Clinical trials play an essential role in developing new drugs, medical devices, vaccines, and treatment approaches. They also help researchers understand how well therapies work across different populations.
But despite their importance, clinical trials still face a representation challenge. Enrollment has long lacked diversity. Many patients from racial and ethnic backgrounds are heavily underrepresented in medical research, which greatly affects how the results are interpreted across different communities.
Healthcare provider bias may also contribute to this lack of representation in clinical trials. A new study published in the Journal of Racial and Ethnic Disparities is examining whether unconscious provider assumptions could play a role.
The study involved 171 patients receiving treatment and 28 oncologists at an urban cancer center. Providers completed an Implicit Attitudes Test (IAT) about their assumptions about patients. IAT is a psychological tool that measures unconscious attitudes, preferences, and stereotypes by tracking a person’s reaction times during a rapid categorization task.
Patients were asked questions about clinical trial conversations, experiences of discrimination, the patient-provider relationship, communication, and trust.
The researchers analyzed results by comparing non-Hispanic white patients with patients from other racial or ethnic backgrounds.
RELATED: Clinical Trials Need More Black Voices. Here’s How You Can Help Shape the Future of Medicine
The results were quite revealing. Almost 90 percent of providers showed a moderate preference for viewing non-Hispanic white patients as more compliant, a perception that researchers suggest could influence clinical interactions. Nearly 68 percent acknowledged making assumptions based on what the patient looked like.
On the flip side, patients reported that fewer than half ever discussed clinical trials with their provider, and only 22 percent enrolled.
The findings suggest that some patients may be missing opportunities to learn about clinical trials. Researchers noted that provider assumptions and patients’ experiences of discrimination could shape these conversations, though more research is needed to better understand the relationship.
Black Americans have been historically underrepresented in cancer clinical trials. According to the National Cancer Institute (NCI), while Black people make up about 14 percent of the U.S. population, only 5 to 7 percent of clinical trial participants are Black. In a study examining 358 cancer clinical trials involving 93,825 patients, only 2.9 percent of Black patients participated in pharmaceutical-sponsored trials, compared with 9 percent in publicly funded studies.
When Black patients are underrepresented in clinical trials, researchers have less information about how treatments perform across diverse populations. More participation improves the evidence used to guide care for everyone.
While the responsibility shouldn’t fall entirely on patients to discuss clinical trials, they can help open the door by asking questions about research opportunities during follow-up appointments.
Healthcare providers aren’t the only way to learn about clinical trial opportunities. BlackDoctor’s Clinical Trials Resource Center and ClinicalTrials.gov have free databases you use to find open trials near you.
RELATED: How to Find a Clinical Trial That Actually Works for You
The study’s findings suggest that a lack of discussion surrounding clinical trials and provider bias can influence patients’ interest in medical research. Patients from historically underrepresented racial and ethnic groups may be less likely to hear about research opportunities that could provide access to innovative treatments.
While change won’t happen overnight, these findings open the door to a broader discussion on how to address barriers to clinical enrollment. On a health systems level, increasing diversity in clinical trials will require both improving access and ensuring every eligible patient has the opportunity to learn about research participation.
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