Terrance L. Albrecht

Cancer clinical trials are essential for testing new treatments and represent state-of-the-art cancer treatment, but only a small percentage of patients ever enroll in a trial. Under-enrollment is an even greater problem among minorities, particularly African Americans, representing a racial/ethnic disparity in cancer care. One understudied cause is patient-physician communication, which is often of poor quality during clinical interactions between African-American patients and non-African-American physicians. Partnering Around Cancer Clinical Trials (PACCT) involves a transdisciplinary theoretical model proposing that patient and physician individual attitudes and beliefs and their interpersonal communication during racially discordant clinical interactions influence outcomes related to patients’ decisions to participate in a trial. The overall goal of the study is to test a multilevel intervention designed to increase rates at which African-American and White men with prostate cancer make an informed decision to participate in a clinical trial. Data collection will occur at two NCI-designated comprehensive cancer centers. Participants include physicians who treat men with prostate cancer and their African-American and White patients who are potentially eligible for a clinical trial. The study uses two distinct research designs to evaluate the effects of two behavioral interventions, one focused on patients and the other on physicians. The primary goal is to increase the number of patients who decide to enroll in a trial; secondary goals include increasing rates of physician trial offers, improving the quality of patient-physician communication during video recorded clinical interactions in which trials may be discussed, improving patients’ understanding of trials offered, and increasing the number of patients who actually enroll. Aims are to 1) determine the independent and combined effects of the two interventions on outcomes; 2) compare the effects of the interventions on African-American versus White men; and 3) examine the extent to which patient-physician communication mediates the effect of the interventions on the outcomes. PACCT has the potential to identify ways to increase clinical trial rates in a diverse patient population. The research can also improve access to high quality clinical care for African American men bearing the disproportionate burden of disparities in prostate and other cancers. Clinical Trials.gov registration number: NCT02906241 (September 8, 2016).

Health and healthcare disparities are well documented across many diseases and conditions. Not surprisingly, disparities also exist in the context of palliative care, placing a particular burden on members of racial and ethnic minority groups. This chapter describes patterns of disparities that have been documented in various palliative care domains, including the use of services, geographic or medical settings, pain management, disenrollment from hospice, and advance directives. Although most research is on African American, Hispanic, and Asian adults, the chapter also reviews the limited research on additional ethnic groups and on children. The chapter also proposes a conceptual model to discuss the multiple and multilevel factors that contribute to these disparities, including societal, hospital, and provider; patient-provider interpersonal communication; and patient and family factors, and describes current research limitations and makes recommendations for future research. Communication interventions and strategies that may reduce or eliminate palliative care disparities are suggested.

The authors examine the intersection between theory and research on prosocial behavior and cancer research involving human participants in clinical trials. They begin with a discussion of the problem that is the focus of the chapter—very low rates of patient participation in clinical trials. The authors then propose that both patients’ decision to participate in such trials and oncologists’ decisions to ask patients to participate represent prosocial actions. They use Penner et al.’s (2005) multilevel framework for the analysis of prosocial actions to examine patient decisions about participation in cancer clinical trials. Specifically, at the micro level of analysis, they examine the role of personality traits in patient decisions about participation. At the meso level, they examine how interpersonal variables (e.g., perceptions of and feelings about the oncologist) affect these decisions. Finally, they consider whether a macro level of analysis, which involves helping in group rather than an interpersonal context, might provide a useful framework for understanding patient motives for participation in a clinical trial. A similar framework is used to examine physician decisions about asking a patient to participate in clinical trial. A discussion of potential future directions for research concludes, including both basic research on motives for participation and applied research intended to increase the rates of patient participation in clinical trials.

Objective. This study used the Ottawa Decision Support Framework to evaluate a model examining associations between clinical trial knowledge, attitudinal barriers to participating in clinical trials, clinical trial self-efficacy, and clinical trial preparedness among 1256 cancer patients seen for their first outpatient consultation at a cancer center. As an exploratory aim, moderator effects for gender, race/ethnicity, education, and metastatic status on associations in the model were evaluated. Methods. Patients completed measures of cancer clinical trial knowledge, attitudinal barriers, self-efficacy, and preparedness. Structural equation modeling (SEM) was conducted to evaluate whether self-efficacy mediated the association between knowledge and barriers with preparedness. Results. The SEM explained 26% of the variance in cancer clinical trial preparedness. Self-efficacy mediated the associations between attitudinal barriers and preparedness, but self-efficacy did not mediate the knowledge-preparedness relationship. Conclusions. Findings partially support the Ottawa Decision Support Framework and suggest that assessing patients’ level of self-efficacy may be just as important as evaluating their knowledge and attitudes about cancer clinical trials.

BRCA 1/BRCA2 founder mutations have been documented among Ashkenazi Jews. Little is known about cancer rates and cancer-related health behaviors among an insular subset of this population, Orthodox Jews. The goal of this study was estimate the risk of breast and ovarian among the Orthodox Jewish population. We used geo-coding with surveillance, epidemiology, and end results (SEER) data to identify this subgroup and estimate breast and ovarian cancer rates. Relative to neighborhoods with lower estimated Jewish populations, higher breast cancer rates were found in neighborhoods with higher estimated Orthodox Jewish population, there were no comparable differences in ovarian cancer rates. Implications include more research on health behaviors that may contribute to breast cancer in this insular community.

This essay focuses on a particular kind of caregiving--parents caring for children who have pediatric cancer. Pediatric cancer requires extensive and costly involvement from the parents of the children, especially during the invasive and highly stressful treatments that are required to treat the disease. We view this caregiving as an example of a costly long-term investment and examine the causes and the consequences of differences in parents’ motives to engage in such actions. We have found that positively- valenced empathic responses ( i.e.,” empathic concern”) among parents immediately before treatments were associated with children experiencing less pain and distress during treatments, possibly because of how high empathic concern parents communicate with their children. Drawing on Selective Investment Theory we posit that empathic concern is an emotion regulating state that is coordinated by the social bonds proposed in the theory. That is, when parents are faced with a costly long-term investment, the emotions associated with empathic concern may serve to resolve the caregiving conflict between selfish and altruistic motives in favor of the latter. We also have found that children who are resilient and cope well with stressors elicit the highest levels empathic concern from their parents. Drawing on the concept of inclusive fitness, we suggest because parents who experience high levels of empathic concern are more effective helpers; this confers additional benefits on already resilient and adaptive children. This, in turn, increases the likelihood that the genetic characteristics associated with such altruistic behaviors will be present among the descendants of these caregivers. We present some preliminary data to support this argument.

Much cancer-related health communication research has involved studies of the effects of media campaigns and strategies on secondary prevention. Cancer diagnosis rates, however, continue to affect millions of people. The need exists for communication studies to address the quality of the clinical interaction, the point of actual care delivery in addressing diagnosis, treatment, and survivorship. Using examples from a 6-year communication and behavioral oncology research program established at the Karmanos Cancer Institute (KCI) in Detroit, Michigan, we describe selected empirical issues; models, particularly the “convergence model” (adapted from Rogers & Kincaid, 1981 Rogers , E. , & Kincaid , D. L. ( 1981 ). Communication networks: A paradigm for new research . New York : Free Press . [Google Scholar] ); and associated constructs that are relevant and promising foundations for building future research in cancer clinical settings. Two examples from our empirical research program are described.