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Supportive Care in Cancer
Published in: Supportive Care in Cancer 4/2015

01-04-2015 | Review Article

Cancer patient decision making related to clinical trial participation: an integrative review with implications for patients’ relational autonomy

Authors: Jennifer A. H. Bell, Lynda G. Balneaves

Published in: Supportive Care in Cancer | Issue 4/2015

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Abstract

Purpose

Oncology clinical trials are necessary for the improvement of patient care as they have the ability to confirm the efficacy and safety of novel cancer treatments and in so doing, contribute to a solid evidence base on which practitioners and patients can make informed treatment decisions. However, only 3–5 % of adult cancer patients enroll in clinical trials. Lack of participation compromises the success of clinical trials and squanders an opportunity for improving patient outcomes. This literature review summarizes the factors and contexts that influence cancer patient decision making related to clinical trial participation.

Methods

An integrative review was undertaken within PubMed, CINAHL, and EMBASE databases for articles written between 1995 and 2012 and archived under relevant keywords. Articles selected were data-based, written in English, and limited to adult cancer patients.

Results

In the 51 articles reviewed, three main types of factors were identified that influence cancer patients’ decision making about participation in clinical trials: personal, social, and system factors. Subthemes included patients’ trust in their physician and the research process, undue influence within the patient-physician relationship, and systemic social inequalities. How these factors interact and influence patients’ decision-making process and relational autonomy, however, is insufficiently understood.

Conclusions

Future research is needed to further elucidate the sociopolitical barriers and facilitators of clinical trial participation and to enhance ethical practice within clinical trial enrolment. This research will inform targeted education and support interventions to foster patients’ relational autonomy in the decision-making process and potentially improve clinical trial participation rates.
Appendix
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Footnotes
1
It is not clear in many of these studies whether physicians informing patients about CTs were treating physicians or physician-investigators. This difference may have important implications for patients’ relational autonomy. For example, the dual role of physician-investigators may impact the trust patients have in these physicians and the way in which information was provided, since physician-investigators could have secondary interests that conflict with the patient’s best interest.
 
2
Clinical equipoise means there is genuine uncertainty in the expert medical community about whether a treatment will be beneficial [82].
 
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Metadata
Title
Cancer patient decision making related to clinical trial participation: an integrative review with implications for patients’ relational autonomy
Authors
Jennifer A. H. Bell
Lynda G. Balneaves
Publication date
01-04-2015
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 4/2015
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-014-2581-9

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