Influence of clinical communication on patients' decision making on participation in clinical trials

Purpose To investigate how communication among physicians, patients, and family/companions influences patients' decision making about participation in clinical trials. Patients and Methods We video recorded 235 outpatient interactions occurring among oncologists, patients, and family/companions ( if present) at two comprehensive cancer centers. We combined interaction analysis of the real-time video-recorded observations ( collected at Time 1) with patient self-reports ( Time 2) to determine how communication about trial offers influenced accrual decisions. Results Clinical trials were explicitly offered in 20% of the interactions. When offers were made and patients perceived they were offered a trial, 75% of patients assented. Observed messages ( at Time 1) directly related to patients' self-reports regarding their decisions ( 2 weeks later), and how they felt about their decisions and their physicians. Specifically, messages that help build a sense of an alliance ( among all parties, including the family/companions), provide support ( tangible assistance and reassurance about managing adverse effects), and provide medical content in language that patients and family/companions understand are associated with the patient's decision and decision-making process. Conclusion In two urban, National Cancer Institute - designated comprehensive cancer centers, a large percentage of patients are not offered trials. When offered a trial, most patients enroll. The quality and quantity of communication occurring among the oncologist, patient, and family/ companion when trials are discussed matter in the patient's decision-making process. These findings can help increase physician awareness of the ways that messages and communication behaviors can be observed and evaluated to improve clinical practice and research.