From information processing to behavioral intentions: exploring cancer patients' motivations for clinical trial enrollment

Development and validation of Join Clinical Trial Questionnaire (JoinCT)

AIM

Participant recruitment has always been a major challenge in clinical trials. This study aimed to develop and validate the Join Clinical Trial Questionnaire (JoinCT), exploring the willingness to join a clinical trial and associated factors in patients.

METHODS

This questionnaire development study involved four phases: (i) exploring and understanding the subject matter, (ii) questionnaire development, (iii) content validity testing, and lastly, (iv) field-testing of the questionnaire. For the field-testing phase, a cross-sectional self-administered survey of JoinCT was conducted among cancer patients with various socio-demographic backgrounds and medical conditions. Besides content validity, Cronbach's alpha was used to evaluate the internal consistency of domains, and confirmatory factor analysis was used to evaluate the model fit of the JoinCT framework.

RESULTS

A total of 389 respondents participated in the survey. Based on the results obtained from a field data collection phase, JoinCT consisted of four independent variables domains, namely "knowledge", "perception of benefits", "perception of risks", and "confidence". The only dependent variable was the willingness to participate in a clinical trial. The minimum Cronbach's alpha was 0.937, and the model fit for the overall framework of JoinCT is also excellent with Comparative Fit Index (> 0.90), root mean square error approximation (< 0.08), and Standardized Root Mean Square Residual (< 0.08).

CONCLUSIONS

The Join Clinical Trial Questionnaire (JoinCT) was successfully validated with excellent reliability and validity, and a good model fit. The main factors that contribute to willingness to participate in clinical trials are knowledge, perception of benefits, perception of risks, and confidence.

Disparities in cancer clinical trials information-seeking: Findings from the National Cancer Institute's Cancer Information Service

OBJECTIVE

To better understand cancer clinical trials (CCT) information-seeking, a necessary precursor to patient and provider engagement with CCT.

METHODS

Data from the National Cancer Institute's Cancer Information Service (CIS) were used to examine CCT information-seeking patterns over a 5-year period. Descriptive and logistic regression analyses were conducted to examine characteristics of CIS inquiries and their associations with having a CCT discussion.

RESULTS

Between September 2018 - August 2023, 117,016 CIS inquiries originated from cancer survivors, caregivers, health professionals, and the general public; 27.5 % of these inquiries included a CCT discussion (n = 32,160). Among CCT discussions, 35.5 % originated from survivors, 53.5 % from caregivers, 6.1 % from the public, and 4.9 % from health professionals. Inquiries in Spanish had lower odds of a CCT discussion (OR=.26, [.25-.28]), whereas inquiries emanating from the CIS instant messaging (OR=2.29, [2.22-2.37]) and email (OR=1.24, [1.18-1.30]) platforms were associated with higher odds of discussing CCT compared to the telephone. Individuals who were male, younger, insured, and had higher income and education had significantly higher odds of a CCT discussion while those who were non-Hispanic Black and living in rural locales had significantly lower odds.

CONCLUSIONS

Disparities in CCT information-seeking may contribute to downstream CCT participation.

PRACTICE IMPLICATIONS

Quality, language-concordant health information is needed to enable equitable awareness of - and ultimately engagement in - CCT.

Unleashing the power of clinical trial data: a proposal for enhancing informed consent and data sharing

Although clinical trial participants support data sharing, access to patient-level data remains limited. Innovative solutions are needed to ensure scientists can access the data from clinical trials. This commentary proposes a potential strategy.

A randomized prospective trial of an ostomy telehealth intervention for cancer survivors

BACKGROUND

Cancer survivors with ostomies face complex challenges. This study compared the Ostomy Self-Management Telehealth program (OSMT) versus attention control usual care (UC).

METHODS

Three academic centers randomized participants. OSMT group sessions were led by ostomy nurses and peer ostomates (three for ostomates-only, one for support persons, and one review session for both). Surveys at baseline, OSMT completion, and 6 months were primary outcome patient activation (PAM), self-efficacy (SE), City of Hope quality of life-Ostomy (COH-O), and Hospital Anxiety and Depression Scale (HADS). Surveys were scored per guidelines for those completing at least two surveys. Linear mixed effects models were used to select potential covariates for the final model and to test the impact of OSMT within each timeframe.

