Nurse-Led Education Clears Up Clinical Trial Myths in Kidney Cancer

A nurse-led educational intervention combining an in-person session and an animated video improved trial-naïve patients' understanding of key clinical trial concepts, including placebo use and randomization, in a single-center study of 101 patients with kidney cancer at Fox Chase Cancer Center in Philadelphia, Pennsylvania. Willingness to consider a trial did not change (3.44 vs 3.52 on a 5-point scale; P = .33), and whether better understanding leads to higher enrollment has not been measured.

The findings are scheduled for presentation as a poster at the 2026 American Nurses Enterprise (ANE) Research Symposium, held October 28 in Chicago, Illinois, as a pre-conference to the American Nurses Credentialing Center (ANCC) Magnet & Pathway Conference.¹

What did the Fox Chase study set out to do?

Patient-related barriers to oncology clinical trial participation, such as limited education about trials and added financial burden, are well documented in the literature, but few studies have evaluated strategies to address them, according to the investigators.¹ Fox Chase clinical research nurses Kimberly Costello, BSN, RN, CCRC, OCN; Courtney Lambert, BSN, RN, OCN; and Kristin Virag, MSN, RN, OCN, served as co-investigators alongside principal investigator Susan Rux, PhD, DNP, RN, OCN; Rutika Kokate, PhD, MS, scientific manager for the genitourinary research team in the Fox Chase Office of Clinical Research; and Brian Egleston.^1,2 The team designed and tested an intervention intended to improve access to trial participation.¹

The work was funded by a Department of Defense Kidney Cancer Research Program Nurse-Initiated Research Award.¹ When the $564,000 grant was announced in 2024, Fox Chase noted that most patients in oncology clinical trials are non-Hispanic White, male, and younger than 65 years, and identified racial and ethnic minorities, women, older adults, and people with low socioeconomic status as groups that face barriers to participation.²

How was the educational intervention developed?

The investigators first convened a focus group of 8 patients with kidney cancer and used semi-structured interviews to assess baseline clinical trial knowledge.¹ Those insights shaped an in-person educational session and an animated video, which were offered to trial-naïve patients with kidney cancer at the center. Pre- and post-intervention surveys captured demographics, clinical trial knowledge, and perceptions of trials.¹

"It was integral that we used actual cancer patients in creating the content for our education session and our video to gather what did they want to see and hear in an educational session about clinical trials," Lambert told Oncology Nursing News. The focus group included 4 patients who were enrolled in clinical trials and 4 with no trial experience. "It was their information that helped determine what the educational session and video looked like in the end," Lambert said.

Who took part in the study?

Of 101 patients surveyed, 67 (70.5%) were male and 74 (77.8%) were aged 60 years or older; patients aged 70 to 79 years made up the largest age group (36.6%).¹ Most participants (86.3%) identified as White and 8.4% as Black or African American; 4.0% identified as Hispanic or Latino. More than half (60.1%) had education beyond high school, and 82.1% reported an annual household income of $30,000 or more.¹

Which clinical trial concepts did patients understand better after the intervention?

The largest knowledge gains involved 2 concepts that many patients misunderstood at baseline.¹ The proportion of patients correctly endorsing each statement changed as follows:

• Placebo is almost never used (true): 29.0% before vs 61.7% after (P < .001)
• Treatment assignment in a randomized trial is by chance (true): 57.9% vs 80.9% (P < .001)
• Patients can stop participating at any time (true): 94.7% vs 100% (P = .06)
• A trial is a last treatment option (false): 71.3% vs 73.7% (P = .65)

On a 1-to-5 scale, mean self-rated understanding of clinical trials rose from 3.27 to 3.95 (P < .001), and mean confidence in knowing how to find trial information rose from 3.24 to 3.88 (P < .001). Mean concern about the cost and time of participating, rated from 0 to 4, decreased from 1.59 to 1.22 (P = .03).¹ Changes in insurance concerns (1.29 vs 1.09; P = .11) and willingness to consider a trial (3.44 vs 3.52; P = .33) were not statistically significant.¹

The investigators suggested the nonsignificant findings may reflect strong baseline familiarity with concepts that patients did not perceive as obstacles.¹

Why do placebo and randomization misconceptions matter in kidney cancer?

