title: Patients' decision-making process regarding participation in phase I oncology research.
abstract: OBJECTIVE
  This study assesses the decision-making process of patients enrolling in phase I oncology studies.
  
  
  METHODS
  Participants were eligible if they had consented to participate in a phase I cancer study at one of five cancer centers, understood English, and were older than 18 years. Trained interviewers conducted structured in-person interviews.
  
  
  RESULTS
  Of the 163 participants, 88% were white, 96% had health insurance, and 51% were college graduates or post graduates. Overall, 81% were aware of hospice, but only 6% had seriously considered hospice for themselves; 84% were aware of palliative care and 10% seriously considered it for themselves; and 7% considered getting no treatment at all. Overall, 75% reported moderate or a lot of pressure to participate in the phase I study because their cancer was growing, whereas 7% reported such pressure from the study investigators and 9% felt such pressure from their families. For 63% of patients, the most important information for decision making was that the phase I drug killed cancer cells; only 12% reported that the adverse effects of the drug(s) was the most useful information. More than 90% of patients said they would still participate in the study even if the experimental drug caused serious adverse effects, including a 10% chance of dying.
  
  
  CONCLUSIONS
  Patients are aware of many alternatives to phase I studies, but do not seriously consider them. Very few experience pressure from family or researchers to participate in research. Their main goal is to fight their cancer, and almost no adverse effect, including death, would dissuade them from enrolling.
authors.affiliation: Department of Clinical Bioethics, Warren G. Magnuson Clinical Center, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892-1156, USA. agrawalm@mail.nih.gov
authors.forename: Manish
authors.initials: M
authors.lastname: Agrawal
authors.forename: Christine
authors.initials: C
authors.lastname: Grady
authors.forename: Diane L
authors.initials: DL
authors.lastname: Fairclough
authors.forename: Neal J
authors.initials: NJ
authors.lastname: Meropol
authors.forename: Kim
authors.initials: K
authors.lastname: Maynard
authors.forename: Ezekiel J
authors.initials: EJ
authors.lastname: Emanuel
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001364:Awareness; D017321:Clinical Trials, Phase I as Topic; D032882:Comprehension; D003657:Decision Making; D005260:Female; D017051:Hospice Care; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D018579:Patient Selection; D010361:Patients / Q000523:psychology*; D011209:Power, Psychological; D014481:United States
chemical_list: D000970:Antineoplastic Agents