RESULTS

A total of 90 OSMT and 101 UC fulfilled analysis criteria. Arms were well-matched but types of tumors were unevenly distributed (p = .023). The OSMT arm had a nonsignificant improvement in PAM (confidence interval [CI], -3.65 to 5.3]; 4.0 vs. 2.9) at 6 months. There were no significant differences in other surveys. There was a significant OSMT benefit for urinary tumors (four SE domains). Higher OSMT session attendance was associated with post-session improvements in five SE domains (p < .05), two COH-O domains (p < .05), and HADS anxiety (p = .01). At 6 months, there remained improvements in one SE domain (p < .05), one COH-O domain (p < .05), and HADS anxiety (p < .01).

CONCLUSIONS

No clear benefit was seen for the OSMT intervention, although there may be an advantage based on type of tumor. Benefit with greater session attendance was also encouraging.

PLAIN LANGUAGE SUMMARY

Cancer patients with ostomies have many challenges. We tested a telehealth curriculum compared to usual care. There are indications of benefit for the program for those that attend more sessions and those with urostomies.

The role of perceived expertise and trustworthiness in research study and clinical trial recruitment: Perspectives of clinical research coordinators and African American and Black Caribbean patients

This study investigates the role of source credibility on minority participant recruitment, particularly African American and Black Caribbean patients. A total of nine focus groups (N = 48 participants) were conducted with both patient groups and clinical research coordinators (CRCs). Using the elaboration likelihood model as a guiding framework for analysis, this study found that the credibility of research coordinators (or other professionals who recruit for research studies and clinical trials) was instrumental in shaping attitudes of prospective participants. The perspectives of patients and CRCs aligned closely, with few exceptions. For both groups, professionalism and professional displays (clothing, institutional artifacts) enhanced perceived expertise, a core component of credibility. Trustworthiness, another important component of credibility, was fostered through homophily between recruiter and patient, expressions of goodwill and assuaging anxiety about CRCs' financial motivations for recruitment. Additionally, CRCs believed that credibility was supported when CRCs could emphasize transparency and truthfulness in communication. The importance of these findings for the development of empirically-based training programs to improve communication practices in recruitment contexts is discussed.

PFAS Contamination: Pathway from Communication to Behavioral Outcomes

ABSTRACTGuided by the risk information seeking and processing model, this study examines social cognitive variables that motivate individuals to actively seek and process information related to per- and polyfluoroalkyl substances (PFAS) contamination. Results indicate that information insufficiency, affective response, and informational subjective norms are positively related to information seeking and systematic processing, which are positively associated with policy support and intention to adopt risk mitigation behaviors. These findings suggest that when communicating the health risks of PFAS contamination to the general public, cognitive, affective, and normative factors are important initial steps to generate public interest in relevant information.

Understanding Information Processing and Protective Behaviors during the Pandemic: A Three-Wave Longitudinal Study

BACKGROUND

Few existing studies have examined information processing as an independent variable to predict subsequent information behaviors in a pandemic context, and the mechanism of subsequent information behavior processing following the initial or prior information behavior is unclear.

OBJECTIVE

Our study aims to apply the risk information seeking and processing model to explain the mechanism of subsequent systematic information processing in the context of the COVID-19 pandemic.

METHODS

A three-wave longitudinal online national survey was administered during the period of July 2020 to September 2020. Path analysis was conducted to test the relationships between prior and subsequent systematic information processing and protective behaviors.

RESULTS

One important finding was the key role of prior systematic information processing, as indirect hazard experience was found to be a direct predictor of risk perception (β = 0.15, p = 0.004) and an indirect predictor of protective behaviors. Another important finding was the central role of information insufficiency as a mediator/driving force in subsequent systematic information processing and protective behavior.

CONCLUSIONS

The study has made important contributions in that it extends the scholarship on health information behaviors by (a) highlighting that relevant hazard experience in risk information seeking and processing model should be expanded to include indirect experience, and (b) providing the mechanism of subsequent systematic information processing following prior information processing. Our study also provides practical implications on health/risk communication and protective behaviors' promotion in the pandemic context.

