Barriers and facilitators for clinical trial participation among diverse Asian patients with breast cancer.

Abstract

108 Background: Recruitment rates for breast cancer trials are low for racial/ethnic minorities. Little is known about factors influencing trial recruitment in Asian patients. Our aim is to examine the barriers and facilitators for participation in trials among multi-ethnic Asian women with breast cancer. Methods: We recruited a convenience sample from consecutive women seen at a National Cancer Centre. Two experienced bilingual (English and Chinese) moderators conducted focus groups to theme saturation. The question guide incorporated open-ended questions soliciting opinions about trial participation and knowledge. Women were first asked if they were willing, unwilling, or still open to participate in future trials. Sessions were audiotaped and transcribed. Transcripts were independently coded for emergent themes. Results: Sixteen of 103 women approached participated in five focus groups. Chinese, Malay and Indian participants aged 29 to 69 represented different cancer stages. Five had no prior knowledge of trials. We identified three major areas consisting of 24 minor themes for barriers and facilitators. Major themes fell into: 1) individual- or patient-related, 2) trial-related and and 3) sociocultural factors. When analysis was stratified by willingness to join trials, we found that women willing to join trials expressed themes representing facilitators (better test therapy, cost-effective profile, or trust in doctors and local systems). Women unwilling to participate expressed themes associated with barriers, while women still open to participation expressed themes representing both facilitators and barriers. Malay women were more likely to express themes related to ‘fatalism’ as a barrier. Conclusions: We found that facilitators and barriers to trial participation among Asian women were similar to those previously reported in Western women. Knowledge of trials is limited among women receiving breast cancer treatment. Unique sociocultural factors suggest that approaches customised to local and community beliefs are needed to improve trial participation in minority groups.