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

J Clin Oncol. 2008 Jun 1;26(16):2666-73. doi: 10.1200/JCO.2007.14.8114.


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.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Clinical Trials as Topic / psychology*
  • Communication*
  • Decision Making*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasms / therapy
  • Patient Participation / psychology*
  • Physician-Patient Relations*