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. 2013 Mar;22(3):481-9.
doi: 10.1002/pon.3043. Epub 2012 Feb 14.

The relationships among knowledge, self-efficacy, preparedness, decisional conflict, and decisions to participate in a cancer clinical trial

S M Miller  1 , S V Hudson, B L Egleston, S Manne, J S Buzaglo, K Devarajan, L Fleisher, J Millard, N Solarino, J Trinastic, N J Meropol
Affiliations

The relationships among knowledge, self-efficacy, preparedness, decisional conflict, and decisions to participate in a cancer clinical trial

S M Miller et al. Psychooncology. 2013 Mar.

Abstract

Background: Cancer clinical trials (CCTs) are important tools in the development of improved cancer therapies; yet, participation is low. Key psychosocial barriers exist that appear to impact a patient's decision to participate. Little is known about the relationship among knowledge, self-efficacy, preparation, decisional conflict, and patient decisions to take part in CCTs.

Objective: The purpose of this study was to determine if preparation for consideration of a CCT as a treatment option mediates the relationship between knowledge, self-efficacy, and decisional conflict. We also explored whether lower levels of decisional conflict are associated with greater likelihood of CCT enrollment.

Method: In a pre-post test intervention study, cancer patients (N = 105) were recruited before their initial consultation with a medical oncologist. A brief educational intervention was provided for all patients. Patient self-report survey responses assessed knowledge, self-efficacy, preparation for clinical trial participation, decisional conflict, and clinical trial participation.

Results: Preparation was found to mediate the relationship between self-efficacy and decisional conflict (p = 0.003 for a test of the indirect mediational pathway for the decisional conflict total score). Preparation had a more limited role in mediating the effect of knowledge on decisional conflict. Further, preliminary evidence indicated that reduced decisional conflict was associated with increased clinical trial enrollment (p = 0.049).

Conclusions: When patients feel greater CCT self-efficacy and have more knowledge, they feel more prepared to make a CCT decision. Reduced decisional conflict, in turn, is associated with the decision to enroll in a clinical trial. Our results suggest that preparation for decision-making should be a target of future interventions to improve participation in CCTs.

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Conflict of interest statement

Conflict of Interest: No financial disclosures were reported by the authors of this paper. None of the authors have any potential conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Mediational Pathway of Knowledge and Self-Efficacy for Decisional Conflict
Figure 2
Figure 2
Study Flow Diagram
See this image and copyright information in PMC

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