Factors affecting older African American women's decisions to join the PLCO Cancer Screening Trial

Graduate School of Public Health, 217 Parran Hall, University of Pittsburgh, Pittsburgh, PA 15261, USA.
Journal of Clinical Oncology (Impact Factor: 18.43). 01/2006; 23(34):8730-8. DOI: 10.1200/JCO.2004.00.9571
Source: PubMed


The purpose of this study is to describe the factors associated with the decisions of older African American women to join the PLCO (Prostate, Lung, Colorectal and Ovarian) Cancer Screening Trial when recruited.
African American women between ages 55 and 74 years who were never diagnosed with a PLCO cancer were eligible for our study. Two methods of recruitment were used. First, mailings were sent to a random sample of women describing the PLCO followed by a telephone call to determine interest in the PLCO. If women were not interested in PLCO but consented to participate in our study, they were interviewed immediately. Second, we followed up with African American women who responded to mass mailings sent out before the start of our study by the Pittsburgh PLCO office. Women completed an interview about their cancer and clinical trial knowledge, attitudes, beliefs, and behaviors. The responses of women who joined the PLCO Trial are contrasted with the responses of women who did not join.
Numerous factors were associated with the decision of older African American women to join the PLCO, including perceptions of cancer prevention and detection, the experience of having a loved one with cancer, knowledge of and experience with clinical trials, and beliefs regarding the benefits and risks of clinical trial participation.
Minority recruitment to cancer clinical trials could be increased by designing interventions focused on individual, organizational, and community needs.

