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Sanusi IA, Arisoyin AE, Aruoture S, Folorunsho IL, Okereke OP, Adeyemo DA, Salawu MA, Okobi OE, Gupta A, Akunne HS, Patel R, Emmanuel O, Ezeudemba NC. Exploring the Prevalence and Factors Influencing Clinical Trial Awareness in US Adults with Self-Reported Depression and Anxiety. Cureus 2023; 15:e40780. [PMID: 37485134 PMCID: PMC10362504 DOI: 10.7759/cureus.40780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 07/25/2023] Open
Abstract
OBJECTIVE Lack of clinical trial awareness is a crucial barrier to clinical trial enrollment. The objective of this study was to examine the prevalence and factors associated with clinical trial awareness among US adults with self-reported depression and anxiety. METHODS Data were collected from 896 adults who self-reported depression and anxiety from the 2020 Health Information National Trends Survey. Multinomial logistic regression was utilized to assess predictors of clinical trial awareness, particularly socio-demographic, health-related, and technological variables. Odds ratios (OR) for the associations were reported. RESULTS About 60.4% of adults with self-reported depression or anxiety reported being aware of clinical trials. In the multivariable regression, education level, health-related social media use, and having access to a regular provider were all significantly associated with greater odds of clinical trial awareness among individuals with depression and/or anxiety. Specifically, individuals with at least some college education (OR 2.07, 95% confidence interval (CI); 1.28-3.34; p = 0.004) were more likely to report awareness of clinical trials than those with less than a college education. Similarly, compared to those without access to health providers, individuals with depression and/or anxiety who had a regular provider had greater odds of clinical trial awareness (OR 2.23, 95% CI; 1.16-4.31; p = 0.017). Additionally, those who reported two or more health-related uses of social media were significantly more likely to report clinical trial awareness than their counterparts who reported no health-related social media use (OR 3.17, 95% CI; 1.48-6.80; p = 0.004). CONCLUSION Our study shows that about six in 10 adults with depression and anxiety in the United States were aware of clinical trials. However, some sub-groups of patients, particularly those without access to a regular health provider, those with a lower education level, and those with limited use of social media for health purposes, remain inadequately informed and may lack awareness of available clinical trials. These findings are crucial and identify subgroups of people with mental disorders that may benefit from targeted interventions to improve clinical trial awareness.
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Affiliation(s)
| | | | - Shaw Aruoture
- Psychiatry, Behavioral Hospital Of Bellaire, Houston, USA
| | | | | | | | - Mujeeb A Salawu
- Medicine and Surgery, University of Ilorin College of Health Sciences, Ilorin, NGA
- Internal Medicine and Psychiatry, Houston Health Department, Houston, USA
| | - Okelue E Okobi
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | - Akash Gupta
- Internal Medicine, Spartan Health Sciences University, Vieux Fort, LCA
| | | | - Radhey Patel
- Psychiatry and Behavioral Sciences, Avalon University School of Medicine, Willemstad, CUW
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Ghooi RB. Clinical trial agreements and insurance policies - role of the EC. Perspect Clin Res 2022; 13:121-122. [PMID: 35928640 PMCID: PMC9345259 DOI: 10.4103/picr.picr_271_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/20/2022] [Indexed: 11/25/2022] Open
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Kircher SM, Yarber J, Rutsohn J, Guevara Y, Lyleroehr M, Alphs Jackson H, Walradt J, Desai B, Mulcahy M, Kalyan A, Benson AB, Agulnik M, Mohindra N, DeSouza J, Garcia SF. Piloting a Financial Counseling Intervention for Patients With Cancer Receiving Chemotherapy. J Oncol Pract 2019; 15:e202-e210. [PMID: 30625023 DOI: 10.1200/jop.18.00270] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE National organizations encourage communication about costs of cancer care; however, few data are available on health system models for identifying and assisting patients with financial distress (FD). We report the feasibility and acceptability of a financial counseling (FC) intervention for patients who receive chemotherapy at a comprehensive cancer center. MATERIALS AND METHODS Patients were randomly assigned 1:1 to FC or standard care. The FC arm received education, financial assistance screening, and an estimation tool with total billed charges and out-of-pocket (OOP) cost of one cycle of chemotherapy from a financial counselor through phone call and in-person visit. Participants completed measures of FD, health-related quality of life, and acceptability. RESULTS Ninety-five participants enrolled (mean age, 61 years; 72% white; 50% commercially insured), with a 32% attrition rate between assessments. Rates of completion for the phone call, in-person, and entire intervention were 98%, 47%, and 30%, respectively. The OOP estimation tool was considered understandable and acceptable to the majority of participants. No significant changes in FD were found between arms. Emotional functioning was negatively associated with having high FD (95% CI, -0.13379 to -0.013; P = .0189). Being married was associated with a decrease in log-odds of having high FD (β = -1.916; 95% CI, -3.358 to -0.475; P = .0092). CONCLUSION Implementation of an FC program that provides transparent cost data is feasible and acceptable. Incorporation of FC into clinical workflow, including phone counseling, is important to improve feasibility. Additional work is needed to develop tailored educational materials that are patient specific.
