ABSTRACT
Background: Minority and older adult patients remain underrepresented in cancer clinical trials (CCTs). The current study sought to examine sociodemographic inequities in CCT interest, eligibility, enrollment, decline motivation, and attrition across two psychosocial CCTs for gynecologic, gastrointestinal, and thoracic cancers. Methods: Patients were approached for recruitment to one of two interventions: (1) a randomized control trial (RCT) examining effects of a cognitive-behavioral intervention targeting sleep, pain, mood, cytokines, and cortisol following surgery, or (2) a yoga intervention to determine its feasibility, acceptability, and effects on mitigating distress. Prospective RCT participants were queried about interest and screened for eligibility. All eligible patients across trials were offered enrollment. Patients who declined yoga intervention enrollment provided reasons for decline. Sociodemographic predictors of enrollment decisions and attrition were explored. Results: No sociodemographic differences in RCT interest were observed, and older patients were more likely to be ineligible. Eligible Hispanic patients across trials were significantly more likely to enroll than non-Hispanic patients. Sociodemographic factors predicted differences in decline motivation. In one trial, individuals originating from more urban areas were more likely to prematurely discontinue participation. Discussion: These results corroborate evidence of no significant differences in CCT interest across minority groups, with older adults less likely to fulfill eligibility criteria. While absolute Hispanic enrollment was modest, Hispanic patients were more likely to enroll relative to non-Hispanic patients. Additional sociodemographic trends were noted in decline motivation and geographical prediction of attrition. Further investigation is necessary to better understand inequities, barriers, and best recruitment practices for representative CCTs.
ABSTRACT
For people with HIV/AIDS (PWHA), partner loss has unique factors that complicate the grieving process and can lead to prolonged bereavement. Empirical evidence has demonstrated the benefits of emotional disclosure through therapeutic writing on physical symptoms, immune responses, and psychological distress. Therapeutic writing is based on the assumption that writing about one's deepest thoughts and feelings allows cognitive, behavioral, and kinesthetic processing of stressful life events and/or traumas. The present case study explores the benefits and challenges of using expressive writing, in addition to cognitive-behavioral therapy, to address partner loss and disenfranchised grief in the context of living with HIV. This article (a) reviews the literature on coping with loss and factors that can make PWHA more vulnerable to disenfranchised grief; (b) describes a former patient whose partner loss was complicated by lack of closure around the termination of his 6-year-long relationship, the death of that partner without the family informing him, and his anger surrounding his partner infecting him with HIV; and (c) discusses how the therapist created a comprehensive treatment plan using therapeutic writing to improve emotional processing. Results suggest that therapeutic writing assisted with symptom alleviation, improvement in psychological well-being, and increased overall quality of life. Although the loss of a partner is a common human experience, therapists need to be aware that PWHA may have additional or different care needs that can put them at risk of heightened or prolonged bereavement. Recommendations for using therapeutic writing are included. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