U.S. Political Partisanship and COVID-19: Risk Information Seeking and Prevention Behaviors

The global pandemic caused by SARS-CoV-2 (COVID-19) poses serious health risks to humans; yet, despite recommendations by governments and health organizations, a significant number of Americans are not engaging in preventive behaviors. To understand and explain this phenomenon, we seek guidance from a theoretical model that merges the risk information seeking and processing model and the theory of planned behavior. Furthermore, given the politicized nature of the pandemic in the U.S., we pose different information seeking patterns according to media partisanship, asserting that partisanship is likely to affect cognitive structures regarding COVID-19 decision making. Our results suggest two distinct routes for information seeking to decision-making. Conservative media use is directly associated with preventive behavior avoidance, while liberal media use is indirectly associated with preventive behavior engagement. This work contributes to our collective understanding of what drives preventive behaviors in the context of health risk, particularly in the case of a highly politicized national health crisis with global implications.

Information Seeking Behaviors and Intentions in Response to Environmental Health Risk Messages: A Test of A Reduced Risk Information Seeking Model

This study tests the effects of environmental health risk messages on perceived risk, information needs and decisions to seek information, testing a reduced risk information seeking and processing model (R-RISP). Participants (N = 1,823) were randomized to one of three risk conditions (arsenic, bisphenol A [BPA] or volatile organic compounds [VOCs]) and one of the three message conditions (high threat, low threat or no message); participants in the high and low threat message conditions were also randomly assigned to a seeking cue to action condition (with or without seeking cue). Overall, the results support the R-RISP model, demonstrating the importance of current knowledge perceptions and informational subjective norms in information acquisition decisions. In addition, the results also provide initial evidence that environmental health risk messages can prompt information seeking and increase intentions to seek information in the future. Avenues for future research are discussed.

Experience, experts, statistics, or just science? Predictors and consequences of reliance on different evidence types during the COVID-19 infodemic

As an unprecedented global disease outbreak, the COVID-19 pandemic is also accompanied by an infodemic. To better cope with the pandemic, laypeople need to process information in ways that help guide informed judgments and decisions. Such information processing likely involves the reliance on various evidence types. Extending the Risk Information Seeking and Processing model via a two-wave survey (N = 1284), we examined the predictors and consequences of US-dwelling Chinese's reliance on four evidence types (i.e. scientific, statistical, experiential, and expert) regarding COVID-19 information. Overall, Risk Information Seeking and Processing variables such as information insufficiency and perceived information gathering capacity predicted the use of all four evidence types. However, other Risk Information Seeking and Processing variables (e.g. informational subjective norms) did not emerge as important predictors. In addition, different evidence types had different associations with subsequent disease prevention behaviors and satisfaction with the US government's action to address the pandemic. Finally, discrete emotions varied in their influences on the use of evidence types, behaviors, and satisfaction. The findings provide potentially valuable contributions to science and health communication theory and practice.

The Influence of Family Communication Patterns on the Processing of Messages to Increase Family Health History Seeking Intentions

The current study extends family communication patterns (FCP) research to assess how family communication schemata (conversation and conformity orientation dimensions) influence systematic processing of health appeals intended to persuade individuals to seek family health history information, emphasizing an updated conceptualization of family conformity (i.e., the expanded conformity orientation scale). Our results suggest that conversation orientation and the conformity dimension of parental control are the primary drivers of systematic processing of family health history messages. Systematic processing, in turn, was significantly associated with more positive attitudes and greater intentions to seek health information from family members. Our results suggest family communication patterns may impact individual engagement with family health history campaign messages, thus campaign designers may want to consider how best to tailor messages to match family communication characteristics.

The Public's Risk Information Seeking and Avoidance in China During Early Stages of the COVID-19 Outbreak

This study uses the Planned Risk Information Seeking Model (PRISM) to estimate the public's information seeking and avoidance intentions during the COVID-19 outbreak based on an online sample of 1031 Chinese adults and provides support for the applicability of PRISM framework in the situation of a novel high-level risk. The results indicate that information seeking is primarily directed by informational subjective norms (ISN) and perceived seeking control (PSC), while the main predictors of information avoidance include ISN and attitude toward seeking. Because ISN are the strongest predictor of both information seeking and avoidance, the way the public copes with COVID-19 information may be strongly affected by individuals' social environment. Furthermore, a significant relationship between risk perception and affective risk response is identified. Our results also indicate that people who perceive greater knowledge of COVID-19 are more likely to report greater knowledge insufficiency, which results in less information avoidance.

