title: A disparity of words: racial differences in oncologist-patient communication about clinical trials.
abstract: BACKGROUND
  African Americans are consistently underrepresented in cancer clinical trials. Minority under-enrolment may be, in part, due to differences in the way clinical trials are discussed in oncology visits with African American vs. White patients.
  
  
  OBJECTIVE
  To investigate differences in oncologist-patient communication during offers to participate in clinical trials in oncology visits with African American and White patients.
  
  
  METHODS
  From an archive of video-recorded oncology visits, we selected all visits with African American patients that included a trial offer (n = 11) and a matched sample of visits with demographically/medically comparable White patients (n = 11). Using mixed qualitative-quantitative methods, we assessed differences by patient race in (i) word count of entire visits and (ii) frequency of mentions and word count of discussions of clinical trials and key elements of consent.
  
  
  RESULTS
  Visits with African American patients, compared to visits with White patients, were shorter overall and included fewer mentions of and less discussion of clinical trials. Also, visits with African Americans included less discussion of the purpose and risks of trials offered, but more discussion of voluntary participation.
  
  
  CONCLUSIONS
  African American patients may make decisions about clinical trial participation based on less discussion with oncologists than do White patients. Possible explanations include a less active communication style of African Americans in medical visits, oncologists' concerns about patient mistrust, and/or oncologist racial bias. Findings suggest oncologists should pay more conscious attention to developing the topic of clinical trials with African American patients, particularly purpose and risks.
authors.affiliation: Department of Oncology, Wayne State University, Detroit, MI, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Eggly
authors.affiliation: Department of English, Wayne State University, Detroit, MI, USA.
authors.forename: Ellen
authors.initials: E
authors.lastname: Barton
authors.affiliation: Department of English, Wayne State University, Detroit, MI, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Winckles
authors.affiliation: Department of Oncology, Wayne State University, Detroit, MI, USA.
authors.forename: Louis A
authors.initials: LA
authors.lastname: Penner
authors.affiliation: Department of Oncology, Wayne State University, Detroit, MI, USA.
authors.forename: Terrance L
authors.initials: TL
authors.lastname: Albrecht
mesh_terms: D001741:Black or African American; D001294:Attitude to Health; D002986:Clinical Trials as Topic; D003142:Communication; D054521:Cultural Competency; D005260:Female; D006801:Humans; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D008913:Minority Groups; D018579:Patient Selection; D010817:Physician-Patient Relations; D036301:Qualitative Research; D009626:Terminology as Topic; D014743:Videotape Recording / Q000379:methods; D044465:White People
keywords: cancer; discourse analysis; health-care disparities; minorities; patient-physician communication
references.citation: J Clin Oncol. 2008 Jun 1;26(16):2666-73
references.pmid: 18509178
references.citation: Am J Public Health. 2012 May;102(5):979-87
references.pmid: 22420787
references.citation: Patient Educ Couns. 2011 Jan;82(1):63-8
references.pmid: 20430566
references.citation: J Clin Oncol. 2004 Feb 15;22(4):730-4
references.pmid: 14966098
references.citation: Ann Fam Med. 2013 Jan-Feb;11(1):43-52
references.pmid: 23319505
references.citation: Control Clin Trials. 1995 Oct;16(5):277-85; discussion 286-9, 293-309
references.pmid: 8582146
references.citation: Annu Rev Public Health. 2006;27:167-94
references.pmid: 16533114
references.citation: Am J Public Health. 2008 Jun;98(6):1137-42
references.pmid: 17901437
references.citation: J Natl Med Assoc. 2010 Mar;102(3):184-9
references.pmid: 20355347
references.citation: Ann Intern Med. 2003 Dec 2;139(11):907-15
references.pmid: 14644893
references.citation: Patient Educ Couns. 2008 Jan;70(1):143-8
references.pmid: 17983722
references.citation: J Clin Oncol. 1999 Oct;17(10):3324-32
references.pmid: 10506636
references.citation: CA Cancer J Clin. 2011 Jul-Aug;61(4):212-36
references.pmid: 21685461
references.citation: J Soc Issues. 2012 Jun 25;68(2):
references.pmid: 24319297
references.citation: Cancer. 2006 Mar 15;106(6):1197-204
references.pmid: 16453333
references.citation: Soc Sci Med. 2007 Aug;65(3):586-98
references.pmid: 17462801
references.citation: Contemp Clin Trials. 2009 Mar;30(2):103-4
references.pmid: 19244624
references.citation: Med Educ. 2005 Jun;39(6):632-40
references.pmid: 15910440
references.citation: J Exp Soc Psychol. 2010 Mar 1;46(2):436-440
references.pmid: 20228874
references.citation: Soc Sci Med. 2008 Aug;67(3):478-86
references.pmid: 18508171
references.citation: Cancer. 2006 Sep 15;107(6):1313-20
references.pmid: 16909424
references.citation: Cancer. 2003 Jan 1;97(1 Suppl):329-34
references.pmid: 12491497
references.citation: Cancer. 2009 Jun 1;115(11):2553-61
references.pmid: 19296516
references.citation: Health Psychol. 2012 Sep;31(5):539-47
references.pmid: 21895368
references.citation: J Health Care Poor Underserved. 2010 Aug;21(3):879-97
references.pmid: 20693733
references.citation: Cancer. 2007 Feb 1;109(3):465-76
references.pmid: 17200964
references.citation: Cancer. 2008 Jan 15;112(2):228-42
references.pmid: 18008363
references.citation: J Clin Oncol. 2006 Feb 20;24(6):904-9
references.pmid: 16484700
references.citation: Cancer. 2008 Feb 1;112(3):447-54
references.pmid: 18085590
references.citation: Patient Educ Couns. 2006 Sep;62(3):355-60
references.pmid: 16860520
references.citation: Am J Public Health. 2004 Dec;94(12):2084-90
references.pmid: 15569958
references.citation: Med Care. 2008 Jul;46(7):678-85
references.pmid: 18580386
references.citation: JAMA. 2011 Sep 7;306(9):995-6
references.pmid: 21900142
references.citation: Patient Educ Couns. 2012 Oct;89(1):25-30
references.pmid: 22560252