African American participation in clinical trials: Voices of physicians who refer and participants who enroll

Logan R Thornton, The University of Texas School of Public Health


Researchers' ability to draw scientifically sound conclusions about the effectiveness of experimental medications tested in clinical trials is hampered when study volunteers are not racially and ethnically diverse. In particular, trials may be held up to scrutiny about the applicability of study findings if study volunteers do not represent the disease burden in the community. Minority participation in clinical trials is a significant challenge. African Americans are a significant minority group that experiences a significant disease burden across many cancers, heart disease, stroke and respiratory illnesses. Much is reported in the body of literature on barriers to participation but less well known are factors that contribute to their enrollment, if and how these factors work together, and whether a physician recommendation played a role in the decision-making process. We conducted our empirical work with physicians who are a part of the National Medical Association, a professional member organization with the aim to support the interests of African American physicians. Twenty-three semi-structured interviews revealed three major themes: educating, reassuring, and recommending communication approaches employed to facilitate trial referrals; physician preferences for only referring compliant patients to trials; and perceived similarities between patient and provider on demographics, culture or background facilitates trust and referrals. A similar process was employed to determine which facilitators, including physician referral, exist for African American patients. Personal benefits, a desire to change the disease trajectory in the African American community, and staff characteristics were communicated to us as facilitating factors for participation. We learned the importance of clear communication that is relevant to the African American community in referring racially concordant participants to clinical trials; that peer recommendation influences participants to enroll in observational trials rather than physician recommendation; and that studies perceived as genuinely impacting the African American community in the way of disease or risk reduction are attractive to participants in part because of a shared identity and commitment among African American physicians who suggest the clinical trial and among family and peers who are affected by the target disease.

Subject Area

African American Studies|Public health

Recommended Citation

Thornton, Logan R, "African American participation in clinical trials: Voices of physicians who refer and participants who enroll" (2014). Texas Medical Center Dissertations (via ProQuest). AAI3645219.