Applied Clinical Trials
A recent survey indicates pharmacists should provide more clinical trial information to patients.
In the critical movement to provide effective and comprehensive public outreach and education, all stakeholder groups within the clinical research enterprise must be enlisted. One group that has been largely overlooked is pharmacists.
Kenneth A. Getz
Major international opinion polls indicate that pharmacists are one of the most trusted sources for health-related information. A new survey recently completed by the Center for Information and Study on Clinical Research Participation (CISCRP) finds that the public is very interested in receiving information about clinical trials from pharmacists, but it is reluctant to request it and highly unlikely to receive it.
CISCRP distributed an online survey in April 2010. In all, 147,000 subscribers of online social networks serving health-information seeking communities from 54 public/patient organizations were contacted. Using standardized methods for estimated online survey response rates, 2650 questionnaires were completed, representing approximately a 3% response rate. This study was funded by an unrestricted educational grant provided by Eli Lilly & Company.
The vast majority of respondents indicate that they want their pharmacist to tell them about clinical trials. Yet the public appears highly unlikely to ask for information about clinical trials, and pharmacists appear highly unlikely to readily offer such information. These findings suggest that it is critically important to understand the underlying causes of public reluctance to utilize this information source and to develop targeted educational programs that engage the pharmacist community and teach the public how to better leverage that community.
Nearly 80% of survey respondents said that they want their pharmacist to inform them about clinical trials for their health conditions. And 72% said that they are "very interested" or "somewhat interested" in receiving information about clinical trials from their pharmacist. Yet six out of 10 (59%) respondents indicate that they are "not very likely" or "not at all likely" to ask their pharmacist for information about clinical trials.
Only 2% of respondents indicate that they have ever asked their pharmacist for information about clinical trials. And less than 1% have ever received such information from their pharmacist.
The CISCRP study finds that respondents are not talking to their pharmacists as much as might be expected. This is in large part a reflection of structural market changes that have occurred over the past two decades, as most local mom and pop pharmacies situated on Main Street have become part of national pharmacy chains, often located within shopping malls and grocery stores.
As part of this change, pharmacist training has been integrated into more cost conscious, high throughput environments where close relationships with patients are less likely to form.
Indeed, 11% of respondents indicate that "My pharmacist does not talk to me," and another 50% indicate that "My pharmacist answers questions only if I ask." In a separate survey item, 43% of respondents said that they "never" talk to their pharmacist about their health. Less than one-out-of-four reports that they receive information about anything other than the medicine that is being prescribed.
CISCRP analyzed differences in survey responses by demographic and behavioral subgroups. Demographic subgroups included gender; age (i.e., younger than 30, 31-60 years old or 61 and older); education level (i.e., high school or less, college or post-graduate degree); and type of pharmacy frequently used (i.e., chain, grocery, local, Internet/mail-order, hospital/clinic, other or no pharmacy use).
A number of significant differences are observed: Women appear more inclined to seek clinical trials information from their pharmacists as are those with a lower education level; and individuals who have established comfortable and familiar relationships with local, smaller pharmacies tend to be more receptive to asking for information about clinical trials.
When asked whether respondents want "their pharmacist to tell them about clinical trials for their health condition," the majority (80%) said "yes." Significant differences were found between respondents using a local vs. grocery/national chain (P<0.001). No significant differences were found between respondents by gender, age or education level.
When respondents were asked "If you want to learn more about clinical trials, how likely is it that you would ask a pharmacist?" 42% said that they are "very likely" or "somewhat likely," 39% indicate that they are "not very likely," and 19% indicate "not at all likely." Significant differences were found between respondents by gender (P<0.05), education level (P<0.001), and pharmacy type (P<0.001). No significant difference was detected by age of respondent.
A large difference is observed between those who use pharmacies and those who do not: Only one-third of respondents who do not use a pharmacy indicate that they are "somewhat likely" and none indicated that they are "very likely" to ask their pharmacist about clinical trials.
It is important to reiterate that respondents with a higher education level tend to be less likely to ask a pharmacist about clinical trials, with a significant 10-percentage point difference in each survey response between those with a post-graduate degree vs. those with no higher than a high school education.
As expected, familiarity with and the extent to which one has established a relationship with a pharmacist are also highly associated with greater receptivity to receiving and asking for clinical trials information. Respondents who indicate speaking more often with their pharmacist about their health are more interested in receiving information about clinical trials from them. Nearly six out of 10 (58%) respondents who speak with their pharmacist about their health on a weekly basis are "very interested" in receiving clinical trials information from them. This compares with 46% of those who speak with their pharmacist on a monthly basis who are "very interested," 30% of those who speak a few times per year, and 20% of those who say they "never" speak to their pharmacist about their health.
The majority of survey respondents are open to receiving printed information about clinical trials from a pharmacist with receptivity to email format high as well. Respondents most want information about how to find clinical trials, their safety, and where to go to learn more.
When asked how they would like to receive information about clinical trials from a pharmacist, two out of three (69%) respondents said that they would like to receive printed information delivered at the pharmacy. Email is an acceptable format for 48% of respondents. Most respondents, however, do not want to receive information by mail or telephone.
The CISCRP study identifies three primary topics that the public is most interested in receiving from their pharmacists: how to find clinical trials, whether clinical trials are safe and effective, and how to learn more about clinical trials. A smaller percentage (12%) of respondents are interested in asking their pharmacist why clinical trials are needed, which may suggest that most respondents do not think pharmacists would be appropriate sources for general background information on clinical trials.
Overall, the CISCRP study findings suggest that pharmacists have the potential to become valuable providers of clinical research educational materials. The public is open to receiving information from their pharmacist—particularly in print and emailed formats—but only if they know to ask for information from this source and only if pharmacists are encouraged to become regular providers of that information.
Observed subgroup differences offer insight into ways to begin implementing educational programs—although long-term, the greatest outreach will come from engaging the largest national pharmacy chains. CISCRP has recently embarked on a subsequent study among pharmacists to understand how best to engage this community.
Funding to educate and engage pharmacists will go a long way in helping to build this valuable outreach channel. But funding must come from a variety of sources, and the materials must come from a neutral, independent educator or the media and the public may both perceive such outreach initiatives as self-serving, primarily designed to recruit clinical study volunteers.
The results of this CISCRP study inform our understanding of whether and how pharmacists might be enlisted to assist in educating and reaching patients and the public. Pharmacy directed outreach strategies may prove crucial in helping to restore public trust and in sustainably building public understanding and support of the clinical research process.
Kenneth A. Getz MBA, is a Senior Research Fellow at the Tufts CSDD and Chairman of CISCRP, both in Boston, MA, email: firstname.lastname@example.org