4Background & Need Low participation rates in cancer clinical trials Disparities between the general population and medically-underserved groupsThe significance of aversion to randomization in Phase III clinical trials
5Clinical Communication & Clinical Trials Metaphorical language in the clinical contextCommon metaphorical explanations for randomization:Toss of a coinLotteryPicking a number from a hat
6Study 1RQ1: Are conventional metaphors for randomization appropriate for use with rural, low-income, older adult women?RQ2: Are there culturally appropriate metaphors that can be used to describe chance for rural, low-income, older adult women?
7Study 1 Methods Design Participants Four focus groups (N=30) In-depth interviews (N=11)ParticipantsWomen living in rural PA counties<200% of HHS Poverty GuidelinesOver age 50Focus Groups: M=67.2, SD=9.65Interviews: M=70.3, range: 55-84
8Study 1 FindingsRQ1: Are conventional metaphors for randomization appropriate for rural, low-income, older adult women?Conventional metaphorsTrivializing (“you don’t flip a coin for something serious”)Devaluing (“only worth flipping a coin…”)Gambling (“gambling with my life.”)Definitions for randomizationThe role of chance (“is there a chance you will get treatment?”)
9Study 1 FindingsRQ2: Are there culturally appropriate metaphors that can be used to describe chance?A culturally-grounded metaphor for randomization:Sex of baby “…Like how some people are born women and some are born men.”
10Study TwoRQ1: What predicts rural, low-income, older adult women's intentions to participate in cancer clinical trials?
11Study 2 Methods Experimental Design Participants (N=106) 4 message condition (attention control, definition, conventional metaphor, cultural metaphor) pretest-posttest design with random assignmentParticipants (N=106)Women living in rural PA counties<200% of HHS Poverty Guidelines75% annual income between $10,000-$15,000Over age 50 (M=68.10, SD=12.32)
13Study 2 FindingsRelationships among trait variables and intentions to participate in clinical trials:AgeRural identityIntrinsic religiosityExtrinsic religiosityPre-message behavioral intentionsPost-messagebehavioralintentions-.10.31**.15.22*.80**
14Study 2 FindingsRelationships among message outcomes and intentions to participate in clinical trials:AttentionCompre-hensionAffectiveResponseYieldingCredibilityPost-messagebehavioralintentions.50**-.07-.03.44**.43**
15Study 2 FindingsEffect of message strategy on intentions to participate in clinical trials: F(3,105)=.48, nsAttentionControlStandard DefinitionConventionalMetaphorCulturalPost-messagebehavioralintentionsM = 3.90sd = .75M = 3.80sd = .58M = 3.93sd = .91M = 3.71sd = .77
16Study 2 FindingsInteraction of attention & message strategy as a predictor of behavioral intentions
17Study 2 Limitations Design Measurement Non-clinical population The perception of being “tested” as a threat to internal validity
18ConclusionUsing conventional metaphors for randomization with rural women may have unintended effects.Culturally appropriate language appears to be most important when audiences have limited attention (e.g., high cognitive demand resulting from cancer diagnosis).Contextual cues may influence how individuals interpret metaphors used to explain randomization.