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Preston MA, Mays GP, Bursac Z, Thomas BR, Laryea J, Tilford JM, Odlum M, Smith SA, Henry-Tillman RS. Insurance coverage mandates: Impact of physician utilization in moderating colorectal cancer screening rates. Am J Surg 2018; 215:1004-1010. [PMID: 29555083 DOI: 10.1016/j.amjsurg.2018.02.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 02/27/2018] [Indexed: 12/26/2022]
Abstract
Precision public health requires research that supports innovative systems and health delivery approaches, programs, and policies that are part of this vision. This study estimated the effects of health insurance mandate (HiM) variations and the effects of physician utilization on moderating colorectal cancer (CRC) screening rates. A time-series analysis using a difference-in-difference-in-differences (DDD) approach was conducted on CRC screenings (1997-2014) using a multivariate logistic framework. Key variables of interest were HiM, CRC screening status, and physician utilization. The adjusted average marginal effects from the DDD model indicate that physician utilization increased the probability of being "up-to-date" vs. non-compliance by 9.9% points (p = 0.007), suggesting that an estimated 8.85 million additional age-eligible persons would receive a CRC screening with HiM and routine physician visits. Routine physician visits and mandates that lower out-of-pocket expenses constitute an effective approach to increasing CRC screenings for persons ready to take advantage of such policies.
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Affiliation(s)
- Michael A Preston
- University of Arkansas for Medical Sciences, Department of Surgery, Health Initiatives and Disparities Research, 4301 West Markham Street #827, Little Rock, AR 72205-7199, USA.
| | - Glen P Mays
- University of Kentucky, Department of Health Management & Policy, College of Public Health, 111 Washington Avenue #201, Lexington, KY 40536-003, USA.
| | - Zoran Bursac
- University of TN Health Science Center, Center for Population Sciences, Department of Preventive Medicine, 66 N Pauline St., Suite 307, Memphis, TN 38163, USA.
| | - Billy R Thomas
- University of Arkansas for Medical Sciences, Department of Pediatrics Neonatology, College of Medicine, 4301 West Markham Street, Little Rock, AR 72205-7199, USA.
| | - Jonathan Laryea
- University of Arkansas for Medical Sciences, Department of Surgery, Health Initiatives and Disparities Research, 4301 West Markham Street #827, Little Rock, AR 72205-7199, USA.
| | - J Mick Tilford
- University of Arkansas for Medical Sciences, Department of Health Policy & Management, College of Public Health, 4301 West Markham Street, Little Rock, AR 72205-7199, USA.
| | - Michelle Odlum
- Columbia University, School of Nursing, 617 West 168th Street, Rm 225, New York, NY 10032, USA.
| | - Sharla A Smith
- University of Kansas School of Medicine-Wichita, Department of Preventive Medicine & Public Health, 1010 N. Kansas Street, Wichita, KS 67214, USA.
| | - Ronda S Henry-Tillman
- University of Arkansas for Medical Sciences, Department of Surgery, Health Initiatives and Disparities Research, 4301 West Markham Street #827, Little Rock, AR 72205-7199, USA.
