Abstract B15: Facilitators and barriers to clinical trials participation among Medicaid eligible Hispanic patients and their physicians in Arizona

Research has documented the historical under representation of racial/ethnic minority populations in clinical trials. This under representation limits our understanding of a wide range of biological, social, and cultural factors that influence health and reduces the generalizability of new treatments to these groups, possibly contributing to health disparities. The goal of this study was to gather data about barriers and facilitators to participation of Hispanics in clinical trials from the combined perspective of patients and their providers in Arizona. Focus groups were conducted with Hispanic Medicaid eligible patients (n=13) and Medicaid serving physicians (n=30). Two focus groups were conducted with patients, two with physicians that do not recruit or refer patients to clinical trials, and two with physicians that do recruit or refer patients to clinical trials. Transcribed focus group interviews were read and reviewed by two of the researchers for themes and codes in a two-part process. First, a previously published conceptual model of factors affecting patient participation in clinical trials was revised and used to develop a set of themes and codes. And second, respondent transcripts were independently reviewed by two researchers and passages were thematically classified as they related to the patient and physician themes of awareness, attitudes, resources and opportunities. Participating Medicaid eligible Hispanic patients have a basic understanding of clinical trials. Most believe clinical trials lead to the development of more effective treatments and are open to participating in clinical trials research. The primary barrier to recruiting Hispanic patients to clinical trials does not appear to be negative patient attitudes toward clinical trials. Medicaid eligible Hispanic patients do not report the kind of mistrust of medical research experienced by African American patients. Language, time, and transportation barriers appear to be more significant obstacles to recruiting and referring Hispanic patients than mistrust. Physicians believe that their patients have little understanding of clinical trials, that desperation and financial need are the primary patient motivators for clinical trials participation, yet Hispanic patients are trusting and are generally willing to participate based on their physician's recommendation. Barriers to physician recruitment and referral of patients include: concern that study participation may not be in the patient's best interest, lack of staffing and time to conduct trials recruitment and referral activities, and lack of financial incentives to physicians for assisting in the recruitment/referral process. This is reflected in the approximately 11% of Arizona Medicaid primary care providers reporting that they recruit or refer patients to clinical trials. With so few primary care providers recruiting or referring patients to clinical trials, there are opportunities to engage more community physicians in both recruitment and referral activities.