The Barriers and Enablers to Participation in Oncology Clinical Trials for Ethnically Diverse Communities: A Qualitative Systematic Review Using Metaethnography.
Lorraine Turner, Sally Taylor, Ashleigh Ward and 2 others
PMID 40106657WHAT IT FOUND
Patients and clinicians disagreed on why ethnic minorities avoid cancer trials.
Patients cited mistrust, family influence, and cost. Clinicians blamed patient reluctance and time pressures, often overlooking their own biases and the structural barriers in trial design.
Key findings
01Patients reported fear of being treated as a 'guinea pig' and mistrust rooted in historical medical abuse, while clinicians often attributed non-participation to patient reluctance or lack of knowledge.
02Family members and carers were frequently influential in the decision to join or decline a trial, a factor often underappreciated by healthcare professionals.
03Healthcare professionals identified time constraints and lack of training as major barriers, noting that discussing trials took significantly longer than standard care and that cultural competency training was often inadequate or absent.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The included studies were almost exclusively from the United States, with only one from Singapore, limiting generalizability to other healthcare systems. The patient population was predominantly African American or Black women, with underrepresentation of men, Indigenous populations, and other ethnic groups. Healthcare professional participants were majority White, which may reflect a limited perspective on the biases experienced by minority patients. The review relies on qualitative data, so it identifies themes and perceptions but cannot quantify the magnitude of barriers or the effectiveness of interventions.
Declared interests
The authors have no funding or conflicts of interest to disclose.
The easy way to misread this
Do not interpret the finding that clinicians blame 'patient reluctance' as evidence that patients are unwilling. The review shows this is often a misinterpretation of mistrust or structural barriers. Conversely, do not assume that 'race-neutral' approaches are effective; the review found that ignoring ethnicity can overlook specific cultural and historical factors driving non-participation.