What do we believe in? Rumors and processing strategies during the COVID-19 outbreak in China

The COVID-19 pandemic is called the first infodemic in history. Those first confronted by the enormous challenge of fighting this infodemic to save their lives were the people of Hubei Province in China. To understand how they defined and processed rumors, we conducted an interview study with Hubei residents when they were under lockdown. We found that they typically defined rumors in terms of one or two of three features: non-factual information, information unsanctioned by the government, and information causing panic. They reported low motivation in verifying the information and often either rejected any information they perceived as suspicious or waited for the government to debunk rumors. Even among those who tried to verify information, most relied exclusively on heuristic processing cues such as source credibility, linguistic and visual cues, and intuition. Systematic processing strategies such as fact-checking and discussing with family and friends were seldom used.

Health Communication and Decision Making about Vaccine Clinical Trials during a Pandemic

The COVID-19 pandemic has magnified the importance of clinical trials for finding a safe and effective vaccine to protect against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19. Although communication about vaccines and vaccine hesitancy were challenges long before COVID-19, the twin facts of a pandemic and an "infodemic" of health information, misinformation, and disinformation have raised new challenges for vaccine-related communication and decision-making. The goal of this commentary is to highlight strategies to improve communication and decision-making for adults considering participation in COVID-19 vaccine clinical trials. First, I present a general conceptual model for clinical trial participation that can be applied to various vaccine and other clinical trial contexts. Next, I introduce the ASK (Assume, Seek, Know) approach for enhancing clinical trial participation: (1) assume that all patients will want to know their options, (2) seek the counsel of stakeholders, and (3) know your numbers. The ideas presented in this commentary are intended to enhance vaccine-specific clinical trial communication, decision-making, and literacy, while dually offering strategies and resources that may help reduce vaccine hesitancy and increase vaccine uptake over time.

When Trust Is Not Enough: A Serial Mediation Model Explaining the Effect of Race Identity, eHealth Information Efficacy, and Information Behavior on Intention to Participate in Clinical Research

Black participants remain significantly underrepresented in clinical research. Mistrust in medical researchers has been named a key barrier to the successful enrollment of minority study participants. However, trust is a social-interactional construct, and its effects on behavior are complex. This study hypothesized that intention to participate in clinical research is mediated by trust in medical researchers, eHealth literacy, and information seeking behavior. The data were collected through an online survey ( N = 340) and analyzed to identify serial mediation. The model showed insignificant direct effect of race identity on behavioral intention, c' = -0.19, t(335) = -1.22, p = .22, but a significant total effect, c = -0.44, t(335) = -2.59, p < .01. The indirect effect of race identity on behavioral intention was also significant. The positive effect of trust in medical researchers on decisions to participate in clinical research can be amplified by stronger eHealth literacy and active information seeking, which can be supported through focused strategic health education and communication interventions. A focus on the development of information literacy that could provide prospective minority research volunteers with skills for informed decision making should be explored as an option for increasing mindful, informed participation in clinical research among currently underrepresented racial and ethnic groups.

Multimedia psychoeducation for patients with cancer who are eligible for clinical trials: A randomized clinical trial

BACKGROUND

Supporting patients' decision making about clinical trials may enhance trial participation. To date, few theory-based interventions have been tested to address this issue. The objective of the current study was aimed to evaluate the effect of a multimedia psychoeducation (MP) intervention, relative to a print education (PE) intervention, on patients' decision support needs and attitudes about clinical trials.

METHODS

Patients with cancer who were eligible for participation in a National Cancer Institute therapeutic cancer clinical trial were recruited through the nationwide University of Rochester Cancer Center National Cancer Institute Community Oncology Research Program from 2014 to 2016 and were randomized to the MP or PE intervention. Assessments at baseline (before intervention), postintervention, and at a 2-month follow-up visit included patients' decision support needs, attitudes regarding clinical trials, and clinical trial participation.

