Valentino J, Andrykowski M A, Wood T A
Division of Otolaryngology, University of Kentucky Chandler Medical Center, Lexington, USA.
J Ky Med Assoc. 1999 Mar;97(3):111-7.
We examined the attitudes of the Kentucky adult population toward experimental oncology treatment and randomized clinical oncology trials.
We conducted a health survey of 654 noninstitutionalized adults randomly selected from Kentucky households. We posed to them a series of questions evaluating demographics, general health, and personality characteristics. We asked specific questions to characterize the subjects' experiences with cancer, their desires for autonomy in medical treatment, their health-related behaviors, and their preconceived opinions about specific cancer screening examinations. We then asked the subjects about their willingness to undergo experimental treatment and their willingness to participate in a randomized clinical oncology trial within the framework of a defined, specific oncology scenario.
Of our subjects, 73% were willing to consider an experimental form of therapy of indeterminate benefit; however, only 39% were willing to consider a randomized clinical trial of two therapies, given the same oncology scenario. The influences of demographic factors, general health, personality factors, personal experience with cancer, and desire for autonomy in health care were found to be of minimal importance in predicting a willingness to participate.
A strong negative bias toward randomized clinical trials appears to exist within this population. Continued public education regarding the value of clinical trials to the individual, as well as their selfless benefit to humanity, is clearly needed.
我们研究了肯塔基州成年人群对肿瘤实验性治疗和随机肿瘤临床试验的态度。
我们对从肯塔基州家庭中随机选取的654名非机构化成年人进行了一项健康调查。我们向他们提出了一系列评估人口统计学、总体健康状况和性格特征的问题。我们还询问了一些具体问题,以了解受试者患癌症的经历、他们在医疗中对自主权的渴望、他们的健康相关行为以及他们对特定癌症筛查检查的先入之见。然后,我们在一个明确的、特定的肿瘤学场景框架内,询问受试者接受实验性治疗的意愿以及参与随机肿瘤临床试验的意愿。
在我们的受试者中,73%愿意考虑一种益处不确定的实验性治疗方式;然而,在相同的肿瘤学场景下,只有39%愿意考虑两种治疗方法的随机临床试验。研究发现,人口统计学因素、总体健康状况、性格因素、个人患癌经历以及对医疗自主权的渴望,在预测参与意愿方面的影响极小。
该人群中似乎对随机临床试验存在强烈的负面偏见。显然需要持续对公众进行关于临床试验对个人的价值以及它们对人类无私益处的教育。