Barriers to participation in clinical trials: a physician survey

Abstract

Background: Clinical trials are vital for evidence-based cancer care. Oncologist engagement in clinical trials has an effect on patient recruitment, which in turn can affect trial success. Identifying barriers to clinical trial participation might enable interventions that could help to increase physician participation.

Methods: To assess factors affecting physician engagement in oncology trials, a national survey was conducted using the online SurveyMonkey tool (SurveyMonkey, San Mateo, CA, U.S.A.; http://www.surveymonkey.com). Physicians associated with the Canadian Cancer Clinical Trials Network and the Canadian Cancer Trials Group were asked about their specialty, years of experience, barriers to participation, and motivating interventions, which included an open-ended question inviting survey takers to suggest interventions.

Results: The survey collected 207 anonymous responses. Respondents were predominantly medical oncologists (46.4%), followed by radiation oncologists (24.6%). Almost 70% of the respondents had more than 10 years of experience. Significant time constraints included extra paperwork (77%), patient education (54%), and extended follow-up or clinic visits (53%). Timing of events within trials was also a barrier to participation (55%). Most respondents favoured clinical work credits (72%), academic credits (67%), a clinical trial alert system (75%), a regular meeting to review trial protocols (65%), and a screening log to aid in patient accrual (67%) as motivational strategies. Suggested interventions included increased support staff, streamlined regulatory burden, and provision of greater funding for trials and easier access to ancillary services.

Conclusions: The present study confirms that Canadian oncologists are willing to participate in clinical research, but face multiple barriers to trial participation. Those barriers could be mitigated by the implementation of several interventions identified in the study.

Keywords: Clinical trials; barriers; cross-sectional studies; health operations research; motivating interventions; oncologists; physician engagement surveys; trial participation.

FIGURE 1

Medical specializations of the 207 survey respondents.

FIGURE 2

Years of practice for the 207 survey respondents.

FIGURE 3

(A) Time constraints to participation in clinical trials (207 respondents). (B) Weighted agreement score. Of the respondents, 76% ranked extra paperwork in clinical trials as a significant time constraint. More than 50% of respondents agreed that additional clinic visits or extended follow-up and patient education were barriers, but more respondents strongly agreed that, compared with educating the patient about the trial (9%), additional clinic visits constituted a barrier (13%).

FIGURE 4

(A) Other barriers to participation in clinical trials (204 respondents). (B) Weighted agreement score. Of the respondents, 51% agreed that the timing of events in trials was a barrier; however, only 8% strongly agreed. More than 50% of respondents disagreed that trials deviated from standard of care or that lack of complete awareness of trials was problematic, with 20% strongly disagreeing that complete awareness constituted a barrier.

FIGURE 5

(A) Motivating interventions for clinical trial participation (204 respondents). (B) Weighted agreement score. Clinical and academic work credits were highly ranked by respondents (29.6% and 19.6% expressing strong agreement respectively), with 72% and 67% expressing overall agreement respectively. Most respondents agreed with using a clinical trial alert system to draw attention to new trials (78%), a regular meeting to review trial protocols (66%), and a screening log to aid in patient accrual (65%). Attendance at an annual conference presenting new trials and trial planning software attracted less agreement (43% and 42% agreement respectively).