Lee Guek Eng, Ow Mandy, Lie Desiree, Dent Rebecca
National Cancer Centre Singapore, 11, Hospital drive, Postal code 169610, Singapore, Singapore.
Duke-NUS Graduate Medical School, Singapore, Singapore.
BMC Womens Health. 2016 Jul 22;16:43. doi: 10.1186/s12905-016-0319-1.
Recruitment rates for cancer trials are low for racial/ethnic minorities. Little is known about factors influencing trial recruitment in Asian patients. Our aim is to examine the barriers and facilitators for participation in trials among multi-ethnic Asian women with breast cancer.
We recruited a convenience sample from consecutive women seen at the National Cancer Centre. Two experienced bilingual (English and Chinese) moderators conducted focus groups to theme saturation. The question guide incorporated open-ended questions soliciting opinions about trial participation and knowledge. Women were first asked if they were willing, unwilling, or still open to participate in future trials. Sessions were audiotaped and transcribed. Transcripts were independently coded for emergent themes.
Sixteen of 103 women approached participated in five focus groups. Chinese, Malay, and Indian participants aged 29 to 69 represented different cancer stages. Five had no prior knowledge of trials. We identified three major themes comprising of 22 minor themes for barriers and facilitators. The major themes were: 1) patient-related, 2) trial-related, and 3) sociocultural factors. Women willing to join trials expressed themes representing facilitators (better test therapy, cost-effective profile, or trust in doctors and local healthcare systems). Women unwilling to participate expressed themes associated with barriers, while women still open to participation expressed themes representing both facilitators and barriers. Malay women were more likely to express themes related to 'fatalism' as a barrier.
DISCUSSION/CONCLUSION: We found that facilitators and barriers to trial participation among Asian women were similar to those previously reported in Western women. Knowledge of trials is limited among women receiving breast cancer treatment. Unique sociocultural factors suggest that approaches customised to local and community beliefs are needed to improve trial participation in minority groups.
癌症试验中种族/族裔少数群体的招募率较低。关于影响亚洲患者试验招募的因素知之甚少。我们的目的是研究多民族亚洲乳腺癌女性参与试验的障碍和促进因素。
我们从国立癌症中心连续就诊的女性中招募了一个便利样本。两名经验丰富的双语（英语和中文）主持人进行焦点小组讨论，直至主题饱和。问题指南包含开放式问题，征求关于试验参与和知识的意见。首先询问女性是否愿意、不愿意或仍对参与未来试验持开放态度。会议进行录音和转录。对转录本独立编码以确定新出现的主题。
103名被邀请的女性中有16名参加了5个焦点小组。年龄在29至69岁之间的华裔、马来裔和印度裔参与者代表了不同的癌症阶段。5人此前对试验一无所知。我们确定了三个主要主题，包括22个关于障碍和促进因素的次要主题。主要主题为：1）患者相关，2）试验相关，3）社会文化因素。愿意参加试验的女性表达了代表促进因素的主题（更好的测试治疗、性价比或对医生和当地医疗系统的信任）。不愿意参加的女性表达了与障碍相关的主题，而仍对参与持开放态度的女性表达了代表促进因素和障碍的主题。马来女性更有可能表达与“宿命论”相关的障碍主题。
讨论/结论：我们发现亚洲女性参与试验的促进因素和障碍与此前西方女性报告的相似。接受乳腺癌治疗的女性对试验的了解有限。独特的社会文化因素表明，需要根据当地和社区信仰定制方法，以提高少数群体的试验参与率。
