The Role of Healthcare Bias in Clinical Trial Knowledge, Awareness and Offering in Hispanic sub-Populations

Hispanics (H) remain underrepresented in clinical trials (CT). The impact of healthcare bias (HB) on CT awareness and offering remains understudied. We sought to investigate CT knowledge, awareness, and offering in our ethnically diverse population.

An IRB-approved, 22-question survey was administered in English or Spanish at the participant's request. Comparisons used chi-square analyses with statistical significance declared at p<0.05.

We enrolled 276 participants. 34% (94/276) identified as H. 85/94 (90.4%) H identified Spanish as their preferred language. Compared to non-White Hispanics (NHW), H were younger (≤70: 84.2% vs 71.8%, p=0.004), single (41.1% vs 19.9%), less educated (< college: 32.7% vs 72.1%), and less English-speaking (4.2% vs 100%). CT awareness was higher in US-born participants (86.3% vs 34.9% of foreign-born). H were 4.6 times less likely to have CT awareness compared to NHW. Spanish-speaking H were 3.5 times less likely to be aware compared to English-speaking H. H from Puerto Rico were 81% more likely to be aware of CT compared to other H countries (p<0.001). CT offering was also higher in US-born (87.5% vs 12.5%, p=0.02) and English-speaking H (82.1% vs 17.9%, p=0.02). CT knowledge (defined as answering all questions related to CT misinformation correctly) was directly associated with CT awareness (p<0.001) but not with offering. Most Spanish-speaking H received CT information from their oncologist (58.2%), social media (50.3%), and community (30.2%).

CT knowledge and awareness deficiencies persist in H. Being born outside of the US/Puerto Rico and preserving Spanish as the primary language were associated with lower CT awareness and offering. This study demonstrates CT barriers for H are evolving and provides evidence for the role of HB in CT awareness and offering. Causes for HB will need to be studied, as will countermeasures to minimize its impact. In an RVU-based healthcare system, facilitating CT education and consenting when linguistic and cultural incongruence exists would increase CT diversity and should be prioritized. Social media and community advocacy are important sources of medical information for H, which validates the impact of the Barrio Advantage phenomenon, and shines light on potential avenues to minimize HB and H underrepresentation in CT.