title: Attitudes and barriers towards participation in an acupuncture trial among breast cancer patients: a survey study.
abstract: BACKGROUND
  As breast cancer patients increasingly use complementary and alternative medicine (CAM), clinical trials are needed to guide appropriate clinical use. We sought to identify socio-demographic, clinical and psychological factors related to willingness to participate (WTP) and to determine barriers to participation in an acupuncture clinical trial among breast cancer patients.
  
  
  METHODS
  We conducted a cross-sectional survey study among post-menopausal women with stage I-III breast cancer on aromatase inhibitors at an urban academic cancer center.
  
  
  RESULTS
  Of the 300 participants (92% response rate), 148 (49.8%) reported WTP in an acupuncture clinical trial. Higher education (p = 0.001), increased acupuncture expectancy (p < 0.001), and previous radiation therapy (p = 0.004) were significantly associated with WTP. Travel difficulty (p = 0.002), concern with experimentation (p = 0.013), and lack of interest in acupuncture (p < 0.001) were significant barriers to WTP. Barriers differed significantly by socio-demographic factors with white people more likely to endorse travel difficulty (p = 0.018) and non-white people more likely to report concern with experimentation (p = 0.024). Older patients and those with lower education were more likely to report concern with experimentation and lack of interest in acupuncture (p < 0.05).
  
  
  CONCLUSIONS
  Although nearly half of the respondents reported WTP, significant barriers to participation exist and differ among subgroups. Research addressing these barriers is needed to ensure effective accrual and improve the representation of individuals from diverse backgrounds.
authors.affiliation: Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce St, 2 Gates Building, Philadelphia, PA 19104, USA. jun.mao@uphs.upenn.edu.
authors.forename: Jun J
authors.initials: JJ
authors.lastname: Mao
authors.forename: Tiffany
authors.initials: T
authors.lastname: Tan
authors.forename: Susan Q
authors.initials: SQ
authors.lastname: Li
authors.forename: Salimah H
authors.initials: SH
authors.lastname: Meghani
authors.forename: Karen
authors.initials: K
authors.lastname: Glanz
authors.forename: Deborah
authors.initials: D
authors.lastname: Bruner
mesh_terms: D015670:Acupuncture Therapy / Q000523:psychology*; D000368:Aged; D001290:Attitude; D001943:Breast Neoplasms / Q000208:ethnology / Q000523:psychology / Q000628:therapy*; D002986:Clinical Trials as Topic / Q000523:psychology*; D003430:Cross-Sectional Studies; D003625:Data Collection; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006805:Human Experimentation; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D010358:Patient Participation / Q000523:psychology*; D044469:Racial Groups / Q000523:psychology; D045808:Refusal to Participate / Q000208:ethnology / Q000523:psychology*