Reasons for accepting or declining to participate in randomized clinical trials for cancer therapy

This paper reports on the reasons why patients agreed to or declined entry into randomized trials of cancer following discussions conducted by clinicians in both District General and University Hospitals. Two hundred and four patients completed a 16-item questionnaire following the consultation, of these 112 (55%) were women with breast cancer. Overall results showed that 147 (72.1%) patients accepted entry to a randomized clinical trial (RCT). The main reasons nominated for participating in a trial were that ‘others will benefit’ (23.1%) and ‘trust in the doctor’ (21.1%). One of the main reasons for declining trial entry was that patients were ‘worried about randomization’ (19.6%). There was a significantly higher acceptance rate for trials providing active treatment in every arm 98 (80.6%) compared with those trials with a no treatment arm 46 (60.5%), χ2test P = 0.003. The study outlines a number of factors that appear to influence a patient’s decision to accept or decline entry into an RCT of cancer therapy. An important factor is whether or not the trial offers active treatment in all arms of the study. Communication that promotes trust and confidence in the doctor is also a powerful motivating influence. © 2000 Cancer Research Campaig

Reply to Thomas Singer

In reply to Dr. Singer, I question whether clinicians have a monopoly on understanding the unconscious. I reiterate the contention that if clinicians are to engage in cultural analysis, they need to be aware of the epistemology and methodology of disciplines whose sole purpose is to understand culture. Singer unwittingly acknowledges that the discipline of history is an unrecognised, albeit central, component of the theory of cultural complexes. To emphasise the importance of historical research, I challenge the widely held belief that the notion of a cultural unconscious should be attributed to Joseph Henderson. I clarify that my initial aim was to show that there are competing ways in which the term cultural complex has been used within depth psychology and accordingly, it is not a purely Jungian contribution. The current Jungian understanding of cultural complexes is in danger of becoming an uncritical meta-narrative promoting a laissez-faire approach, to which I take exception