RESULTS

In total, 418 patients with various types of cancer were recruited (ages 26-89 years). Relative to the PE intervention, the MP intervention did not significantly affect decision support needs. However, patients in the MP arm reported significantly more positive attitudes about clinical trials and were more likely to participate in a clinical trial than those in the PE arm (69% vs 62%; P = .01). Furthermore, an improvement in attitudes about clinical trials significantly mediated the effect of the intervention on participation in clinical trials.

CONCLUSIONS

The MP intervention was able to improve patient attitudes toward clinical trials compared with the PE intervention, and this improvement led to increased rates of participation in trials. The MP intervention could be disseminated to improve attitudes about clinical trials among patients with cancer.

Factors driving public tolerance levels and information-seeking behaviour concerning insects in the household environment

BACKGROUND

The public's negative attitudes towards household insects drive tolerance for these insects and their control. Tolerance levels are important in integrated pest management (IPM), as are pest knowledge and information. The risk information seeking and processing (RISP) model describes the relationships between personal factors and information-seeking behaviour. We combined IPM and RISP to determine important relationships between factors driving insect tolerance levels and information-seeking behaviour through an online survey and tested whether this model is valid and generally applicable.

RESULTS

Relationships between variables from both IPM and RISP models were tested for seven insect species. Tolerance levels were measured with two factors: willingness to pay for pest control and whether insects are tolerated. Willingness to pay for control was positively affected by age, experience, risk perception, insect characteristics, and negative emotions and affected behavioural intention, by influencing information sufficiency and information-seeking behaviour. Tolerability was influenced by perception of insect characteristics and determines whether control measures are taken.

CONCLUSION

It was possible to combine the RISP and IPM models. Relevant driving factors were a person's age, experience, risk perception, negative affective responses, tolerance levels, relevant channel beliefs about online forums, information sufficiency and information-seeking behaviour. There was, however, variation in important factors between different insects. © 2017 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Understanding the Role of Message Frames on African-American Willingness to Participate in a Hypothetical Diabetes Prevention Study

The objective of this research was to evaluate the impact of message framing (e.g., highlighting health disparities vs. progress toward reducing disparities) on willingness to enroll in a hypothetical research study. African-American (AA, n = 1513) and White (n = 362) adults completed an online survey about diabetes, health behaviors including physical activity, and attitudes about research. AA participants were randomized to view a general message (same message as provided to all White participants) or 1 of 4 alternate messages that framed the need for people to participate in research in terms of race and/or health disparities. Among AAs, there were no differences in willingness to enroll in the study by message frame. However, individual characteristics including younger age, female sex, attitudes about research, a sense of obligation, and community responsibility were significant predictors of willingness to enroll in the study. AA participants who received the general message were equally willing as White participants to enroll in the study. Highlighting race and health disparities in study recruitment materials may not be needed to increase interest among AAs. Factors beyond race appear to be stronger motivators for participation. Unlike previous research, racial framing did not suppress motivation to enroll in our hypothetical study.

The impact of social media on risk perceptions during the MERS outbreak in South Korea

Analyzing nationally representative online panel survey data during the MERS outbreak in South Korea, this study examined the role of social media exposure in shaping public's risk perceptions of MERS. The present study also investigated the moderating role of heuristic-systematic processing and self-efficacy in the relationship between social media exposure and risk perceptions. The findings of this study showed that social media exposure was positively related to forming risk perceptions. Moreover, heuristic-systematic processing and self-efficacy were found to moderate the impact of social media on risk perceptions. The interaction effects suggested that the role of social media in increasing risk perceptions of MERS was heighted by heuristic-systematic processing and self-efficacy. The results and implications of this study are discussed in greater details.

The Role of Health Care Provider and Partner Decisional Support in Patients' Cancer Treatment Decision-Making Satisfaction

Cancer patients rely on multiple sources of support when making treatment decisions; however, most research studies examine the influence of health care provider support while the influence of family member support is understudied. The current study fills this gap by examining the influence of health care providers and partners on decision-making satisfaction. In a cross-sectional study via an online Qualtrics panel, we surveyed cancer patients who reported that they had a spouse or romantic partner when making cancer treatment decisions (n = 479). Decisional support was measured using 5-point, single-item scales for emotional support, informational support, informational-advice support, and appraisal support. Decision-making satisfaction was measured using Holmes-Rovner and colleagues' (1996) Satisfaction With Decision Scale. We conducted a mediated regression analysis to examine treatment decision-making satisfaction for all participants and a moderated mediation analysis to examine treatment satisfaction among those patients offered a clinical trial. Results indicated that partner support significantly and partially mediated the relationship between health care provider support and patients' decision-making satisfaction but that results did not vary by enrollment in a clinical trial. This study shows how and why decisional support from partners affects communication between health care providers and cancer patients.

