Barriers and facilitators to mexican-american participation in clinical trials: physician and patient focus group perspectives
Jesse Nodora, Tomas Nuño, Ken O’Day, Virginia Yrun, Francisco Garcia
DOI: 10.4236/health.2010.27113   PDF    HTML     5,164 Downloads   9,775 Views   Citations


Racial/ethnic minority populations are under- represented in clinical trials and Hispanic participation rates are particularly low. This study assessed barriers and facilitators to clinical trials participation by Medicaid eligible Mexican- Americans and their serving physicians. Qualitative data from two focus groups conducted among Mexican-American Medicaid eligible patients and four physician focus groups were analyzed. Mexican-American patients have a basic understanding of clinical trials. While most are open to participating in clinical research, not speaking English, time, and transportation were identified as barriers. Physicians believe that desperation and financial need are the primary patient motivators for participation. Barriers to physician recruitment and referral include: lack of information about clinical trials, concern that study participation may not be in the patient’s best interest, and lack of staffing and time to conduct trials. Ample opportunities exist to engage providers and patients in future efforts to increase Mexican-American patient recruitment into clinical trials.

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Nodora, J. , Nuño, T. , O’Day, K. , Yrun, V. and Garcia, F. (2010) Barriers and facilitators to mexican-american participation in clinical trials: physician and patient focus group perspectives. Health, 2, 742-752. doi: 10.4236/health.2010.27113.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Applied Clinical Trials (2004) Subject recruitment by far biggest clinical trial concern. Applied Clinical Trials,
[2] Ford, J.G., Howerton, M.W., Lai, G.Y., Gary, T.L., Bolen, S., Gibbons, M.C., Tilburt, J., Baffi, C., Tanpitukpongse, T.P., Wilson, R.F., Powe, N.R. and Bass, E.B. (2008) Barriers to recruiting underrepresented populations to cancer clinical trials: A systematic review. Cancer, 112(2), 228-242.
[3] Institute of Medicine (1999) The Unequal Burden of Cancer: An Assessment of NIH Research and Programs for Ethnic Minorities and the Medically Underserved. National Academic Press, Washington, D.C.
[4] Kagawa-Singer, M. (2000) Improving the validity and generalizability of studies with underserved U.S. popula- tions expanding the research paradigm. Annals of Epidemiology, 10(8), S92-103.
[5] U.S. department of Health and Human Services NIH Policy and Guidelines on The Inclusion of Women and Minorities as Subjects in Clinical Research–Amended, (2001) guidelines_amended_10_2001.htm
[6] Ford, J.G., Howerton, M.W., Bolen, S., Gary, T.L., Lai, G.Y., Tilburt, J., Gibbons, M.C., Baffi, C., Wilson, R.F., Feuerstein, C.J., Tanpitukpongse, P., Powe, N.R. and Bass, E.B. (2005) Knowledge and access to information on recruitment of underrepresented populations to cancer clinical trials. Evidence Report/Technology Assessment, 1-11.
[7] Adams-Campbell, L.L., Ahaghotu, C., Gaskins, M., Daw- kins, F.W., Smoot, D., Polk, O.D., Gooding, R. and DeWitty, R.L. (2004) Enrollment of African Americans onto clinical treatment trials: Study design barriers. Journal of Clinical Oncology, 22(4), 730-734.
[8] Sateren, W.B., Trimble, E.L., Abrams, J., Brawley, O., Breen, N., Ford, L., McCabe, M., Kaplan, R., Smith, M., Ungerleider, R. and Christian, M.C. (2002) How sociode- mographics, presence of oncology specialists, and hospi- tal cancer programs affect accrual to cancer treatment tri- als. Journal of Clinical Oncology, 20(8), 2109-2117.
[9] Comis, R.L.A.C., Stovall, E., Krebs, L., Risher, P. and Taylor, H. (2000) A quantitative survey of public attitudes towards cancer clinical trials. In Proceedings of the American Society of Clinical Oncology, 19, 1728-1733.
[10] Ramirez, A.G., Wildes, K., Talavera, G., Napoles-Spri- nger, A., Gallion, K. and Perez-Stable, E.J. (2008) Clinical trials attitudes and practices of Latino physicians. Contemporary Clinical Trials, 29(4), 482-492.
