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Lower trial participation by culturally and linguistically diverse (CALD) cancer patients is largely due to language barriers
Author(s) -
Smith Allan ‘Ben’,
Agar Meera,
Delaney Geoff,
Descallar Joseph,
DobellBrown Kelsey,
Grand Melissa,
Aung Jennifer,
Patel Pinky,
Kaadan Nasreen,
Girgis Afaf
Publication year - 2018
Publication title -
asia‐pacific journal of clinical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.73
H-Index - 29
eISSN - 1743-7563
pISSN - 1743-7555
DOI - 10.1111/ajco.12818
Subject(s) - medicine , generalizability theory , confidence interval , clinical trial , logistic regression , odds ratio , culturally sensitive , family medicine , social psychology , psychology , developmental psychology
Aim Clinical trials play a critical role in advancing cancer care, but international research shows that few cancer patients, particularly culturally and linguistically diverse (CALD) patients, participate in trials. This limits generalizability of trial results and increases health disparities. This study aimed to establish rates and correlates of trial participation among CALD patients in South Western Sydney Local Health District (SWSLHD), a highly culturally diverse area. Methods Data from all cancer patients diagnosed and/or treated in SWSLHD from January 2006 to July 2016 were analyzed retrospectively. The primary outcome was trial enrolment among patients born in non‐English speaking countries (CALD) versus English speaking countries (non‐CALD). Multivariable logistic regression evaluated CALD status as a predictor of trial participation. Moderators of trial participation by the different CALD groups, namely those whose preferred language was English (CALD‐PLE) or was not English (CALD‐PLNE), were examined by testing interactions between CALD status and other demographic and clinical variables. Results A total of 19 453 patients were analyzed (54.9% non‐CALD, 16.5% CALD‐PLE, 18.5% CALD‐PLNE). Overall, 7.4% of patients were enrolled in a trial. Trial participation was significantly lower in CALD patients than non‐CALD patients (5.7% vs 8.4%; odds ratio [OR] = 0.80; 95% confidence interval [CI], 0.69–0.91; P = 0.001). CALD‐PLNE patients were less likely to participate in trials than non‐CALD (OR = 0.45; 95% CI, 0.36–0.56; P < 0.0001) and CALD‐PLE patients (OR = 0.53; 95% CI, 0.67–0.41; P < 0.0001). Conclusions Limited English proficiency seems particularly unfavorable to trial participation. Development and evaluation of strategies to overcome language barriers (e.g. simplified and translated multimedia participant information materials) is needed.