Lambert noted that in her consenting work outside the project, placebo use comes up constantly. "And I can tell you, that is probably a question that almost every patient asks is, is there a placebo involved?" she said. "...but for kidney cancer, there rarely is placebo used by itself."

Virag said randomization was another concept worth clarifying. "Because when people think of randomization, you're like, oh, like you flip a coin, you know," she said. She added that the team also addressed coverage assumptions: "Some people are like, oh, I'll go on a study and everything will be covered because I'm on a study like insurance wise. So I think kind of clearing up that was a big one also."

For Costello, the goal of that education is informed choice rather than persuasion. "Our job is to help them understand fully what the trial is so they can make a, you know, educated decision, informed decision on whether they want to participate or not," she said.

Virag described that education as ongoing for patients who enroll. "So it's a continuous process from consent all the way to the first day of treatment, even while they're on treatment, you know, because sometimes topics or questions come up, you know, as you go further along," she said. "So I think we as research nurses... are at a unique spot to kind of continue the education throughout the clinical trial process for the patient."

How can nurses fit trial education into a busy clinic?

Space and time were practical constraints. Costello explained that the team worked around existing clinic workflows, asking patients to watch the video on study iPads with headphones while they waited for laboratory work, physician visits, or treatment. "A lot of times the patients were willing to watch it while they're getting their treatment," she said. "So we had to adapt. But we were successful with it."

Lambert said the team is exploring sharing the video with new patients with kidney cancer through the institution's patient portal, "so that patients are shown the video before they see their provider and then they know to ask questions, 'Am I eligible for any clinical trials?'"

The work adds to a growing focus on the nursing role in trials. Recent Oncology Nursing News coverage has described how oncology nurses lead day-to-day clinical trial operations through protocol review and planning, and how trial nurses balance protocol knowledge with patient education and communication.^3,4

What are the key takeaways for oncology nurses?

• Address placebo questions directly. Fewer than one-third of patients (29.0%) knew placebo is almost never used before the intervention.¹ Placebo alone is rarely used in kidney cancer trials, Lambert noted.
• Explain randomization in plain language. Understanding that assignment is by chance rose from 57.9% to 80.9% after education.¹
• Clarify what insurance covers. Patients may assume trial participation covers all costs; correcting that early supports informed consent.
• Assess what patients absorbed. Asking patients what the physician just explained helps tailor education to their level of understanding.
• Use waiting and infusion time. Brief video education on a tablet with headphones fit into existing workflows without dedicated space.
• Reinforce education over time. Research nurses can revisit trial concepts from consent through the first day of treatment and beyond.

References

1. Costello K, Lambert C, Virag K, Kokate R, Egleston B, Rux S. Enhancing access and participation in clinical trials among underrepresented patients with kidney cancer. Poster presented at: 2026 American Nurses Enterprise Research Symposium; October 28, 2026; Chicago, IL. Abstract PS6-55.

2. Nursing researchers at Fox Chase Cancer Center and Temple Health receive $564,000 grant to increase clinical trial enrollment of underrepresented kidney cancer patients. News release. Fox Chase Cancer Center. January 24, 2024. Accessed October 23, 2026. https://foxchase.org/news/2024-1-24-nursing-researchers-at-fox-chase-cancer-center-and-temple-health-receive-564000-grant-to-increase-clinical-trial-enrollment-of-underrepresented-kidney-cancer-patients

3. ONN Staff. Oncology nurses lead clinical trial success via planning and delegation. Oncology Nursing News. June 22, 2026. Accessed October 23, 2026. https://www.oncnursingnews.com/view/oncology-nurses-lead-clinical-trial-success-via-planning-and-delegation

4. Attobrah Q. The evolving role of oncology nurses in clinical trials. Oncology Nursing News. April 30, 2026. Accessed October 23, 2026. https://www.oncnursingnews.com/view/the-evolving-role-of-oncology-nurses-in-clinical-trials