Centering Black Voices: Factors Influencing a Cancer Patient's Decision to Join a Clinical Trial

The enrollment of Black patients (BPs) in cancer-related clinical trials has recently declined, and its etiology remains poorly understood. We aim to characterize psychosocial factors that influence patients with curative gastrointestinal, thoracic, gynecologic, and head and neck malignancies when enrolling in a research trial, to improve recruitment and retention of BPs.

We conducted a cross-sectional, descriptive study using a questionnaire adapted from 2 validated surveys for patients who completed definitive radiation treatment for the aforementioned malignancies. Chi-square and Mann-Whitney U tests assessed differences between the populations.

From October 2023 to February 2024, 172 of 247 eligible patients agreed to participate (survey participation 70%). BP comprised 24% of patients who participated (n = 42). BPs were less likely to be married (16.7% vs 68.8%; P < .001), have a bachelor's (9.5% vs 24.2%; P = .048), or graduate degree (2.4% vs 14.1%; P =.046), and a lower median income ($69,318 vs $106,823; P < .001) when compared with non-Black patients (NBPs). Both groups were equally invited to an actual clinical trial (BPs vs NBPs; 17.9% vs 21.7%; P = NS); however, fewer BP reported that they would participate (17.1% vs 31.9%; P < .001). Patients with a higher motivation prediction relevance score were 2.5 times more likely to join a trial (P = .031), whereas those with a higher religious prediction relevance score were 44% less likely to join (P = .036). Compared with NBPs, BPs were more apt to agree that illness/death is determined by God's will (48% vs 17.3%; P = .024) and that God determines wellness, not research (55.1% vs 16.5%; P < .001). Eighteen percent of BP agreed that research harms minorities versus 3.6% of NBP (P = .001). BPs felt that there was nothing for them (11.8% vs 3.2%; P = .01) or their community (25.1% vs 5.3%; P = .006) to gain by participating in research when compared with NBPs. At least 90% of participants in both groups trusted their cancer doctors.

Spiritual beliefs may play a key role in clinical trial decision-making among BPs. Although most patients trust their cancer care team, there remains underlying distrust in clinical research among BPs.