The relationships among knowledge, self-efficacy, preparedness, decisional conflict, and decisions to participate in a cancer clinical trial

Background Cancer clinical trials (CCTs) are important tools in the development of improved cancer therapies; yet, participation is low. Key psychosocial barriers exist that appear to impact a patient's decision to participate. Little is known about the relationship among knowledge, self‐effica...

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Published in:	Psycho-oncology (Chichester, England) Vol. 22; no. 3; pp. 481 - 489
Main Authors:	Miller, S. M., Hudson, S. V., Egleston, B. L., Manne, S., Buzaglo, J. S., Devarajan, K., Fleisher, L., Millard, J., Solarino, N., Trinastic, J., Meropol, N. J.
Format:	Journal Article
Language:	English
Published:	Chichester, UK John Wiley & Sons, Ltd 01-03-2013 Wiley Subscription Services, Inc
Subjects:	Aged Cancer Cancer therapies Clinical trials Clinical Trials as Topic - psychology Conflict (Psychology) Decision Making Educational programmes Enrollment Female Health Knowledge, Attitudes, Practice Humans Knowledge Male Middle Aged Neoplasms - psychology Neoplasms - therapy Oncology Patient Education as Topic - methods Patient Selection preparation Self Efficacy Selfefficacy United States > US
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Summary:	Background Cancer clinical trials (CCTs) are important tools in the development of improved cancer therapies; yet, participation is low. Key psychosocial barriers exist that appear to impact a patient's decision to participate. Little is known about the relationship among knowledge, self‐efficacy, preparation, decisional conflict, and patient decisions to take part in CCTs. Objective The purpose of this study was to determine if preparation for consideration of a CCT as a treatment option mediates the relationship between knowledge, self‐efficacy, and decisional conflict. We also explored whether lower levels of decisional conflict are associated with greater likelihood of CCT enrollment. Method In a pre–post test intervention study, cancer patients (N = 105) were recruited before their initial consultation with a medical oncologist. A brief educational intervention was provided for all patients. Patient self‐report survey responses assessed knowledge, self‐efficacy, preparation for clinical trial participation, decisional conflict, and clinical trial participation. Results Preparation was found to mediate the relationship between self‐efficacy and decisional conflict (p = 0.003 for a test of the indirect mediational pathway for the decisional conflict total score). Preparation had a more limited role in mediating the effect of knowledge on decisional conflict. Further, preliminary evidence indicated that reduced decisional conflict was associated with increased clinical trial enrollment (p = 0.049). Conclusions When patients feel greater CCT self‐efficacy and have more knowledge, they feel more prepared to make a CCT decision. Reduced decisional conflict, in turn, is associated with the decision to enroll in a clinical trial. Our results suggest that preparation for decision‐making should be a target of future interventions to improve participation in CCTs. Copyright © 2012 John Wiley & Sons, Ltd.
Bibliography:	National Cancer Institute - No. R01 CA127655; No. K01 CA131500; No. P30CA06927 ark:/67375/WNG-26696D7R-W istex:5D8C2DA2FB5CF5EA0BD744E4D418A5DCB3C4ADC4 ArticleID:PON3043 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Evidence Based Healthcare-3 ObjectType-Feature-1
ISSN:	1057-9249 1099-1611
DOI:	10.1002/pon.3043