Recruitment to Clinical Trials in Rural Communities

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.