Determinants of Seeking and Avoiding Risk-Related Information in Times of Crisis

This research is designed to provide insight into the psychological (e.g., threat appraisal or coping appraisal) and other determinants (e.g., information quality judgments or demographics) of risk information seeking or avoidance in times of an acute risk, as part of the process of increasing public resilience through adherence to risk mitigating advice. Data were collected via telephone interviews. A specialized agency interviewed 1,000 Dutch citizens, randomly confronted with one of eight fictitious, but realistic, acute risk and emergency situations. Results indicate that information seeking in an acute situation is anticipated by a less elaborate set of predictors (age and risk perception) than information seeking in a nonacute situation (age and risk perception, as well as educational level and social norm). Although risk perception is a predictor for risk information seeking, its predictive value for acute-risk-related behavior, as one might have assumed based on theories such as protection motivation theory (PMT) or the extended parallel process model (EPPM), appears to be limited. Implications for risk communication are discussed.

Exploring the motivations of patients with type 2 diabetes to participate in clinical trials: a qualitative analysis

PLAIN ENGLISH SUMMARY

Certain patient groups are reluctant to engage with clinical research and consequently findings are not always truly representative of the wider population. With the emphasis on evidence-based clinical practice, clinical research as a core activity for the National Health Service (NHS) and the rising prevalence of diabetes within the United Kingdom (UK) it is important to understand what motivates people to volunteer for research in diabetes and identify the barriers to this involvement. This research interviewed 12 people with type 2 diabetes who had previously taken part in diabetes clinical trials. The transcripts of these interviews were analysed to identify themes that informed the study findings.There were wide ranging reasons for participating in clinical trials. Both altruistic and self-interest motivation were universally expressed. The thought of helping others was a powerful experience but for some there was a sense of duty to volunteer especially if they had benefited from NHS care. Participating was empowering, with extra access to healthcare professionals, practical information and support for their condition. Coping with the logistics of being in a trial relied upon a strong network of family and friends. Some felt anxious at the end of the trial having been supported during the research and appreciating the camaraderie of belonging to a group or team.This study provides insights into the motivations and barriers to involvement in clinical research in type 2 diabetes helping researchers to encourage and support more volunteers in clinical trials.

ABSTRACT

Background Certain patient groups are reluctant to engage with clinical research and consequently findings of the research are not always truly representative of the wider population. This, together with a growing prominence of evidence-based clinical practice, an increasing emphasis of clinical research as a core activity for the NHS and the rising prevalence of diabetes within the UK population, requires an understanding of motivations and barriers for patients consenting to participate in diabetes clinical trials.Methods To understand patients' motivations for participating in clinical trials in type 2 diabetes. We conducted a qualitative study involving 12 participants with type 2 diabetes with previous involvement in clinical trials. Individual, tape-recorded, semi structured interviews were conducted to explore motivations and experiences of the participants. We carried out thematic content analysis to identify themes, from which theoretical interpretations were formed.Results There were wide ranging reasons for participating in clinical trials. We identified 3 key themes: (1) Motivations ranged from altruism to self-interest; (2) participation in clinical trials was an empowering experience; and (3) key to participation was a strong network of support.Conclusion Patients are motivated to participate in clinical trials by a sense of altruism coupled with self-interest. This self-interest centres on the belief that participation would be an informative and empowering experience with increased access to healthcare professionals. However the ability to cope with the logistics of being in clinical trials relies upon an extensive and reliable network of support from family, friends, work colleagues and employers, together with a collaborative approach to their care from the researchers and their usual healthcare providers.

