Abstract
Representative enrollment in clinical trials is critical to ensure equitable and effective translation of research to practice, yet disparities in clinical trial enrollment persist. To examine person-level factors associated with invitation to and participation in clinical trials. This cross-sectional study analyzed responses from 3689 US adults who participated in the nationally representative Health Information National Trends Survey, collected February through June 2020 via mailed questionnaires. Demographic, clinical, and health behavior-related characteristics. History of invitation to and participation in a clinical trial, primary information sources, trust in information sources, and motives for participation in clinical trials were described. Respondent characteristics are presented as absolute numbers and weighted percentages. Associations between respondent demographic, clinical, and health behavior-related characteristics and clinical trial invitation and participation were estimated using survey-weighted logistic regression models. The median (IQR) age of the 3689 respondents was 48 (33-61) years, and most were non-Hispanic White individuals (2063 [59%]; non-Hispanic Black, 452 [10%]; Hispanic, 521 [14%]), had more than a high school degree (2656 [68%]), were employed (1809 [58%]), and had at least 1 medical condition (2535 [61%]). Overall, 439 respondents (9%) had been invited to participate in any clinical trial. Respondents with increased odds of invitation were non-Hispanic Black compared with non-Hispanic White (adjusted odds ratio [aOR], 1.85; 95% CI, 1.13-3.02), had greater than a high school education compared with less than high school education (eg, ≥college degree: aOR, 4.84; 95% CI, 1.89-12.39), were single compared with married or living as married (aOR, 1.68; 95% CI, 1.04-2.73), and had at least 1 medical condition compared to none (eg, 1 medical condition: aOR, 2.25; 95% CI, 1.32-3.82). Respondents residing in rural vs urban areas had 77% decreased odds of invitation to a clinical trial (aOR 0.33; 95% CI 0.17-0.65). Of invited respondents, 199 (47%) participated. Compared with non-Hispanic White respondents, non-Hispanic Black respondents had 72% decreased odds of clinical trial participation (aOR, 0.28; 95% CI, 0.09-0.87). Respondents most frequently reported "health care providers" as the first and most trusted source of clinical trial information (first source: 2297 [59%]; most trusted source: 2597 [70%]). The most frequently reported motives for clinical trials participation were "wanting to get better" (2294 [66%]) and the standard of care not being covered by insurance (1448 [41%]). The findings of this study suggest that invitation to and participation in clinical trials may differ by person-level demographic and clinical characteristics. Strategies toward increasing trial invitation and participation rates across diverse patient populations warrant further research to ensure equitable translation of clinical benefits from research to practice.
Highlights
Evidence-based evaluation of new health care treatments and interventions via clinical trials is critical for improving individual and population health
Respondents with increased odds of invitation were non-Hispanic Black compared with non-Hispanic White, had greater than a high school education compared with less than high school education, were single compared with married or living as married, and had at least 1 medical condition compared to none
Respondent factors associated with increased odds of reported clinical trial invitation included being non-Hispanic Black compared with non-Hispanic White, having some college education or a college degree or higher compared with less than high school education, being single compared with married or living as married, and having at least 1 more medical condition compared with none (1 condition: adjusted odds ratios (aOR), 2.25; 95% CI, 1.32-3.82; 2 conditions: aOR, 2.67; 95% CI, 1.56-4.57; Ն3: aOR, 3.76; 95% CI, 2.01-7.03) (Table 2)
Summary
Evidence-based evaluation of new health care treatments and interventions via clinical trials is critical for improving individual and population health. Previous research has shown that person-level factors, such as sociodemographic characteristics, may affect whether individuals are invited to participate in clinical trials, while motivations and beliefs may affect decisions to participate if invited.[9,10,11,12,13,14] Much of the existing literature on trials tends to be condition-specific, focused on participation rather than invitation, and specific to subpopulations of the US public. We describe respondent primary trial information sources, trust in information sources, and motives for participation in clinical trials to inform future efforts addressing disparities in clinical trial invitation and participation
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