Differences in rural and urban patient perceptions of facilitative factors for cancer clinical trial participation.

BACKGROUND

Rural populations are underrepresented within cancer clinical trials. Lower enrollment may exacerbate disparities in rural and urban health outcomes. Although research on the patient-related facilitators of clinical trial participation has been conducted, rural populations have limited representation within this research. The present study aims to understand the factors that influence clinical trial participation in rural compared to urban cancer patients.

METHODS

We conducted semi-structured interviews with rural (n = 15) and urban (n = 15) cancer patients currently enrolled in an active treatment clinical trial. The participants were recruited from the University of Vermont Cancer Center and affiliated Central Vermont Medical Center. Rural was defined using the Rural-Urban Commuting Area Codes (rural ≥ 4). The interviews included closed- and open-ended questions. Closed-ended questions were analyzed quantitatively, and qualitative themes were extracted from open-ended questions.

RESULTS

Although rural and urban patients rated the quantitatively measured factors similarly, differences were found within the qualitative themes. Personal transportation and a free, local lodging option were more essential for rural patients. Similarly, all patients benefited from well-coordinated appointments, but rural patients especially appreciated when cancer-related visits were coordinated with non-cancer ones. Rural patients also tended to prefer in-person contact with their healthcare team. Urban patients more often noted enrolling in trials to advance treatment for future patients or receive additional services themselves.

CONCLUSIONS

Our findings indicate that the structure and systems of clinical trials may improve care coordination experiences above and beyond treatment as usual. All patients benefit from care coordination, but it is especially important for rural patients who often experience fragmented care. Planning for coordinated appointments, travel logistics, and in-person communication may increase rural patient participation in clinical trials.