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    • "It is difficult to recruit subjects who (1) are from minority ethnic groups and/or males [18] [22] [30], (2) have low health literacy [19] [20] [29] [31], (3) have low socioeconomic status [4] [18] [20] [20] [29], (4) have high disease burden [19] [20] [23], and (5) have other priorities in one's personal life, such as personal issues or caregiver burden [19] [23]. Bergeron et al reported the percentage of rural residents with educational levels of high school and above is lower than individuals in urban areas [4]. "
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    ABSTRACT: Rural residents diagnosed with cardiovascular disease (CVD) or with CVD-related risks are underrepresented in behavioral intervention trials based on an extensive review of published studies. The low participation rate of rural residents weakens both the internal and external validity of published studies. Moreover, compared to urban residents, limited research exists to describe the unique barriers that limit the participation of rural residents in behavioral intervention trials. Objective: The purpose of this review is to identify a conceptual framework (CF) underpinning common barriers faced by rural CVD patients to enroll in behavioral intervention trials. Methods: We conducted a literature review using several electronic databases to obtain a representative sample of research articles, synthesized the evidence, and developed a CF to explain the barriers that may affect the research participation rate of rural residents with CVD or related risks. Results: We found our evidence-based CF well explained the barriers for rural CVD patients to take part in behavioral intervention trials. Besides contextual factors (i.e. patient, community and research levels), other common factors impacting rural patients’ intent to enroll are lack of awareness and understanding about behavioral trials, limited support from their healthcare providers and social circles, unfavorable attitudes, and the lack of opportunity to participating research. Conclusion and Implication of result: the findings demonstrate the evidence-based model consisting of interlinked multi-level factors may help our understanding of the barriers encountered by rural CVD patients participating interventions to promote behavioral change. The implication for researchers is that identifying and developing strategies to overcome the barriers precedes conducting studies in rural communities.
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    • "Other factors, not integrated in the above models, have been described, such as awareness for issues concerning CRC, colonoscopy screening, information on the symptoms of CRC (Gorin 2005; Soler-Michel et al 2005), health system barriers (Denberg et al 2005; Ogedegbe et al 2005; Dujoncquoy et al 2006), sociodemographic factors, personal medical history (Champion 1984; Jacobs 2002; Gorin 2005; Trauth et al 2005), as well as attitudes towards health, family medical history, experience of cancer (Jacobs 2002; Trauth et al 2005), and fatalistic attitudes in relation to cancer (Powe 1995, 1997). "
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    ABSTRACT: To characterize determining factors for compliance with colonoscopy recommendations in the familial screening of colorectal cancer through exploration of individual psychosociological factors and issues relating to patient/physician/sibling communication. A qualitative approach involving a review of the literature and interviews with general practitioners, specialists, patients, and their siblings. A confrontation of the content of interviews with data from the literature made it possible to confirm the relevance of classic prevention models, the Health Belief Model and the Theory of Planned Behavior in the French cultural and healthcare environments, as well as their ability to identify the main individual factors liable to motivate or to discourage familial screening. The family network plays a decisive part in the transmission of information from the patient towards siblings. Physicians have expectations relating to communication aids and backup. This study above all highlights the difficulty in determining who is best suited to giving information to the patient, and when and how to relay this information to first-degree relatives. In view of the many difficulties in establishing interaction between patient, physician and siblings that is liable to lead on to efficient screening, we propose the study of the usefulness of a health-counseling intervention aimed to tailor and follow-up the delivery of screening information to the first-degree relatives.
    Patient Preference and Adherence 02/2008; 2:47-55. · 1.68 Impact Factor
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    • "— — Patient barrier: Intervention characteristics Brown and Topcu, 2003 27 — Patient barriers: African American older age; lower income — Diener-West, 2001 31 — Patient barriers: Age; living near treatment center — Ford, 2004 33 — Patient barriers: Unlisted telephone number; age — Grann, 2005 35 — Patient barriers: SES; African American race — Gross, 2005 40 — Patient Barriers: SES (reside in high poverty zip code) — Gross, 2005 39 — Patient barriers: Poverty; study design barriers: no. of comorbid conditions — Gross, 2005 37 — Study design barriers: Comorbidity exclusion; age exclusion — Gross and Krumholz, 2005 38 — Provider barriers: Index of managed care competition — Kemeny, 2003 45 — Patient barriers: Age; study design barriers: disease stage, no. of comorbidities — Lara, 2005 51 Patient barriers: Lack of education about clinical trials Patient barriers: Race (African American or Asian); age (18–24 y); income < $25,000 — Martel, 2004 57 — Provider barriers: Referral source (ie, surgeons) — Melisko, 2005 59 — — Patient barriers: Transportation; time commitment; loss of income; loss of control Murthy, 2004 63 — Patient barriers: Race (African American; Hispanic) — Sateren, 2002 5 — Patient barriers: Lack/inadequate health insurance; being a black man aged 30–59 y; Asian adults and Latino/Hispanic adults — Simon, 2004 71 — Patient barriers: Lack/inadequate health insurance — Thornquist, 1991 74 — Patient barriers: Age (50–54 y; 65–69 y) — Trauth, 2005 75 Patient barriers: Lack of knowledge about origins of cancer; lack of education about clinical trials — — Twelves, 1998 76 — Patient barriers: Age — "
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    ABSTRACT: Racial and ethnic minorities, older adults, rural residents, and individuals of low socioeconomic status are underrepresented among participants in cancer-related trials. The authors conducted a systematic review to determine the barriers to participation of underrepresented populations in cancer-related trials. Their search included English-language publications that reported original data on the recruitment of underrepresented groups to cancer treatment or prevention trials between 1966 and December 2005 in multiple electronic databases. They also hand-searched titles in 34 journals from January 2003 to December 2005 and they examined reference lists for eligible articles. Titles and abstracts were reviewed to identify relevant studies. Data on barriers to participation were synthesized both qualitatively and based on statistically significant associations with trial enrollment. Of 5257 studies that were cited, 65 studies were eligible for inclusion in the current analysis, including 46 studies on recruitment into cancer therapeutic trials, 15 studies on recruitment into prevention trials, and 4 studies on recruitment into both prevention and treatment trials. Numerous factors were reported as barriers to participation in cancer-related trials. However, only 20 of the studies reported statistically significant associations between hypothesized barriers and enrollment. The available evidence had limitations in quality regarding representativeness, justification of study methods, the reliability and validity of data-collection methods, potential for bias, and data analysis. The results indicated that underrepresented populations face numerous barriers to participation in cancer-related trials. The current systematic review highlighting the literature on recruitment of underrepresented populations to cancer trials and may be used as the evidence base toward developing an agenda for etiologic and intervention research to reduce the disparities in participation in cancer-related trials. Cancer 2008. © 2007 American Cancer Society.
    Cancer 01/2008; 112(2):228 - 242. DOI:10.1002/cncr.23157 · 4.89 Impact Factor
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