Organizational Barriers to Physician Participation in Cancer Clinical Trials
Objective
To assess barriers to physician participation in cancer
clinical trials among oncologists, oncology leaders, and health
plan leaders.
Study Design
Mail survey of 221 oncologists combined with
semistructured telephone interviews with oncology and plan leaders
at 10 integrated healthcare systems.
Methods
The survey instrument examined physicians' involvement
in clinical trials; their perception of the value of trials to them,
their patients, and their organization; and the presence of infrastructure
support for trials and associated resource constraints. The
interviews investigated similar issues from the leaders' perspective.
We used linear regression to model trial enrollment and standard
qualitative techniques to analyze the interviews.
Results
Oncologists estimated they enrolled 7% of patients in
trials. They expressed extremely favorable attitudes toward trials as
a source of high-quality patient care and a benefit to themselves
professionally. While positive attitudes toward trials were common,
and were significant bivariate predictors of enrollment, organizational
factors were the predominant predictors in multivariate
analysis. The best combination of factors independently predicting
enrollment related to organizational support for trials, subspecialty
of the oncologist, and limitations of trial eligibility requirements.
Conclusions
To increase trial participation, there is a critical
need for infrastructure to support trials, especially additional support
staff and research nurses. In addition, there is a need for better
intra-organizational communication and consideration of the
impact of trial design on internal health plan resources. This
research supports the need to continue a national dialogue about
the broadly defined benefits and costs of clinical trials to patients,
physicians, and health plans.
Return to top
|