[11] Howerton, M.W., Gibbons, M.C., Baffi, C.R., Gary, T.L., Lai, G.Y., Bolen, S., Tilburt, J., Tanpitukpongse, T.P., Wilson, R.F., Powe, N.R., Bass, E.B. and Ford, J.G. (2007) Provider roles in the recruitment of underrepresented populations to cancer clinical trials. Cancer, 109(3), 465- 476.
[12] Office of Management and Budget (1995) Standards for Classification of Federal Data on Race and Ethnicity.
[13] U.S. Census Bureau (2004) U.S. Interim Projections by Age, Sex, Race, and Hispanic Origin.
[14] Pew Hispanic Center (2009) Statistical Portrait of His- panics in the United States, 2007, Table 5 Detailed His- panic Origin: 2007.
[15] Pew Hispanic Center (2009) Mexican Immigrants in the United States, 2008.
[16] Current Population Survey Annual Social and Economic Supplement (2006) U.S. Hispanic Population: 2006.
[17] Livingston, G, M.S., Cohn, D’Vera, (2008) Hispanics and Health Care in the United States: Access, Information and Knowledge. Pew Hispanic Center and Robert Wood Johnson Foundation.
[18] Markman, M., Petersen, J. and Montgomery, R. (2008) An examination of the influence of patient race and ethnicity on expressed interest in learning about cancer clinical trials. Journal of Cancer Research and Clinical Oncology, 134(1), 115-118.
[19] Wendler, D., Kington, R., Madans, J., Van Wye, G., Christ-Schmidt, H., Pratt, L.A., Brawley, O.W., Gross, C.P. and Emanuel, E. (2006) Are racial and ethnic minorities less willing to participate in health research? PLoS Medicine, 3(2), e19.
[20] Washington, H. (2007) Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present. Doubleday, New york.
[21] Advani, A.S., Atkeson, B., Brown, C.L., Peterson, B.L., Fish, L., Johnson, J.L., Gockerman, J.P. and Gautier, M. (2003) Barriers to the participation of African-American patients with cancer in clinical trials: A pilot study. Can- cer, 97(6), 1499-1506.
[22] Corbie-Smith, G., Thomas, S.B., Williams, M.V. and Moody-Ayers, S. (1999) Attitudes and beliefs of African Americans toward participation in medical research. Journal of General Internal Medicine, 14(9), 537-546.
[23] Freimuth, V.S., Quinn, S.C., Thomas, S.B., Cole, G., Zook, E. and Duncan, T. (2001) African Americans’ views on research and the Tuskegee Syphilis Study. Social Science & Medicine, 52(5), 797-808.
[24] Mouton, C.P., Harris, S., Rovi, S., Solorzano, P. and Johnson, M.S. (1997) Barriers to black women’s participation in cancer clinical trials. Journal of the National Medical Association, 89(11), 721-727.
[25] Jerant, A., Arellanes, R. and Franks, P. (2008) Health status among US Hispanics: Ethnic variation, nativity, and language moderation. Medical Care, 46(7), 709-717.
[26] DeNavas-Walt, C. and Bernadete P. (2008) Income, Poverty, and Health Insurance Coverage in the United States: 2007, Census Bureau, Current Population Reports, Ed. Government Printing Office, W., DC, pp. 60-235.
[27] Kim, S.Y., Millard, R.W., Nisbet, P., Cox, C. and Caine, E.D. (2004) Potential research participants’ views regarding researcher and institutional financial conflicts of interest. Journal of Medical Ethics, 30(1), 73-79.
[28] Embi, P.J., Jain, A., Clark, J., Bizjack, S., Hornung, R. and Harris, C.M. (2005) Effect of a clinical trial alert system on physician participation in trial recruitment. Archives of Internal Medicine, 165(9), 2272-2277.
[29] Embi, P.J., Jain, A. and Harris, C.M. (2008) Physicians’ perceptions of an electronic health record-based clinical trial alert approach to subject recruitment: A survey. BMC Medical Informatics & Decision Making, 8(13), 1-8.
[30] Tam, J.T.H.R., Gura, D., Paraghamian, A., Thomas, H. and Lichtman, S. (2006) Has demand outpaces supply for clinical trial participants? ASCO Annual Meeting Proceedings Part I; 24 (18S), 6016.
[31] Robinson, J.M. and Trochim, W.M. (2007) An examination of community members’, researchers’ and health professsionals’ perceptions of barriers to minority participation in medical research: An application of concept mapping. Ethn Health, 12(5), 521-539.

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