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

S. M. Miller, S. V. Hudson, B. L. Egleston, S. Manne, J. S. Buzaglo, K. Devarajan, L. Fleisher, J. Millard, N. Solarino, J. Trinastic, N. J. Meropol

Research output: Contribution to journalReview articlepeer-review

39 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)481-489
Number of pages9
JournalPsycho-Oncology
Volume22
Issue number3
DOIs
StatePublished - Mar 2013

All Science Journal Classification (ASJC) codes

  • Experimental and Cognitive Psychology
  • Oncology
  • Psychiatry and Mental health

Keywords

  • cancer
  • clinical trials
  • decision-making
  • oncology
  • preparation
  • self-efficacy

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