Related Experiment Video
Updated: Jul 4, 2025
Stereotactic Radiosurgery for Gynecologic Cancer
Published on: April 17, 2012
Critical decisions: A mixed-methods study of decision-making among diverse gynecologic cancer patients considering
Stephanie Margrit Rieder1, Ellen Burgess2, Teresa Rutledge1
1University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA; Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM, USA.
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.
Insights
Gynecologic cancer patients face barriers to clinical trial participation beyond willingness. Addressing precarity factors like uncertainty and financial toxicity can improve trial equity for diverse populations.
Area of Science:
- Oncology
- Clinical Trials
- Health Equity
Background:
- Participation in therapeutic clinical trials for gynecologic cancers lacks diversity.
- This limits access to novel treatments and the generalizability of trial results.
- Reasons for underrepresentation, despite equal willingness to participate, are not well understood.
Purpose of the Study:
- To apply a precarity framework to understand factors influencing enrollment decisions in gynecologic oncology clinical trials.
- To identify and address barriers to improve equity in clinical trial participation.
Main Methods:
- A qualitative and quantitative study of gynecologic cancer patients at a tertiary care facility in the Southwestern United States (2020-2021).
- Patients who discussed trial participation were surveyed and interviewed; oncology providers completed parallel surveys.
- Data analyzed using descriptive statistics and thematic coding.
Main Results:
- 30 patients participated in surveys and interviews.
- No quantitative differences were found in shared decision-making or patient-centered communication between enrolled and non-enrolled patients.
- Qualitative data revealed that patients declining enrollment cited concerns about uncertainty, loss of control, decision-making independence, resource challenges, and financial toxicity.
Conclusions:
- A framework of precarity conceptualizes factors affecting desire to enroll in clinical trials.
- Identifying and mitigating burdens for precarious patients can enhance enrollment and retention in gynecologic oncology trials for diverse populations.
Related Concept Videos
01:16Clinical Trials
There are four phases in a clinical trial. A phase one...
01:27Nursing Ethical Principles II
Consider the following scenario, which illustrates how these principles are applied in the care of Mr. John, a fifty-year-old teacher diagnosed with metastatic liver cancer.
Initially, Mr. John's...
01:21Cancer Survival Analysis
01:27Nurses' Legal Responsibilities I
The legal responsibilities of a nurse regarding informed consent include the following:
01:27Ethical Issues
Ethical Concerns in Healthcare:
01:23Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...