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Mackay CB, Antonelli KR, Bruinooge SS, Saint Onge JM, Ellis SD. Insurance denials for cancer clinical trial participation after the Affordable Care Act mandate. Cancer 2017; 123:2893-2900. [DOI: 10.1002/cncr.30689] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 02/27/2017] [Accepted: 03/01/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Christine B. Mackay
- Department of Health Policy and Management; University of Kansas Medical Center; Fairway Kansas
- University of Kansas Cancer Center; Fairway Kansas
| | | | | | - Jarron M. Saint Onge
- Department of Health Policy and Management; University of Kansas Medical Center; Fairway Kansas
| | - Shellie D. Ellis
- Department of Health Policy and Management; University of Kansas Medical Center; Fairway Kansas
- University of Kansas Cancer Center; Fairway Kansas
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Byrne MM, Tannenbaum SL, Glück S, Hurley J, Antoni M. Participation in cancer clinical trials: why are patients not participating? Med Decis Making 2013; 34:116-26. [PMID: 23897588 DOI: 10.1177/0272989x13497264] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Participation in cancer clinical trials is low, particularly in racial and ethnic minorities in some cases, which has negative consequences for the generalizability for study findings. The objective of this study was to determine what factors are associated with patients' participation or willingness to participate and whether these factors vary by race/ethnicity. DESIGN or METHODS . White, Hispanic, and black participants were obtained through the Florida cancer registry and who were diagnosed with breast, lung, colorectal, or prostate cancer (N = 1100). Participants were surveyed via telephone to obtain demographic information, past participation, and willingness to participate in clinical trials, as well as barriers and facilitators to participation. Logistic and Poisson regressions were performed. RESULTS . Respondents were on average 67.4 years old, 42.7% were male, and 50.1% were married. In this population, 7.7% of respondents had participated in a clinical trial, and 36.5% stated that they would be willing to participate. In multivariate models, blacks and Hispanics were equally likely as whites to be willing to participate in cancer trials, but Hispanics were less likely to have participated, and this was especially more likely in non-English-speaking Hispanics compared with English-speaking Hispanics. Notable barriers across race/ethnicity were mistrust and lack of knowledge of clinical trials. Limitations. Cross-sectional design limits cause-and-effect conclusions. CONCLUSIONS . There are racial differences in participation rates but not in willingness to participate. We hypothesize that willingness to participate is not very high because people are uninformed about participating, particularly in non-English-speaking Hispanics. Barriers and facilitators to participation vary by race. Improved understanding of cultural differences that can be addressed by physicians may restore faith, comprehension, and acceptability of clinical trials by all patients.
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Affiliation(s)
- Margaret M Byrne
- Department of Public Health Sciences (MMB), University of Miami Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center (MMB, SLT), University of Miami Miller School of Medicine, Miami, Florida
| | - Stacey L Tannenbaum
- Sylvester Comprehensive Cancer Center (MMB, SLT), University of Miami Miller School of Medicine, Miami, Florida
| | - Stefan Glück
- Department of Medicine (SG, JH), University of Miami Miller School of Medicine, Miami, Florida
| | - Judith Hurley
- Department of Medicine (SG, JH), University of Miami Miller School of Medicine, Miami, Florida
| | - Michael Antoni
- Department of Psychology, Universityof Miami, Miami, Florida (MA)
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Chun N, Park M. The impact of health insurance mandates on drug innovation: evidence from the United States. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2013; 14:323-344. [PMID: 22290504 DOI: 10.1007/s10198-012-0379-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Accepted: 01/11/2012] [Indexed: 05/31/2023]
Abstract
An important health policy issue is the low rate of patient enrollment into clinical trials, which may slow down the process of clinical trials and discourage their supply, leading to delays in innovative life-saving drug treatments reaching the general population. In the US, patients' cost of participating in a clinical trial is considered to be a major barrier to patient enrollment. In order to reduce this barrier, some states in the US have implemented policies requiring health insurers to cover routine care costs for patients enrolled in clinical trials. This paper evaluates empirically how effective these policies were in increasing the supply of clinical trials and speeding up their completion, using data on cancer clinical trials initiated in the US between 2001 and 2007. Our analysis indicates that the policies did not lead to an increased supply in the number of clinical trials conducted in mandate states compared to non-mandate states. However, we find some evidence that once clinical trials are initiated, they are more likely to finish their patient recruitment in a timely manner in mandate states than in non-mandate states. As a result, the overall length to completion was significantly shorter in mandate states than in non-mandate states for cancer clinical trials in certain phases. The findings hint at the possibility that these policies might encourage drug innovation in the long run.
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Affiliation(s)
- Natalie Chun
- Asian Development Bank, Mandaluyong City 1550, Philippines.
