Assessing Barriers to Clinical Trial Participation
Sample Assessment Questions
General Questions
1. What may make it difficult for you to participate or stay enrolled in the clinical trial? ___________
2. What worries or concerns do you have about this clinical trial? ___________________________
3. What have you heard about clinical trials from family or friends? __________________________
4. What have you heard in the media (TV, radio, newspaper) about clinical trials? ______________
5. What has been explained to you by your doctor or health provider about clinical trials? ________
Practical Barriers
Housing:
1. Where do you usually stay/live? ____________________________________________________
2. Do you have a permanent address? Yes no
3. What housing programs have you already applied for? ___________________________________
4. What housing assistance would you like help getting? ___________________________________
Telephone:
1. Where do you typically receive your calls? ____________________________________________
2. How often is that cell phone disconnected? ___________________________________________
3. How reliable is that person in giving you messages? ____________________________________
4. How much medical information can be left on the voice mail/with the person for you? __________
Health Insurance:
1. What type of health insurance coverage do you have? __________________________________
2. How do you usually pay for medical visits? ___________________________________________
3. How do you usually pay for prescription medicines? ____________________________________
4. What programs such as Medicaid or Medicare have you already applied for? ________________
5. What options do you think you have to pay for your medical care? _________________________
Transportation
1. How do you typically get to medical appointments? __________________________
2. What friends/family members can you go to for help getting to a medical appointment? _________
3. How comfortable are you using public transportation? ________________
Day care/eldercare
1. Are you responsible for caring for another person? Yes No
2. What options do you have for having someone else care for the person when you are at a medical visit? ______________
3. How have you handled this in the past when you have to go to an appointment? ______________
US Citizenship/Legal Resident Status
Ask ONLY if it is required by the clinical trial!
The study requires that I ask this, do you have US citizenship, permanent or temporary legal residence?
Treatment for a Co-morbidity
1. What other medical conditions do you have? _________________________________________
2. Are you under the care of a specialist of a health care provider for a condition? Yes No
3. What health concerns do you have right now in addition to your [condition under study]? _______
Limited English Proficiency
1. In what language do you feel most comfortable speaking? ______________________________
2. In what language do you feel most comfortable reading written materials? __________________
3. Would you prefer translated materials to read? Yes No
4. Would you feel more comfortable if I bring in an interpreter? Yes No
5. What is the easiest way for you to learn new information- reading, listening, computer, video, etc?
Low Literacy Level
Please tell me what you understood of my explanation about the clinical trial.
Which medical or confusing terms can I explain? ______________________________________
What is the easiest way for you to learn new information- reading, listening, computer, video, etc?
What did you find most interesting or just learned (the person will have to explain)? ___________
Lack of Understanding of the Healthcare System
1. Please tell me about past experiences when you had to get specialty medical care? __________
2. What do you find most confusing about where you get your health care? ____________________
3. What do you think would be most helpful for you to figure out where to go and who to call when you have a question? _________________________________________________________________
4. What do you typically do when you need something from your health care provider? __________
Cultural Differences
1. How comfortable do you feel with your health care team? ________________________________
2. How welcome do you feel at the places where you get your medical care? ___________________
3. What do you think is needed for you to feel more comfortable with your healthcare team? _______
4. How comfortable do you feel asking questions? ___________________________________
5. What can we do so you feel more comfortable asking questions and getting answers to your questions? __________________________
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