Identifying Barriers and Motivators to Increase Surgical Clinical Trial Participation for Older Veterans

Patients aged 65+ are underrepresented in surgical clinical trials, and few studies have explored the unique barriers that limit participation of older adults in surgical trials. We aimed to identify barriers and facilitators to participation in surgical randomized trials among adults aged 65+.

Patients aged 65+ years having hernia surgery at two high-volume Veterans' Affairs hospitals.

We conducted semi-structured interviews to identify barriers and facilitators to participation in clinical trials. Interviews were analyzed with directed content analysis.

We interviewed 40 Veterans aged 65+ years. The most frequently cited barriers to participation were logistical (e.g., needing to visit the hospital more frequently) and emotional (e.g., medical mistrust, fear of hospitals, and fear of bodily harm). COVID-19 pandemic-related misinformation was commonly cited by these participants as a justification for medical mistrust. The most frequently cited motivators to participate in trials were altruism, access to novel treatments, increased time with clinicians, and advancing scientific knowledge. Patients uncertain about participation were potentially persuadable by referencing the impact of the trial on their friends and family, or by increasing transparency around trial purpose and design. Notably, using virtual visits to minimize travel to the hospital was not regarded as a viable way to address logistical barriers.

Increasing the participation of older adults in surgical clinical trials will require a multi-factorial strategy that emphasizes communication of benefits to more than just the patient and includes deliberate planning to combat misperceptions and misinformation.