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Recruitment to Clinical Trials in Rural Communities

This research investigates metaphors' impact on rural women's perceptions of cancer clinical trials, emphasizing the need for culturally sensitive language. Findings suggest conventional metaphors may not resonate, highlighting the importance of tailored communication strategies.

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Recruitment to Clinical Trials in Rural Communities

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  1. Recruitment to Clinical Trialsin Rural Communities Janice L. Raup-Krieger, PhD The Ohio State University Roxanne L. Parrott, PhD The Pennsylvania State University

  2. Acknowledgements • Research supported by a pilot project grant from the Appalachia Cancer Network (ACN) • Community cancer coalitions: • Action Health • CPAC • Indiana • Lawrence

  3. Acknowledgements • PSU faculty/students: • Jon Nussbaum, PhD • Michael Hecht, PhD • Eugene Lengerich, VMD • Shyam Sundar, PhD • Collins Airhihenbuwa, PhD • Rachel McLaren, MA • Julie Volkman, MA • Amy Chadwick, MA • Christie Ghetian, MA • Audrey Deterding, PhD

  4. Background & Need • Low participation rates in cancer clinical trials • Disparities between the general population and medically-underserved groups • The significance of aversion to randomization in Phase III clinical trials

  5. Clinical Communication & Clinical Trials • Metaphorical language in the clinical context • Common metaphorical explanations for randomization: • Toss of a coin • Lottery • Picking a number from a hat

  6. Study 1 • RQ1: Are conventional metaphors for randomization appropriate for use with rural, low-income, older adult women? • RQ2: Are there culturally appropriate metaphors that can be used to describe chance for rural, low-income, older adult women?

  7. Study 1 Methods • Design • Four focus groups (N=30) • In-depth interviews (N=11) • Participants • Women living in rural PA counties • <200% of HHS Poverty Guidelines • Over age 50 • Focus Groups: M=67.2, SD=9.65 • Interviews: M=70.3, range: 55-84

  8. Study 1 Findings RQ1: Are conventional metaphors for randomization appropriate for rural, low-income, older adult women? • Conventional metaphors • Trivializing (“you don’t flip a coin for something serious”) • Devaluing (“only worth flipping a coin…”) • Gambling (“gambling with my life.”) • Definitions for randomization • The role of chance (“is there a chance you will get treatment?”)

  9. Study 1 Findings RQ2: Are there culturally appropriate metaphors that can be used to describe chance? • A culturally-grounded metaphor for randomization: • Sex of baby “…Like how some people are born women and some are born men.”

  10. Study Two • RQ1: What predicts rural, low-income, older adult women's intentions to participate in cancer clinical trials?

  11. Study 2 Methods • Experimental Design • 4 message condition (attention control, definition, conventional metaphor, cultural metaphor) pretest-posttest design with random assignment • Participants (N=106) • Women living in rural PA counties • <200% of HHS Poverty Guidelines • 75% annual income between $10,000-$15,000 • Over age 50 (M=68.10, SD=12.32)

  12. Cultural Metaphor Message

  13. Study 2 Findings • Relationships among trait variables and intentions to participate in clinical trials:

  14. Study 2 Findings • Relationships among message outcomes and intentions to participate in clinical trials:

  15. Study 2 Findings • Effect of message strategy on intentions to participate in clinical trials: F(3,105)=.48, ns

  16. Study 2 Findings • Interaction of attention & message strategy as a predictor of behavioral intentions

  17. Study 2 Limitations • Design • Non-clinical population • Measurement • The perception of being “tested” as a threat to internal validity

  18. Conclusion • Using conventional metaphors for randomization with rural women may have unintended effects. • Culturally appropriate language appears to be most important when audiences have limited attention (e.g., high cognitive demand resulting from cancer diagnosis). • Contextual cues may influence how individuals interpret metaphors used to explain randomization.

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