Doctors and patients think differently about clinical trials

A survey of patients and physicians regarding clinical trials shows that doctors don't recognize the importance of side effects as a barrier for their patients in deciding about whether to undergo experimental therapy.

That is one result of a survey of doctors and patients examining the psychosocial influences on clinical trial participation. The results were presented at the American Society of Clinical Oncology's 41st Annual Meeting in Orlando, Florida.

"Our survey shows that oncologists and patients are aware of clinical trials and have favorable attitudes toward them," said Neal J. Meropol, M.D., a medical oncologist at Fox Chase Cancer Center and lead author of the study. "However, there is a significant discordance in perceptions of psychosocial barriers to participation. Namely, oncologists may underestimate the impact of patient fears about side effects on clinical trial participation."

The survey was distributed to all 478 medical oncologists in Pennsylvania and a subset of their patients. In addition to demographic characteristics, information on practical and psychosocial barriers to clinical trial participation was evaluated.

One hundred thirty-six (136) oncologists completed the surveys (81 percent men; median age 49 [range 32 to 71]; 61 percent non-academic; 14 percent non-white). One hundred fifty-nine (159) patients completed the survey (53 percent women; median age 55 [range 22 to 85]; 11 percent non-white; 57 percent educated beyond high school). Eighty-four (84) percent of patients responded that they had heard of clinical trials. A higher education and white race were associated with awareness.

"The majority of both patients and doctors strongly agreed that clinical trials are important to improving cancer treatment," explained Meropol. "However, whereas 79 percent of oncologists strongly agreed that patients benefit from participating, only 57 percent of the patients felt strongly that they would benefit."

When ranking seven potential patient barriers to clinical trials, patients identified fear of side effects as the greatest barrier. In contrast, the doctors ranked this last among psychosocial barriers. Patients and doctors were close in their ranking of clinical trial random assignment as a key barrier (doctors ranked 1, patients ranked 2).

Other non-practical barriers with significant discordance included the lack of trust in medical establishment (doctors ranked 2, patients ranked 6), and patients' lack of understanding of clinical trials (doctors ranked 4, patients ranked 7).

"This survey can help us improve our understanding of oncologists' and patients' perceived barriers, which, in turn, can help us improve the participation rate of patients in clinical trials," concluded Meropol.