Academic journal article The Qualitative Report

Use of Semi-Structured Interviews to Explore Competing Demands in a Prostate Cancer Prevention Intervention Clinical Trial (PCPICT)

Academic journal article The Qualitative Report

Use of Semi-Structured Interviews to Explore Competing Demands in a Prostate Cancer Prevention Intervention Clinical Trial (PCPICT)

Article excerpt

I, Dr. Crocker, conducted this research in partial fulfillment of the requirements for my doctorate in Applied Anthropology. During my doctoral program, I was uniquely situated, also working as a project director for a federally funded, multi-site, prostate cancer prevention intervention clinical trial (PCPICT). This resulted in the creation of a liminal space, often requiring navigation between the "rules" and languages of two very disparate worlds, biomedicine and anthropology, that seemed would never intersect. As the project director, I became increasingly aware of the challenges inherent in the design, implementation, and daily work of conducting a prostate cancer prevention trial. Simultaneously, through the requirements of the doctoral program, I experienced an increased skill set in which I acquired new perspectives and an expanded toolkit with which to examine the world. The overarching aim of my dissertation research was to show how the two worlds could merge, with each informing the other.

As project director, I had observed recruitment below goal at most sites participating in the PCPICT. Upon review of detailed screening logs, our team was able to delineate patient, protocol and infrastructure related barriers that were contributing (Kumar et ah, 2012). Similar challenges to recruitment in chemoprevention clinical trials had been welldocumented by others (Chlebowski, Menon, Chaisanguanthum, & Jackson, 2010; Ruffin & Baron, 2000). What we also recognized as an important influence in recruitment was the support of committed physicians (Kumar et ah, 2012). Referring physicians had been recognized in other arenas for the major role they play in getting patients involved in clinical trials (Ford et ak, 2003; Miller, Crabtree, McDaniel, & Stange, 1998). In fact, physician involvement is considered essential for the provision of much of today's healthcare, and physicians serve as a critical link in the chain of events leading to the delivery of preventative services including cancer screening (Jaén et al., 2001; Nutting et al., 2001). What had not been explored using qualitative methods, and was the driving force behind this project was the role of physicians as the "link" to participation in prostate cancer prevention intervention trials (as PCPICT gatekeepers).

Stange and Nutting (1994) used the theory of competing demands to describe the multiple factors competing for the provision and delivery of preventative services by primary care physicians. The main components (physician, patient, and practice environment) are thought to be influenced by factors such as attitudes, knowledge, expectations, practice organization, and alternative demands. As a result, the multiple demands of the medical encounter compete with those related to prevention during the limited time available. The end result is that not all issues receive attention at a specific visit, with preventative services often peripheral to other priorities (Stange & Nutting, 1994). Competing demands have also been found to vie for physicians' attention and resources beyond the primary care arena. Joseph and Dohan (2009) report a similar influence in recruitment to therapeutic clinical trials. I began to wonder what role "competing demands" was playing in referral and recruitment to the PCPICT.

The dearth of literature on the interaction of these demands in the context of a prostate cancer prevention intervention clinical trial (PCPICT), a growing area of research with unique recruitment challenges, suggested a research gap. I wanted to explore the concept of competing demands as a factor influencing physician participation in the PCPICT. I proposed this starting point to explore the individual provider and structural level factors that were influencing participation in the PCPICT. This critical first would help to provide an indepth understanding of the multitude of factors influencing a physician's participation. In turn, after identification we could focus on solutions. …

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