Exploring Willingness to Participate in Clinical Trials by Ethnicity

African-Americans and Hispanic-Americans are disproportionately affected by cancer, yet underrepresented in cancer clinical trials. Because of this, it is important to understand how attitudes and beliefs about clinical trials vary by ethnicity. A national, random sample of 860 adults was given an online survey about attitudes toward clinical trials. We examined willingness to participate in clinical trials, attitudes toward clinical trials, trust in doctors, attitudes toward alternative and complementary medicine, and preferred information channels. Results indicate that African-American and Hispanic-American participants have more negative attitudes about clinical trials, more distrust toward doctors, more interest in complementary and alternative medicine, and less willingness to participate in clinical trials than white/non-Hispanics, although specific factors affecting willingness to participate vary. The channels people turn to for information on clinical trials also varied by ethnicity. These results help explain the ethnic disparities in cancer clinical trial enrollment by highlighting some potential underlying causes and drawing attention to areas of importance to these groups.

An Empirical Study of the Volkswagen Crisis in China: Customers' Information Processing and Behavioral Intentions

Product-harm crises usually lead to product recalls, which may cause consumers concern about the product quality and safety. This study systematically examines customers' immediate responses to the Volkswagen product recall crisis in China. Particular attention was given to customers' responses to the risk information influencing their behavioral intentions. By combining the protective action decision model and the heuristic-systematic model, we constructed a hypothetical model to explore this issue. A questionnaire survey was conducted to collect data involving 467 participants drawn from the customers of Volkswagen. We used structural equation modeling to explore the model. The results show that customers' product knowledge plays an important role in their responses to the crisis. Having more knowledge would make them perceive a lower risk, but they might need even more information, making them more likely to seek and process information, and subsequently increasing their positive behavioral intentions toward the firm (that is pro-firm behavioral intentions). Risk perception increased customers' information needs, information seeking, and information processing but decreased their pro-firm behavioral intentions. In addition to promoting information seeking, information needed to also facilitate customers' systematic processing and thus increase their behavioral intentions to take corrective action. Customers' behavioral intentions were also spurred by systematic processing, but failed to be predicted by information seeking. In summary, theoretical and practical implications and suggestions for further research are also discussed.

Heart Disease and Colon Cancer Prevention Beliefs and Their Association With Information Seeking and Scanning

Despite their understanding of the links between (a) information seeking and scanning and (b) health outcomes, researchers still know relatively little about the impact of information behaviors on people's disease-related beliefs and attitudes. The goal of this study was to validate findings linking information and health behaviors and to assess whether information seeking and scanning are associated with beliefs about the effectiveness of heart disease and colon cancer risk prevention behaviors (in regard to exercise, controlling one's diet to prevent overweight/obesity, and daily fruit and vegetable intake), as well as determine whether the effects of seeking versus scanning on these beliefs differ. Data from the Annenberg National Health Communication Survey were analyzed (N = 3,212). For colon cancer, significant main effects were detected for information scanning for each of the 3 beliefs assessed (p < .05). For heart disease, both information scanning and heart disease media exposure (p < .05) were associated with stronger beliefs. Information seeking was not associated with beliefs for either disease (p > .05). Our results suggest that disease-related cognitions and beliefs, which ultimately impact decisions to engage in prevention behaviors, may be influenced most by less purposeful forms of information acquisition.

Impact of a clinical trial initiative on clinical trial enrollment in a multidisciplinary prostate cancer clinic

Clinical oncology trials are hampered by low accrual rates, with fewer than 5% of adult patients with cancer treated on study. Clinical trial enrollment was evaluated at The University of Texas MD Anderson Cancer Center's Multidisciplinary Prostate Cancer Clinic (MPCC) to assess whether a clinical trial initiative, introduced in 2006, impacted enrollment. The trial initiative included posting trial-specific information in clinic, educating patients about appropriate clinical trial options during the treatment recommendation discussion, and providing patients with trial-specific educational information. The investigators evaluated the frequency of clinical trial enrollment for men with newly diagnosed prostate cancer seen in the MPCC from 2004 to 2008. Logistic regression evaluated the impact of patient characteristics and the clinical trial initiative on trial enrollment. The median age of the 1370 men was 64 years; 32% had low-risk, 49% had intermediate-risk, and 19% had high-risk disease. Overall, 74% enrolled in at least one trial and 29% enrolled in more than one trial. Trial enrollment increased from 39% before the initiative (127/326) to 84% (880/1044) after the trial initiative. Patient enrollment increased in laboratory studies (from 25% to 80%), quality-of-life studies (from 10% to 26%), and studies evaluating investigational treatments and systemic agents (from 6% to 15%) after the trial initiative. In multivariate analysis, younger men (P<.001) and men seen after implementation of the clinical trial initiative (P<.001) were more likely to enroll in trials. Clinical trial enrollment in the MPCC was substantially higher than that seen nationally in adult patients with cancer, and enrollment rates increased after the introduction of a clinical trial initiative.

