weeks later), and how they felt about their decisions and their physicians. Specifically, messages that help build a sense of an alliance (among all parties, including the family/companions), provide support (tangible assistance and reassurance about managing adverse effects), and provide medical content in language that patients and family/companions understand are associated with the patient's decision and decision-making process.

Conclusion: In two urban, National Cancer Institute–designated comprehensive cancer centers, a large percentage of patients are not offered trials. When offered a trial, most patients enroll. The quality and quantity of communication occurring among the oncologist, patient, and family/companion when trials are discussed matter in the patient's decision-making process. These findings can help increase physician awareness of the ways that messages and communication behaviors can be observed and evaluated to improve clinical practice and research.

Supported by the National Cancer Institute (Grant No. R01CA75003).

Presented in part at the 4th Annual American Association of Cancer Research International Frontiers in Cancer Prevention Research Conference, October 30-November 2, 2005, and the 42nd Annual Meeting of the American Society of Clinical Oncology, June 2-6, 2006, Atlanta, GA.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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