Barriers to Trial Accrual Can Be Overcome With Communication and Education

DURHAM, North Carolina- There are specific communications and education strategies that may help overcome the fears, suspicions, and misperceptions that keep elderly cancer patients from participating in clinical trials, according to Judith K. Payne, PhD, RN, AOCN. Recruitment of elderly cancer patients into clinical trials is low, estimated at even less than the 2% to 4% participation rate of all adult patients with cancer. Dr. Payne described practical ways that doctors, nurses, and other health care providers could increase enrollment-not only by dispelling myths involving clinical trials but also through promoting benefits, such as excellent follow-up care. Changing the Mindset "I'm suggesting that we need to develop a new attitude about recruitment," said Dr. Payne, assistant professor in the School of Nursing at Duke University Medical Center, Durham,North Carolina. "We really need to change the community's mindset of what clinical trials are all about, and dispel some of the apprehensions that older people feel." Apprehension of the unknown arises from patients misunderstandingabout what a clinical trial entails. "People don't always understand even what randomization means, and, if they do, often want to be assured that they will receive a treatment arm-and research doesn't work that way," Dr. Paynesaid. "We need to take the time to explain what the process is. We use these reseearch terms readily and yet my experience has been that many patients, especially the elderly, do not truly understand the process." Overcoming Barriers To overcome this, she said, it is necessary to explain the purpose of research and why randomization is important. Moreover, clinicians can stress the benefits patients derive from research, such as access to the newest and most innovative treatment and best-quality follow-up care. The research center, it should be stressed, is a "special" place with a team personally committed to help facilitate the patient's care at every stage of the trial. The elderly community at large should also hear the message that clinical trials offer safe, innovative, state of the art care. Creating public awareness in a local area can be accomplished through a variety of means. For example, institutions that offer clinical trials can create an awareness at community events frequented by the elderly. "Communication skills will help us build trust. Not every one out there in our communities trusts the health care system-especially regarding research trials," Dr. Payne said. "It's up to us to make sure that happens ...because most of the time, knowledge dispels apprehension." Dr. Payne also recommended honingcommunications skills to accommodate the elderly, some of whom may be hard of hearing or have poor vision. Information should be presented to most patients at a 6th to 8th grade level, because much of it is complicated and of a technical nature, even for the younger adult. However, care should be taken not to present information in a manner that anyone, and especially the elderly patient, may interpret as condescending. Ultimately, when faced with a patient,a clinician may have no more than 5 to 10 minutes to help the patient form an opinion as to whether or not to participate in a trial. Therefore, the clinician explaining the trial should work on presenting relevant information in a succinct and organized way. "Pay attention to details...," Dr. Payne said. "You have to know your job and the clinical trial...nothing is worse than presenting research in a disorganized manner."