As outlined by Marjorie Kagawa-Singer, among Asians/Pacific Islanders many factors are barriers to recruitment, including structural concerns (such as a wide range of fluencies in English), cultural considerations (e.g., different conceptions of health and fear of preventive interventions), and cultural differences (decisions are made by family conference and often take a long time). Confidentiality is also a concern because these individuals often require the town elder to participate in the consent process, representing a breach of confidentiality. Written consent forms are off-putting to the patients. Successful strategies include the use of research team members familiar with Asian and Pacific Island cultures. Allocation of adequate lead times with focus groups is also required, because additional services are often needed.
As outlined by Edward Trapido, Hispanics consist of individuals of diverse races and ethnicities, with many subpopulations. Differences exist with subpopulations according to culture, language, religion, race, age, gender, family role, education, and length of time in the United States. Focus groups consisting of individuals from Miami revealed several important beliefs of the Hispanic participants: physicians did not communicate well with patients; the medical staff was insensitive to their culture and language; they had not been well informed about their cancer; many felt that physicians had financial interests in prescribing surgery or advising enrollment in surgical trials; chemotherapy would bring on certain death; physicians were concerned that patients would not follow up with care; communication difficulties were common when physicians preferred to speak English, even if the patient understood the language (even if the patient's native language was Spanish); patients were often not asked to participate in the trials; and the participants had a high level of concern over Medicare fraud, inconsistent public health policies, the commercialization of medicine, and the need to involve pharmacists and nurses in the process. Other cultural considerations include a sense of fatalism. Patients are often not told their diagnosis to spare them from pain.
General recommendations of this panel included the following:
- recognize variability and diversity within and among ethnic groups;
- include provisions for transportation and family coverage;
- train more community members to work in clinical research;
- stress the importance of enrollment in trials to the family;