Contextual factors associated with rural breast cancer patients’ willingness to participate in clinical trials: A qualitative analysis.

136 Background: Access to cancer clinical trials (CCTs) is a key indicator of high-quality cancer care. Despite ongoing national initiatives aimed at increasing access to CCTs for all patients, rural patients continue to be generally under-represented in CCTs. Prior work has described multilevel barriers to rural CCT participation; however, limited research has examined contextual factors associated with rural patients’ willingness to participate in a CCT. As formative research to inform the development of a rural patient-centered care delivery intervention, we examined contextual factors that may influence CCT participation for rural breast cancer patients. Methods: We conducted semi-structured interviews in 2023-2024 with 14 breast cancer patients residing in rural Hawaii. Participants were referred to the study by their oncology providers. We explored patients’ awareness, knowledge, and contextual factors associated with their willingness and decisions to participate in a CCT. Interviews were recorded and transcribed verbatim. Three researchers independently reviewed the transcripts and conducted thematic analysis using an inductive approach. The final themes and subthemes were defined through team discussions. Results: The mean age of the sample was 63; 100% were female; 50% self-identified as White/Caucasian, 29% Native Hawaiian, 14% two or more races, and 7% Asian. 91% were aware of CCTs, and 9% demonstrated understanding of CCTs. 93% of participants indicated willingness to participate in a CCT. The three main themes were identified: 1) Motivation; 2) Trial information/communication; 3) Considerations. Main themes/subthemes and exemplary quotes are shown in the Table. Conclusions: Findings indicate that most rural breast cancer patients are willing to participate in a CCT if asked and have awareness about CCTs. Among rural cancer patients, the potential for trial participation may be higher depending on contextual and individual factors. Contextual factors such as transparency about trial information and trial design may assist trial participation decision-making in rural patients. Provider-patient discussions about CCTs that address these factors may potentially enhance trial enrollment and participation for rural patients. Themes Subthemes Exemplar Quotes Motivation Personal benefits, altruism, trial participation incentives “If it’s something that will help to beat this…I'm game to do it.” Trial information/communication Transparency about trial information, trial site location, trial-related communication “I would want to know if it’s been tested before, how successful has it been so far.” Considerations Trial design, trial participation logistics, financial “If it’s spaced out, let’s say every two weeks, three weeks…I could do that.”