Health Care Providers

Physician referral is one of the most effective clinical trial awareness and recruitment strategies, but physicians’ lack of awareness on clinical trial availability is a contributing factor to low referral rates. We present opportunities to engage local and community providers in improving minority accrual to clinical trials.

Physicians play an important role in educating and encouraging patients to participate in clinical trials. This figure displays the role of physicians in clinical trial participation among patients who do and do not participate in clinical trials.

Role of Physician in Clinical Trials Participation
Chart: Role of Physician in Clinical Trials Participation

Trial participants are far more likely to have had a doctor educate them about participation and help them find a suitable clinical trial. Patients who participate in clinical trials are also more likely to have first learned about the possibility of participating through a doctor than patients who are aware but choose not to participate. Most patients who participate in clinical trials say that a doctor had a great deal of influence on their decision to participate.

An important question to ask when trying to improve minority accrual to clinical trial is:

How do we get primary care providers and other referring physicians more engaged in making referrals to our practice or institution?

Targeting Healthcare Providers

As noted earlier, physician referral is one of the most effective clinical trials recruitment strategies. However, low physician awareness regarding clinical trial contributes to non- referral rates.

Most clinical trials are conducted at academic and cancer centers, while most cancer patients receive treatment at community medical centers where access to clinical trials may be limited. Improving minority participation in clinical trials requires strategies to increase clinical trial awareness and facilitate community-based recruitment of cancer patients.

Opportunities for involving community physicians in clinical trials appear at the Planning Phase – where engagement of community physicians improves trial design, and inPartnership – where collaboration with local primary care physicians enhances mutual awareness and understanding regarding clinical trials.

Here we presented some Strategies for Engaging Local Physicians

Building new relationships and reach out to existing networks. Relationships with referring physicians can be initiated through activities such as: formal and informal introductions, conversation at meetings, service offers (e.g. giving a presentation of interest to the physician’s practice).

Educate referring providers about clinical trials in general and types of trials available at your institution. Educating referring physicians is an important but frequently overlooked tool for increasing participation in clinical trials. Visits to the referring physician’s office to give an interactive talk and answer questions and concerns staff may have about the role of clinical trials in cancer care can be mutually beneficial. When holding meetings at referring physician’s practice, it is important to involve nurses and other staff at the practice.

Recommend actions for the referring physician and his/ her team, such as advising them to introduce the concept of a clinical trial as a viable treatment option. Other actions that can be recommended include: referring patients who are potentially eligible to oncologists who conduct clinical trials, providing 3 patients with print or other materials about clinical trials, and encouraging patients to ask their oncologist about clinical trials.

Some additional strategies to Engage Local Physicians

Publish reports, newsletters, websites or letters outlining your clinical trial, that can be shared with local physicians.

Develop a clear policy for maintaining communication and keeping them updated about their patients. Once a trusting relationship with a referring practice has been established, it is important to maintain it through frequent contact.

Make presentations before local physician groups and medical societies.

Establish realistic expectations; set practical goals. It is important for the oncologist to emphasize that the research team is prepared to do the work necessary for clinical trial participation and that expectations of the referring office will not be greater than when the patient they refer undergoes standard therapy.

A Practical Example of an intervention is the “Physician Champion”

The concept of “physician champion” has been used to engage physicians by designating a specialist, say a urologist, to serve as the local principal investigator for a study. This provides an opportunity for the specialist to serve as the trial’s physician champion.

Consider collaborating with healthcare providers and/or institutions that see a great proportion of minority patients.

Case Study: ENACCT’s Pilot Education Program (PEP) for Primary Care Providers

ENACCT's Pilot Education Program (PEP) for Primary Care Providers
Chart: ENACCT’s Pilot Education Program (PEP)

A person diagnosed with cancer may learn about the facts and importance of Cancer Clinical Trials (CCTs) through his / her peers. They are offered all treatment options including CCTs by oncologist in a culturally competent manner and experience fewer barriers to access.

But ideally the person is encouraged to ask his or her oncologist about CCTs by a primary care provider with whom they already have a trusting relationship.

Case Study: ENACCT’s Pilot Education Program (PEP) for Primary Care Providers

The PEP program was a partnership-led education and advocacy initiative created to change knowledge among community leaders, primary care providers and clinical research staff. The program provided influential intermediaries with training and information that would encourage them to adopt, and help others like themselves to adopt, a new proactive role in informing patients about clinical trials as a quality treatment option. The Education Network to Advance Cancer Clinical Trials (ENACCT) team held training programs with selected primary care “provider trainers.”

Goals of the program included change in knowledge, attitudes and beliefs about cancer clinical trials (CCTs) among provider trainees; desired outcomes included positive changes in attitude on their role in CCT referral; and Increased discussion with patients and peers about CCTs.

Case Study: ENACCT’s Pilot Education Program (PEP) for Primary Care Providers

Training emphasized types of discussion primary care providers (PCPs) could have with their patients and peers about CCTs, framing CCT access as a quality of care issue. Provider trainers delivered four 2- hour workshops to other PCPs on feasible clinical trial discussions with patients. PCPs who participated in this educational program had a significant increase in knowledge about CCTs and reported positive attitudes about the role of a PCP in referring patients to CCTs.

What are some strategies to engage the Health Care Team?

Educate and train staff to explain clinical trials to minority patients.

In addition to knowing protocol requirements, staff must be aware of and sensitive to cultural beliefs and norms as well as participation barriers (see training module on Cultural Competency)

Staff must possess effective communication skills to effectively assess the likely level of acceptance on the part of the patient

All members of the health care team should be educated and committed to the goal of improving minority participation in clinical trials.

Practical and effective strategies to increase clinical trial awareness for Healthcare Providers…

Including community providers during planning phase of trials

Collaborating with local referring physicians and oncologists

Improving staff awareness of patients’ cultural beliefs and norms

In short, the entire team should be educated and committed to the goal of improving minority accrual to Clinical Trials.

Would you like to partner with EMPaCT in the work of improving clinical trial awareness?

For more information and opportunities to implement and evaluate the strategies presented, please refer to the following pages in this Training Course:

Resources for Improving Clinical Trial Awareness (review & rate existing resources)

Important Literature on Methods for Improving Clinical Trial Awareness and Enrollment

This presentation has been brought to you by EMPACT, enhancing minority participation in clinical trials.