In a cross-sectional study published in JAMA Network Open, political ideology was associated with clinical trial skepticism, with conservative identification linked to higher odds of endorsing such views. Among cancer survivors, Chido-Amajuoyi et al similarly observed greater skepticism among respondents identifying as conservative, although subgroup estimates were less precise.
“Implications are both pragmatic and urgent. If political ideology influences receptivity to clinical trials, recruitment strategies that overlook ideological diversity risk biased enrollment and underrepresentation,” the investigators explained. “Recognizing political ideology as a factor in medical mistrust may help reduce participation barriers and improve representativeness.”
Study Details
This analysis used data from the National Cancer Institute’s Health Information National Trends Survey (HINTS) 7, conducted from March 25 to September 16, 2024, with a response rate of 27.3%. The final analytic sample included 6,377 respondents, of whom 1,009 (9.6%) were cancer survivors. The cohort was 51.8% women (n = 3,768) and included 3,422 non-Hispanic White (60.8%), 906 non-Hispanic Black (10.8%), and 1,249 Hispanic (17.4%) individuals.
Clinical trial skepticism was assessed using the statement, “People should be suspicious of clinical trials,” with 5-point Likert-style response options ranging from strongly agree to strongly disagree; overall, 87.6% of respondents answered this question. Political ideology was the primary exposure, with 2,040 respondents (30.5%) identifying as liberal, 2,269 (37.6%) as moderate, and 2,068 (31.9%) as conservative.
Multinomial logistic regression was used to examine associations between clinical trial skepticism and political ideology in the overall population and among cancer survivors. Models were adjusted for age, sex, self-reported race or ethnicity, educational attainment, household income, and rural–urban residence. Sensitivity analyses included survey-weighted linear regression.
Political Differences in Clinical Trial Skepticism
Overall, 1,735 participants (27.2%) agreed that people should be suspicious of clinical trials.
Cancer survivors and the general population did not differ significantly in levels of skepticism. Among survivors, 435 (43.5%) neither agreed nor disagreed, 204 (22.8%) agreed, and 370 (33.6%) disagreed, compared with 2,184 (42.2%), 1,529 (27.7%), and 1,645 (30.2%), respectively, in the general population (P = .13).
Compared with respondents who neither agreed nor disagreed, those identifying as conservative were more likely to agree that clinical trials should be approached with suspicion than those identifying as liberal (adjusted odds ratio [aOR] = 1.30, 95% CI = 1.10–1.54) or moderate (aOR = 1.43, 95% CI = 1.22–1.67). Compared with moderates, liberals were more likely to disagree with this perspective (aOR = 1.98, 95% CI = 1.70–2.31).
In the cancer survivor subgroup, compared with respondents who neither agreed nor disagreed, those identifying as conservative were more likely to agree than those identifying as moderate (aOR = 1.72, 95% CI = 1.11–2.69) and less likely to disagree than those identifying as liberal (aOR = 0.44, 95% CI = 0.30–0.66). Survivors identifying as liberal were more likely to disagree than those identifying as moderate (aOR = 2.39, 95% CI = 1.60–3.57).
Insights and Opportunities
The researchers reported several limitations, including the cross-sectional study design, which precludes causal inference, reliance on a single-item measure of suspicion, and the potential for nonresponse bias.
Reflecting on their findings, they stated, “This pattern [of greater skepticism among respondents who identified as conservative] is consistent with broader polarization in trust toward scientific institutions and government health agencies, as well as variable participation in clinical trials.”
They further noted, “Tailored engagement strategies should acknowledge and address ideological heterogeneity. Interventions could include ideologically congruent messaging, clinician-mediated invitations emphasizing local oversight and patient confidentiality, efforts to diversify clinical trialists, and community partnerships that build credibility across political groups.”
Hermioni L. Amonoo, MD, MPP, MPH, of Brigham and Women’s Hospital, Boston, is the corresponding author of the article in JAMA Network Open.
Disclosure: The study was funded by the Robert Wood Johnson Foundation Harold Amos Medical Faculty Award to Dr Amonoo. The study authors reported no conflicts of interest.
