background: Despite efforts to increase the diversity of cancer clinical trial (CT) participants, African-Americans (AA) are still underrepresented. While perceptions of participation have been studied, the objective of this study was to compare perceptions and decisional conflict towards CTs among AA cancer patients who have and have not participated in CTs to identify key areas for intervention.

methods: AA cancer patients (N=41) were surveyed at two urban cancer centers and asked to agree/disagree to statements related to CT perceptions (facilitators, barriers, beliefs, values, support, and helpfulness), and complete the O’Connor decisional conflict scale. Independent sample t-tests compared participants by CT participation status; 41% had participated in a CT.

results: Those who had participated in CTs reported significantly lower decisional conflict compared to non-participants (Cohen’s d= 1.23, [95% CI: -41.9, -12.6], p = .001). Similarly, CT participants reported significantly higher score of perceived facilitators (Cohen’s d= 0.77, [95% CI: 2.1, 25.7], p = .023) and significantly lower score of perceived barriers (Cohen’s d= 1.00, [95% CI: -43.6, -9.6], p = .003). No significant differences were shown by age, gender, or education, indicating that participation played a key role.

conclusions: For AA patients who have participated in CTs, decisional conflict is low, meaning that messages about CTs have sufficiently addressed their concerns, especially messages that targeted perceived facilitators and barriers. Further investigation in how the CT decision was made by those already participating might be a better strategy to adapt current interventions with the aim of reducing CT decisional conflict among AA.