Barriers and facilitators to discussion of cancer clinical trials: A qualitative study.

Abstract

e18588 Background: NCCN guidelines indicate that cancer clinical trials (CCTs) are the best management for patients with cancer. However, only 5% of patients enroll in CCTs. Few studies have examined oncology providers’ perceptions of the barriers and facilitators to discussing CCTs. Methods: This qualitative study was part of the ASCO-ACCC Initiative to Increase Racial and Ethnic Diversity in Clinical Trials. A convenience sample of 10 U.S oncology providers participated in this sub-study. Their perceived barriers and facilitators to discussion of CCTs at the provider, patient, system, and CCTs levels were examined. To achieve triangulation, each provider reviewed 5 recent patient encounters to identify actual barriers and facilitators using chart-stimulated recall (CSR). Results: Nine participants were oncologists and 1 was a clinical research coordinator; 5 were female; 4 were White; 3 were Asian and 3 were Black. The table shows the most cited barriers and facilitators to discussion of CCTs, and the number of interviews in which those barriers or facilitators was mentioned. Barriers were patients’ negative attitudes and lack of knowledge of CCTs, provider assumptions about patients, lack of time to discuss CCTs and restrictive CCT eligibility criteria. Facilitators were having a CCT workforce, systematically discussing CCTs with all patients, patients requiring new treatment options or were aware of CCTs, and electronic medical record (EMR) strategies. CSR validated the most cited barriers and facilitators except patient negative attitudes and system barriers and facilitators. Conclusions: Many of the barriers to discussing CCTs are addressable with the cited facilitators (e.g. assumptions can be addressed by systematically discussing CCTs with all patients; lack of time to discuss CCTs can be addressed by a robust CCT workforce; restrictive CCT criteria can be broadened). A larger study is needed to further generalize and validate the findings. [Table: see text]