Table 2 –

Issues in Participating in Clinical Trials Amongst Veterans and Military Personnel

Novak, 201926	Study enrolled 666 active-duty Service members from six U.S. military treatment facilities in a collaborative care study and completed assessments at baseline, 3-, 6-, and 12-months. Data analyzed focused on study assessment completion rates at 3- and 6-months	Survey completion rates at both time-points points were ≥82% in both reimbursement status groups Participants who received reimbursement were significantly more likely to complete follow-up assessments Participants who received reimbursement were significantly more likely to complete study assessments at both 3- and 6-month time-points, controlling for gender, education, and race/ethnicity (p < 0.01) Survey completion was 5% (98% vs 93%) and 4% (95% vs 91%) greater among participants offered reimbursement at three- and six-month time-points, respectively	Results suggest providing Service members reimbursement for research participation is associated with modest increases in retention rates in clinical trials. Important to note this was not disease oriented
Campbell, 200727	People in two outpatient waiting rooms were approached. The questionnaire assessed motivation toward trial involvement through use of five-point Likert-type scales and hypothetical trial scenarios; it also analyzed reasons for participation through subject ranking of reasons.	Veterans' likelihood of participation was only significantly different than non veterans' in relation to one clinical trial scenario - a clinical trial where all subjects were randomized to receive a new medication or placebo for research about a chronic disease for which there was no usual treatment such as Alzheimer’s (p = 0.011) Veterans had different reasons for trial participation than non veterans: To help mankind and further improve medical care for others [altruism] (P = 0.024) Paying back” the people who have treated them (p = 0.003) Acquiring money for volunteering less important to Veterans (p < 0.001) Comparing Veterans with armed conflict and inexperienced counterparts: Reasons for participation similar Veterans with combat experience valued financial compensation less, and altruism, and contributing to medical research based on the care received more	Knowledge of the varying reasons for participation could potentially aid recruitment efforts.
Littman, 201828	10 focus groups in a purposive sample of 89 OEF/OIF Veterans in five US cities Key topics included: Reasons for participating or declining to participate in health-related research Logistics around study Recruitment and conduct Compensation Written materials Information sharing preferences for study results	Key determinants of participating in health-related research were: Receipt of adequate compensation “Duty, honor, and doing the right thing ” -- a desire to fulfill an obligation to help other Veterans Perception of the research topic as relevant and important. For many, both sufficient compensation and a sense that the study would help other Veterans were critical. Important potential deterrents to participating in a research study included considerations regarding the relative costs (e.g., inconvenience, time away from work and family) and risks related to privacy and information security, losing VA benefits, and study participation (e.g., experimental drugs) were Before considering participation, Veterans needed assurance that the study was legitimate and not a “scam”. Interacting with study personnel who were professional, courteous, knowledgeable was also noted as being helpful Importance of transparency a key theme Vague language about study aims or procedures engendered distrust. Desire for studies to communicate results of their specific health tests, as well as overall study findings, back to research participants	Veterans described trust, transparent communication, and respect as essential characteristics of research in which they would be willing to participate.
Hillyer, 2021current study	Survey assessing sociodemographic characteristics, health literacy, and general attitudes about clinical trials Univariable analyses were conducted to evaluate differences in attitudes by age (<65 vs. ≥65 years) and race/ethnicity (non-Hispanic black vs. other).	67/115 (58.3%) Veterans approached completed survey 58.2% reported knowing what a clinical trial is 78.5% stated that they trust doctors who do medical research 87.5% would strongly consider joining a trial if recommended by VA primary care physician 93.8% would participate in a clinical trial if it would help fellow Veterans in the future ( 93.8% would participate in a clinical trial if it would help scientists learn how to treat other Veterans with the same disease 62.5% of non-Hispanic black participants agreed government has a history of using Veterans in experiments without their knowledge compared to 34.2% of Veterans of other race/ethnicity (p = 0.03).	Overall attitudes toward clinical trials were favorable especially when possibility of improving cancer care for fellow Veterans was considered In approaching Veterans regarding participation in a clinical trial recommend: Education aligned with the literacy level of the Veteran Involvement of the VA primary care provider in clinical trial decisions Awareness of a Veteran’s altruism to help othersinformation

Abbreviations: OEF, Operation Enduring Freedom; OIF, Operation Iraqi Freedom