Critical decisions: A mixed-methods study of decision-making among diverse gynecologic cancer patients considering therapeutic clinical trial enrollment

Stephanie Margrit Rieder; Ellen Burgess; Teresa Rutledge; Andrew Sussman; Tawny Boyce; Vernon Shane Pankratz; Miria Kano

doi:10.1016/j.ygyno.2024.01.031

Critical decisions: A mixed-methods study of decision-making among diverse gynecologic cancer patients considering therapeutic clinical trial enrollment

Gynecol Oncol. 2024 Jan 31:184:103-110. doi: 10.1016/j.ygyno.2024.01.031. Online ahead of print.

Authors

Stephanie Margrit Rieder¹, Ellen Burgess², Teresa Rutledge³, Andrew Sussman⁴, Tawny Boyce², Vernon Shane Pankratz², Miria Kano⁵

Affiliations

¹ University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA; Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM, USA. Electronic address: srieder@salud.unm.edu.
² University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.
³ University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA; Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM, USA.
⁴ University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA; Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA.
⁵ University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA; Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA.

PMID: 38301308
DOI: 10.1016/j.ygyno.2024.01.031

Abstract

Objective: Participation in therapeutic clinical trials does not reflect the diversity of gynecologic cancer patients, limiting access to novel therapeutics and generalizability of results. Reasons for inequities in participation among historically underrepresented populations remain undertheorized, as studies have shown equal willingness to participate among groups. We sought to apply a precarity framework to conceptualize the factors that impact patients' desire to enroll, to improve equity in gynecologic oncology clinical trial participation.

Methods: Gynecologic cancer patients at a single tertiary care facility in the Southwestern United States who discussed participation in therapeutic clinical trial with their oncology provider from 2020 to 2021 were identified. Enrolled participants completed surveys and qualitative interviews regarding treatment experiences and decision-making. Oncology providers completed parallel surveys at the time of their patient's enrollment. Descriptive statistics and thematic coding were used to analyze data.

Results: 30 patients were enrolled and participated in surveys and interviews. No differences were found in quantitative data assessing shared decision-making and patient-centered communication between those who enrolled and those who did not. Qualitative data demonstrated that patients who declined trial enrollment expressed concerns regarding uncertainty and loss of control, independence in decision-making, and significant resource challenges and financial toxicity of cancer treatment.

Conclusions: We identified a constellation of factors that contribute to desire to enroll in clinical trials, that we describe using the framework of precarity. Through identification of precarious patients and mitigation of burdens, we anticipate improved enrollment and retention in therapeutic clinical trials among diverse gynecologic oncology patients.

Keywords: Clinical trials; Gynecologic cancers; Health disparities; Intersectionality; Precarity; Qualitative research.