Semantic Barriers to Cancer Clinical Trials Accrual

Although the reasons for lack of participation in clinical trials by underserved populations is complex, the use of technical language to explain clinical trials has been identified as a contributing factor to reduced intention to participate in trials (Valentino, Andrykowski, Wood, 1999). Often, health professionals and investigators use gambling metaphors to assist low-literacy audiences with their understanding of these technical terms. However, these metaphors may connotate "gambling with life" and be perceived as frightening to lay audiences. This study proposes to advance knowledge in this area by addressing the following research questions: 1. What are appropriate metaphors for describing clinical trials concepts (e.g., randomization) to medically underserved populations? 2. Will CT messages perceived as being low-threat be associated with stronger intentions to participate in CT than will high-threat messages? The specific aims of this proposal are to: (1) assess the response to metaphors currently in use and to identify appropriate metaphors for clinical trials concepts for rural, low-income Appalachians through formative research, and (2) examine whether clinical trials metaphors with higher efficacy and less fear are more effective with low-income, rural Appalachians. The first specific aim will be accomplished through focus groups with low-income Appalachian adults. The second specific aim will be accomplished by measuring self-reported fear and physiological arousal of low-income, rural Appalachians to various clinical trials metaphors. This pilot research project will provide initial data to examine whether these findings are applicable to other medically underserved audiences (I.e., racial and ethnic minority groups), as well as contribute to the development of evidence-based communication techniques for referring and recruiting Appalachian populations to clinical trials.