Factors associated with willingness to participate in clinical trials: a nationwide survey study

Background

This study was conducted to investigate awareness of clinical trials (CTs) including perceptions of favorable feelings about, necessity for, and safety of CTs, the ultimate beneficiary of CTs and the factors associated with willingness to participate in CTs among the general population in South Korea.

Methods

A cross sectional survey study was conducted in a randomly selected national sample of 1,515 Korean.

Results

Perception toward CTs was measured using a scale from 0 (strongly disagree) to 10 (strongly agree). Respondents readily understood the necessity for CTs (M = 7.27, SD = 2.15); had moderately favorable feelings (M = 5.32, SD = 2.31) toward CTs and felt that these CTs were moderately safe (M = 4.71, SD = 1.90). Twenty-five percent of the respondents answered that they would be willing to participate in a CT in the future. Perception of the ultimate benefits of CTs, awareness, favorable feelings, safety, and necessity regarding CTs were identified as significant predictors of willingness to participate in CTs.

Conclusion

An awareness of CTs and the perceptions toward CTs were associated with general public willingness to participate in a CT. Findings from this study can be used in planning outreach and recruitment strategies, and to understand the predictors of CT participation.

Discussions of cancer clinical trials with the National Cancer Institute's Cancer Information Service

Clinical trials are essential for the development of new and effective treatments for cancer; however, participation rates are low. One reason for this is lack of knowledge about clinical trials. This study assessed how often clinical trials are discussed on calls to National Cancer Institute's Cancer Information Service (CIS). The authors quantitatively analyzed 283,094 calls to the CIS (1-800-4-CANCER) over 3 years (2006-2008). They calculated descriptive statistics and multivariate regressions to determine whether specific caller characteristics are associated with the presence of a clinical trials discussion. In addition, 2 focus groups were conducted with CIS information specialists (n=12) to provide insight into the findings. The authors found that approximately 9.3% of CIS calls discussed clinical trials, with higher percentages for patients (12.5%) and family members (15.4%). Calls with Hispanics, Blacks, and Spanish speakers were less likely to include a conversation. For all cancers, patients who are in treatment or experiencing a recurrence were statistically significantly more likely to discuss clinical trials. CIS information specialists reported callers' limited knowledge of clinical trials. The CIS has the unique ability to make a substantial effect in educating patients about clinical trials as an option in cancer treatment and care.

"I had already made up my mind": patients and caregivers' perspectives on making the decision to participate in research at a US cancer referral center

BACKGROUND

Hematopoietic cell transplants (HCTs) are associated with high morbidity and mortality, which complicate the decision-making process for people considering HCT clinical trials. There is a lack of research examining longitudinally how patients make clinical trial participation decisions in US cancer referral centers.

OBJECTIVE

A qualitative study was conducted to examine how patients and their family caregivers decide to participate in HCT research at a US cancer referral center.

METHODS

Semistructured interviews were conducted with 25 patients enrolled in early-stage phase 2 HCT research studies and with 20 family caregivers. Interviews were conducted before HCT and approximately days 80 and 365 after HCT.

RESULTS

Most patients (92%) and their caregivers (75%) decided to participate in research well before consent conferences at the cancer referral center. Patients' reasons for deciding to participate included having "no other option," seeking a cure, and following their home oncologists' recommendations.

CONCLUSION

Currently, US researchers are primarily guided by Federal regulations that view the decision-making process as a cognitive one. Findings confirmed cognition was a part of consent; however, most patients made the decision to participate in high-risk clinical trials long before they had been apprised of the specific information about the study and before the consent conference.

IMPLICATIONS FOR PRACTICE

The high risk of death from the disease and/or the HCT underscored the emotional component of decision making and affirmed that researchers need to acknowledge this emotional component to meet the ethical imperative of providing "informed consent."