Are those all my options? Evaluating oncologists' communication strategies in treatment and clinical trial discussions by race and gender.

PURPOSE

Increasing patient enrollment and promoting equity in trial participation are essential to improving cancer care outcomes. Physicians play a crucial role in decision-making, making it important to understand communication strategies used by oncologists when discussing treatment options, including clinical trial participation.

METHODS

This observational qualitative study was conducted from 2022 to 2023. We recruited US medical oncologists who treat colon cancer and have access to clinical trials. Oncologists participated in simulated telehealth encounters with standardized patients with colon cancer who identified as Black or white and were referred to discuss treatment options, including a potential clinical trial.

RESULTS

Of 107 academic physicians contacted, 47 (44%) responded, and 21 (20%) participated. The median age was 41, 43% female, and 33% non-white. Average encounter length was 44:05 minutes. One to four treatment options were discussed. Clinical trials were discussed in nearly all conversations. Average duration of clinical trial-related talk was 08:30 minutes. Conversations with Black female patients were significantly shorter than with white female patients (mean difference: 7 minutes). Recommendations varied with 9/21 oncologists recommending a clinical trial, 9/21 deferring a decision, and 3/21 recommending standard of care. In the post-encounter survey, 86% of oncologists said they recommended a trial but only 43% actually did so.

CONCLUSION

Oncologists' communication about treatment options may impact patients' decisions and trial participation. In our study, fewer than half of oncologists recommended a trial with variability in how options were presented and the length of discussion. There was also a misperception with more oncologists thinking they recommended a trial, but they did not in the encounter. A more structured approach to these complex discussions may help oncologists communicate treatment options to patients in a more equitable and effective way.