Lung cancer patients' decisions about clinical trials and the theory of planned behavior

Our plain-English summary of Lung cancer patients' decisions about clinical trials and the theory of planned behavior, by G.P. Quinn, C.L. Pratt, K. Bryant-George, et al (Journal of Cancer Education, 2011).

The study

• Authors: G.P. Quinn, C.L. Pratt, K. Bryant-George, V.D. Caraway, B. Paternoster, T. Roldan, A. Shaffer, C.O. Shimizu, E.J. Vaughn, C. Williams, G. Bepler
• Journal: Journal of Cancer Education
• Published: 2011;26(4):641-8
• Cited by: 21 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The theory of planned behavior explores the relationship between behavior, beliefs, attitudes, and intentions presupposing that behavioral intention is influenced by a person's attitude about the behavior and beliefs about whether individuals, who are important to them, approve or disapprove of the behavior (subjective norm). An added dimension to the theory is the idea of perceived behavioral control, or the belief that one has control over performing the behavior. The theory of planned behavior suggests that people may make greater efforts to perform a behavior if they feel they have a high level of control over it. In this examination of data, we explored the application of the theory of planned behavior to patient's decisions about participating in a clinic trial. Twelve respondents in this study had previously participated in a clinical trial for lung cancer and nine respondents had declined a clinical trial for lung cancer. The data were analyzed with regard to the four constructs associated with the theory of planned behavior: behavioral intention, attitude, subjective norm, and perceived behavioral control. Results indicate that the theory of planned behavior may be a useful tool to examine psychosocial needs in relation to behavioral intention of clinical trial participation.

In plain English

This qualitative interview study at Moffitt Cancer Center in Tampa explored how people with lung cancer decided whether to join a treatment clinical trial. It did not study asbestos exposure. From June to November 2008 the authors interviewed 21 patients (10 women, 11 men, aged 42 to 84): 12 who had taken part in a trial and 9 who had declined one. The text says most had stage IV non-small cell lung cancer, but its table lists 10 of the 21 with that diagnosis; two had mesothelioma. The interviews were analyzed using the theory of planned behavior, which looks at attitudes, the views of important others, and sense of control. All patients described fear at diagnosis. Of the nine who declined, five cited transportation issues, two preferred standard treatment and two said their family did not support trial participation. All trial participants described trust in their physician or the cancer center as key. Both groups described having a choice of treatment as giving them a sense of control. The authors concluded the theory may be a useful tool for examining these decisions. They noted that qualitative results are not meant to be generalizable and that the study was retrospective.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Qualitative study using semistructured, open-ended interviews, analyzed by content analysis within the theory of planned behavior framework; the authors describe it as retrospective
• Who was studied: 21 thoracic cancer patients at Moffitt Cancer Center, Tampa, Florida, USA, interviewed June to November 2008. Of these, 12 had participated in a treatment clinical trial and 9 had been offered a trial but declined. They were 10 women and 11 men aged 42 to 84: 2 Asian, 12 White, 4 Black and 3 Hispanic. Patients were selected partly by diagnosis type, including mesothelioma. Table 2 lists 16 with non-small cell lung cancer (10 of them stage IV), 3 with small cell lung cancer and 2 with mesothelioma (stage III). The text says the majority had stage IV non-small cell lung cancer, but 10 of 21 is fewer than half.
• Exposure: No asbestos or other environmental or occupational exposure was studied. The subject was patients' decisions to accept or decline a treatment clinical trial.
• Main results:
  • Among the 9 patients who declined a trial, 5 cited transportation issues, 2 preferred standard treatment, and 2 said their family did not support clinical trial participation.
  • All patients reported fear as their initial reaction to the lung cancer diagnosis. Half of both the trial participants and the decliners said the health care professional who gave the diagnosis compounded those fears.
  • The majority of trial participants described a previous personal or family history of cancer that played a role in their decision. The decliners noted a lack of personal or familial cancer history.
  • All trial participants said trust in the physician or research facility was key. Most decliners also trusted their physician and the institution, but said family approval or reducing caregiver burden was ultimately more important.
  • All patients mentioned control during their interviews. The authors interpreted the findings as showing that having a choice of treatment gave patients an improved sense of control, whether or not they chose a trial.
  • The authors found no overt differences in responses by age, gender or ethnicity within this sample.
• The authors' conclusion: The authors concluded that the theory of planned behavior may be a useful tool for examining psychosocial needs in relation to the intention to participate in a clinical trial. They also concluded that attitudes about lung cancer, perceived support from physicians and family, and sense of control together resulted in accepting or declining a trial.
• Limitations the authors state:
  • Qualitative data are not meant to be generalizable, and the study was retrospective.
  • Results might have differed if patients had been followed prospectively from the time of diagnosis.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Lung Cancer, Clinical Trial.

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