All members of the clinical trial team who interact with potential participants play an important role in the informed consent process. And not to point any fingers, but the literature tells us (and we know from our own experiences) that physicians play a key role in patient accrual to clinical trials. It has been estimated that 75% of patients will enroll on a trial if asked by their physician. Conducting an effective consent discussion doesn't just happen and few receive formal training in this area. But it is important. Weaknesses in communication undermine the ability to secure true and ethical consent. The most critical flaws in communication include using coercive or persuasive language, limiting choices, and providing explicit recommendations. After a consult with the recruiting physician, many patients have difficulty understanding the likelihood of personal benefit and the method of treatment allocation in a clinical trial.
Surveys have shown that most people prefer to participate in medical decision making, suggesting that paternalistic approaches of the past should be replaced by patient-centered conversations that value patient preferences.
There are several articles on AccrualNet about communication skills training courses for physicians and nurses recruiting for Phase I-III clinical trials. Brown et.al (2004) have devised a set of ethical communication strategies to assist in discussing participation in clinical trials. Hietanen et al. (2007) and Brown et al. (2007) report that training courses increased shared decision-making behavior, reduced coercive behavior, improved attitudes among patients about clinical trials, and increased patients' understanding and recall of study aims and therapeutic options.
How important are good communication skills to successful accrual? Do you believe that the recruiting physicians and nurses at your institution have adequate communication skills? Have you ever participated in communication skills training?