Barriers to Clinical Trial Enrollment in Racial and Ethnic Minority Patients with Cancer

TLDR

Clinical trials are essential for cancer treatment evaluation, yet most patients, especially racial and ethnic minorities, never enroll, reflecting complex multilevel barriers. The study proposes an evidence‑based intervention targeting individual and interpersonal barriers to increase minority enrollment in cancer trials. Using a multilevel model, the authors identified system, individual, and interpersonal barriers, examined their impact on doctor‑patient communication, and presented examples of interventions to address them. Interventions at each level show modest success, but multilevel approaches hold the greatest promise, suggesting future efforts should address barriers across multiple levels to boost minority enrollment.

Abstract

Clinical trials that study cancer are essential for testing the safety and effectiveness of promising treatments, but most people with cancer never enroll in a clinical trial - a challenge exemplified in racial and ethnic minorities. Underenrollment of racial and ethnic minorities reduces the generalizability of research findings and represents a disparity in access to high-quality health care.Using a multilevel model as a framework, potential barriers to trial enrollment of racial and ethnic minorities were identified at system, individual, and interpersonal levels. Exactly how each level directly or indirectly contributes to doctor-patient communication was also reviewed. Selected examples of implemented interventions are included to help address these barriers. We then propose our own evidence-based intervention addressing barriers at the individual and interpersonal levels.Barriers to enrolling a diverse population of patients in clinical trials are complex and multilevel. Barriers to enrolling a diverse population of patients in clinical trials are complex and multilevel. Interventions focused at each level have been relatively successful, but multilevel interventions have the greatest potential for success.To increase the enrollment of racial and ethnic minorities in clinical trials, future interventions should address barriers at multiple levels.