Clinical trial skepticism influenced by political ideology

Abstract

Approximately 1 in 4 people believe that clinical trials should be approached with suspicion according to data recently published in JAMA Network Open, with political ideology appearing to influence levels of skepticism.¹

Onyema G. Chido-Amajuoyi, MD, MPH, a hematology/oncology fellow at the University of Washington in Seattle, and his colleagues published data from a cross-sectional study evaluating associations between political ideology and clinical trial skepticism.

Data were taken from the National Cancer Institute’s publicly available Health Information National Trends Survey 7, which included 6377 responders, 1009 of whom were cancer survivors. Participants used a Likert scale to respond to the statement “People should be suspicious of clinical trials,” and 27.2% agreed.

Ruth O’Regan, MD, chair of the Department of Medicine at the University of Rochester in New York, says that she was not surprised that more than one fourth of responders expressed skepticism.

“Across therapeutic cancer clinical trials, only 10% or fewer patients enroll,” Dr O’Regan says. “The reasons are multifactorial, but some is skepticism from the patients and their families. We as physicians should do a better job communicating the benefit of clinical trials to patients.”

Among the respondents, 37.6% identified as moderate, 30.5% identified as liberal, and 31.9% identified as conservative. Compared with those who neither agreed nor disagreed with the study statement, those who identified as conservative were more likely to agree that people should be suspicious of clinical trials than liberals (adjusted odds ratio [aOR], 1.30; 95% CI, 1.10–1.54) or moderates (aOR, 1.43; 95% CI, 1.22–1.67).

In addition, those who identified as liberal were more likely than moderates to disagree that people should be suspicious of clinical trials (aOR, 1.98; 95% CI; 1.70–2.31).

Similar trends were seen among respondents who were cancer survivors.

The study researchers called the implications of these data both “pragmatic and urgent.”

“If political ideology influences receptivity to clinical trials, recruitment strategies that overlook ideological diversity risk biased enrollment and underrepresentation,” Dr Chido-Amajuoyi and his colleagues wrote. “Prior research demonstrates disparities in clinical trial participation by political orientation. Recognizing political ideology as a factor in medical mistrust may help reduce participation barriers and improve representativeness.”

Although Dr O’Regan says that the trends related to political ideology in this study were also not surprising, she is not sure how this information could be used in the clinic.

“How do you determine if someone is liberal or conservative?” Dr O’Regan says. “In fact, we tend to steer away from talking about politics in the clinic.”

Instead, Dr O’Regan suggests that clinicians focus on tactics for enrolling patients into clinical trials that address any level of skepticism.

“I typically find that you can tell early on whether or not a patient is skeptical about clinical trials or not,” Dr O’Regan says. “If they are, you can spend more time going through trial details and reassuring them that they are at the least going to be receiving the standard of care, and that they can make the decision to come off the trial whenever they want.”