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NEUROLOGY 2009;72:1682-1688
© 2009 American Academy of Neurology

Who will participate in acute stroke trials?

S. E. Kasner, MD, MSCE, A. Del Giudice, MD, S. Rosenberg, M. Sheen, J. M. Luciano, CRNP, B. L. Cucchiara, MD, S. R. Messé, MD, L. H. Sansing, MD and J. M. Baren, MD

From the Departments of Neurology (S.E.K., A.D.G., S.R., M.S., J.M.L., B.L.C., S.R.M., L.H.S.) and Emergency Medicine (J.M.B.), University of Pennsylvania, Philadelphia.

Address correspondence and reprint requests to Dr. Scott Eric Kasner, University of Pennsylvania Medical Center, 3 West Gates Building, 3400 Spruce Street, Philadelphia, PA 19104 kasner{at}mail.med.upenn.edu

Background: Despite the high incidence of acute stroke, only a minority of patients are enrolled in acute stroke treatment trials. We aimed to identify factors associated with participation in clinical trials of novel therapeutic agents for acute stroke.

Methods: Prospective survey of patients with acute stroke <72 hours from onset. A structured interview was administered to the patient or primary decision-maker. If offered participation in an actual acute treatment trial, questions focused on decisions about that trial; otherwise a similar mock trial was proposed. The primary outcome was whether the subject agreed to participate in the proposed trial.

Results: A total of 200 subjects (47% patients, 53% proxies) completed the survey: mean age 63 ± 14 years, 47% women, 44% white, 50% black. A real acute trial was offered to 22%; others were offered a mock trial. Overall, 57% (95% confidence interval: 50%–64%) of respondents stated they would participate in the proposed acute treatment trial. There were no differences with respect to age, sex, race, educational level, self-assessed stroke severity or stroke type, vascular risk factors, or comorbidities. Misconceptions about key research concepts were found in 50% but did not impact participation. Participation was associated with the perceived risk of the proposed trial intervention (p < 0.001), prior general attitudes about research (p < 0.001), and influences attributed to family, religion, and other personal beliefs (p < 0.001). Patients were more likely to participate than proxy decision-makers (p = 0.04).

Conclusions: Demographic factors, clinical factors, and prior knowledge about research have little impact on the decision to participate in acute stroke clinical trials. Preexisting negative attitudes and external influences about research strongly inhibit participation. Patients are more inclined to participate than their proxy decision-makers.

Abbreviations: CI = confidence interval; OR = odds ratio.

Supplemental data at www.neurology.org

Disclosure: Author disclosures are provided at the end of the article.

Received December 3, 2008. Accepted in final form February 12, 2009.