Bias and stereotyping among research and clinical professionals: Perspectives on minority recruitment for oncology clinical trials.

Abstract

152 Background: Extensive attention has been paid in recent years to the possibility that bias among health care professionals contributes to health disparities. In its 2003 report, Unequal Treatment, the Institute of Medicine concluded that bias against racial minorities may affect communication or care offered. However, the role of bias in the context of recruitment of racial minorities in cancer clinical trials has not been explored. Therefore, we assessed clinical and research personnel’s experiences related to factors influencing recruitment of racial and ethnic minorities for cancer clinical trials. Methods: Ninety-one qualitative interviews were conducted at 5 U.S. cancer centers among 4 stakeholder groups: cancer center leaders, principal investigators, referring clinicians and research staff. Data analysis was conducted using a content analysis approach to generate themes from the transcribed interviews. Results: Five prominent themes emerged. 1) Recruitment interactions with potential minority participants were perceived to be challenging. 2) Potential minority participants were not perceived to be ideal study candidates. 3) A combination of clinic level barriers and negative perceptions of minority study participants led to providers withholding clinical trial opportunities from potential minority participants. 4) When clinical trial recruitment practices were tailored to minority patients, addressing research misconceptions to build trust was a common strategy. 5) For some respondents, race was perceived as irrelevant when screening and recruiting potential minority participants for clinical trials. Conclusions: Not only did some respondents view racial and ethnic minorities as less promising participants, some respondents reported withholding trial opportunities to minorities based on these perceptions. Some providers endorsed using tailored recruitment strategies while others eschewed race as a factor in trial recruitment. The presence of bias and stereotyping among clinical and research professionals recruiting for cancer clinical trials, should be considered when designing interventions to increase minority enrollment.