Study uncovers bias and stereotyping when recruiting patients for clinical trials

New research reveals bias and stereotyping among clinical and research professionals who recruit patients to enroll in cancer clinical trials. The findings are published early online in Cancer, a peer-reviewed journal of the American Cancer Society (ACS).

It is important to include diverse patients in clinical trials to ensure that the results will apply to patients in the general population. Unfortunately, the proportion of racial and ethnic minorities participating in cancer clinical trials is persistently lower than the proportion of minorities in the U.S. population at large.

To examine whether biases held by healthcare and research professionals can help explain why racial and ethnic minorities are not fully represented in clinical trials, a team led by Raegan W. Durant, MD, MPH, of the University of Alabama at Birmingham, conducted interviews of cancer center leaders, principal investigators of clinical trials, referring clinicians, and research staff at five U.S. cancer centers. A total of 91 individuals were interviewed.

Five prominent themes emerged from the interviews:

• Respondents noted language barriers and other factors that made communication with potential minority clinical trial participants difficult.
• Several respondents stated that they did not perceive potential minority patients to be ideal study candidates after they were screened for cancer clinical trials.
• Some respondents described clinicians' time constraints and negative perceptions of minority study participants as challenges.
• When respondents discussed clinical trials with minority patients, they often addressed misconceptions to build trust.
• For some respondents, race was perceived as irrelevant when screening and recruiting potential minority participants for clinical trials.

"Examples of the stereotypes we observed included perceptions that African Americans were less knowledgeable about cancer research studies, less likely to participate due to altruism, or simply less likely to complete all facets of the research study," said Soumya Niranjan, B Pharm, MS, Ph.D., the paper's first author, also from the University of Alabama at Birmingham. "These and other examples of bias based on stereotypes of potential minority participants raise concerns that non-whites may be offered fewer opportunities to participate in cancer research studies." She noted that even when research and healthcare professionals use race-neutral stances during clinical trial recruitment, this approach may overlook some of the well-established methods of engaging and recruiting potential minority participants in a culturally tailored manner.

"By no means does this study indicate that all research and healthcare professionals are biased or that all minorities are being deprived of opportunities to participate in cancer research studies," Dr. Durant stressed. "However, the long-term significance of our findings rests in the notion that biases potentially exist in virtually all forms of human interaction, and recruitment for cancer research studies is no exception. Once we acknowledge the potential presence of this bias in this context, we can better identify it, measure it, and begin to think about how best to address it."