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Ellis SD, Carpenter WR, Minasian LM, Weiner BJ. Effect of state-mandated insurance coverage on accrual to community cancer clinical trials. Contemp Clin Trials 2012; 33:933-41. [PMID: 22683991 DOI: 10.1016/j.cct.2012.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 05/30/2012] [Accepted: 06/03/2012] [Indexed: 01/06/2023]
Abstract
Thirty-five U.S. states and territories have implemented policies requiring insurers to cover patient care costs in the context of cancer clinical trials; however, evidence of the effectiveness of these policies is limited. This study assesses the impact of state insurance mandates on clinical trial accrual among community-based practices participating in the NCI Community Clinical Oncology Program (CCOP), which enrolls approximately one-third of all NCI cancer trial participants. We analyzed CCOP clinical trial enrollment over 17 years in 37 states, 14 of which implemented coverage policies, using fixed effects least squares regression to estimate the effect of state policies on trial accrual among community providers, controlling for state and CCOP differences in capacity to recruit. Of 91 CCOPs active during this time, 28 were directly affected by coverage mandates. Average recruitment per CCOP between 1991 and 2007 was 95.1 participants per year (SD=55.8). CCOPs in states with a mandate recruited similar numbers of participants compared to states without a mandate. In multivariable analysis, treatment trial accrual among CCOPs in states that had implemented a coverage mandate, was not statistically different than accrual among CCOPs in states that did not implement a coverage mandate (β=2.95, p=0.681). State mandates did not appear to confer a benefit in terms of CCOP clinical trial accrual. State policies vary in strength, which may have diluted their effect on accrual. Nonetheless, policy mandates alone may not have a meaningful impact on participation in clinical trials in these states.
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Affiliation(s)
- Shellie D Ellis
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, NC 27599-7411, USA.
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Abstract
OBJECTIVES To summarize the scientific and technologic advances contributing to the increasing number of people who are living with advanced cancer, associated economic costs, psychosocial burdens, and public policy. DATA SOURCES Published books and journal articles, web resources, newspapers and news magazines. CONCLUSION Scientific and technologic advances, combined with unidentified inherent traits, allow some people with advanced cancer to live for varying and increasingly long periods of time. Public policy, provisions for care, and service delivery lag behind the science, thereby excluding this emerging population from the attention now being paid to survivors with potentially curable cancer. IMPLICATIONS FOR NURSING PRACTICE Nurses in clinical practice settings must be attuned to the unique needs associated with living with advanced cancer. Nurses in all settings must advocate for and participate in nursing research efforts to identify needs, gaps and shortcomings in care delivery, and development of interventions, services, programs, and resources to address the needs of this growing population. Finally, awareness that this population has unique needs and burdens prepares nurses to lead and/or participate in efforts to craft public policy that promotes optimal health and well-being among people living with advanced cancer.
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Langford A, Resnicow K, An L. Clinical trial awareness among racial/ethnic minorities in HINTS 2007: sociodemographic, attitudinal, and knowledge correlates. JOURNAL OF HEALTH COMMUNICATION 2010; 15 Suppl 3:92-101. [PMID: 21154086 PMCID: PMC4013828 DOI: 10.1080/10810730.2010.525296] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The purpose of this study was (1) to examine the association of race/ethnicity on clinical trial awareness, controlling for several sociodemographic, attitudinal, and knowledge variables, and (2) to inform future communication campaigns to increase clinical trial awareness and participation. Secondary analysis was conducted among 6,754 Hispanic, Black, and White adult respondents to the National Cancer Institute's 2007 Health Information National Trends Survey (HINTS). The dependent variable was awareness of clinical trials. Logistic regression was used to examine possible correlates of clinical trial awareness including sociodemographics, trust of sources of health information, beliefs about safety of health information, family/personal history of cancer, health seeking information, and awareness of three health agencies. Compared with Whites, Blacks and Hispanics were significantly less likely to have heard of a clinical trial. Other significant correlates of clinical trial awareness included education, income, belief that health information is safely guarded, family history of cancer, awareness of the Centers for Disease control, trust of health information from the Internet and charitable organizations, and distrust of health information from religious institutions. Blacks and Hispanics are significantly less aware of clinical trials. Campaigns that exploit unique beliefs and delivery channels for racial/ethnic subgroups should be considered.
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Affiliation(s)
- Aisha Langford
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 109 South Observatory, Ann Arbor, MI 48109, USA.
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