Identification of Organizational Barriers to HMO Participation in Cancer Clinical Trials

Background

Cancer clinical trials offer the opportunity for cancer patients to access state-of-the-art treatments and, in the process, contribute to the scientific knowledge base about effectiveness of curative interventions. However, accrual to clinical trials is far from optimal. Only about 5 percent of cancer patients receive care through a treatment trial. Understanding the factors that promote or impede trial participation is an essential step toward increasing accrual. Community-based practices, such as HMOs care for a significant proportion of cancer patients, and are thus well-positioned to reach these patients and extend state-of-the-art treatment to them via cancer clinical trials.

Study Aim

This study focused on identifying the organizational barriers that may deter non-profit HMOS from participating in cancer clinical trials and developing approaches, which can later be empirically tested, to overcoming these barriers.

Methods

The study team used surveys and semi-structured interviews to investigate organizational barriers to clinical trials. A self-administered survey was mailed to all of the oncologists at 10 of the 11 sites. A four-phase data collection strategy was implemented to maximize the response rate, and an overall response rate of 90 percent was achieved. Investigators also conducted key-informant interviews with health plan and oncology leaders at the 10 CRN sites.

Significance

The environment surrounding clinical trials continues to change rapidly. Based on recommendations from the Clinical Trials Program Review Group, the National Cancer Institute is undertaking a number of initiatives to develop a more efficient and effective clinical trials system. Identifying the constellation of factors that are associated with organizational support for patient participation in clinical trials is another step in this process.

Project Status

This study was funded as an administrative supplement to the CRN parent grant. Carol Somkin, PhD, from Kaiser Permanente Northern California, was the project leader. The primary aim of the study has been accomplished, and preparation and presentation of findings is nearing completion.

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