Barriers to Participation in Clinical Trials: a Physician Survey

Mahmud, Aamer; Zalay, Osbert C.; Springer, A.; Arts, Karen E.; Eisenhauer, Elizabeth

doi:10.3747/co.25.3857

Cited by 57 publications

(70 citation statements)

References 11 publications

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“…This may correspond with previous findings describing the barriers faced by Canadian physicians when participating in clinical research. 37 Moreover, clinicians from countries with higher survival, such as Denmark and Norway, were more likely to report having no barriers to providing optimal treatment, whereas clinicians from countries with lower survival often reported a lack of treatment monitoring (via national and/or local audit) as a perceived barrier. One example of a current national auditing system is the Danish Gynecological Cancer Database, which has collected data on all women with ovarian cancer treated at Danish hospitals since 2005.…”

Section: Surgerymentioning

confidence: 99%

Exploring international differences in ovarian cancer treatment: a comparison of clinical practice guidelines and patterns of care

Norell

Butler

Farrell

et al. 2020

Int J Gynecol Cancer

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IntroductionThe International Cancer Benchmarking Partnership demonstrated international differences in ovarian cancer survival, particularly for women aged 65–74 with advanced disease. These findings suggest differences in treatment could be contributing to survival disparities.ObjectiveTo compare clinical practice guidelines and patterns of care across seven high-income countries.MethodsA comparison of guidelines was performed and validated by a clinical working group. To explore clinical practice, a patterns of care survey was developed. A questionnaire regarding management and potential health system-related barriers to providing treatment was emailed to gynecological specialists. Guideline and survey results were crudely compared with 3-year survival by ‘distant’ stage using Spearman’s rho.ResultsTwenty-seven guidelines were compared, and 119 clinicians completed the survey. Guideline-related measures varied between countries but did not correlate with survival internationally. Guidelines were consistent for surgical recommendations of either primary debulking surgery or neoadjuvant chemotherapy followed by interval debulking surgery with the aim of complete cytoreduction. Reported patterns of surgical care varied internationally, including for rates of primary versus interval debulking, extensive/‘ultra-radical’ surgery, and perceived barriers to optimal cytoreduction. Comparison showed that willingness to undertake extensive surgery correlated with survival across countries (rs=0.94, p=0.017). For systemic/radiation therapies, guideline differences were more pronounced, particularly for bevacizumab and PARP (poly (ADP-ribose) polymerase) inhibitors. Reported health system-related barriers also varied internationally and included a lack of adequate hospital staffing and treatment monitoring via local and national audits.DiscussionFindings suggest international variations in ovarian cancer treatment. Characteristics relating to countries with higher stage-specific survival included higher reported rates of primary surgery; willingness to undertake extensive/ultra-radical procedures; greater access to high-cost drugs; and auditing.

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Section: Surgerymentioning

confidence: 99%

Exploring international differences in ovarian cancer treatment: a comparison of clinical practice guidelines and patterns of care

Norell

Butler

Farrell

et al. 2020

Int J Gynecol Cancer

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“…Many talked at some length of their struggles to reconcile the significant costs associated with involvement in trials with the increasing pressures on their clinical service. Other authors have documented the considerable time and other costs associated with involvement in trials [42][43][44], with some citing financial constraints as a significant barrier to involvement in (noncommercial) trials [37]. More than a decade ago Snowden et al [45] argued that financial considerations shaped all aspects of trial work and deserved far closer scrutiny than they had received.…”

Section: Discussionmentioning

confidence: 99%

Clinician–researchers and custodians of scarce resources: a qualitative study of health professionals’ views on barriers to the involvement of teenagers and young adults in cancer trials

Hart

Hallowell

Harden

et al. 2020

Trials

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Background: Equipoise and role conflict have been previously identified as important factors in professionals' engagement with trials, inducing behaviours which can impact on recruitment. We explored these phenomena as potential explanations for the low levels of involvement of teenagers and young adults (TYA) with cancer in clinical trials in oncology. Methods: We report findings from interviews with 30 purposively sampled direct-care professionals involved in delivering cancer care and/or facilitating clinical trials in Scotland. We undertook qualitative descriptive analysis, focussed on identifying key issues and themes. Results: Interviewees largely identified as clinician-researchers and portrayed oncology as a specialty in which research was integral to care. They saw their primary responsibility as ensuring patients received the best treatment, but asserted that, in general, trials provided a vehicle for optimal care. Role conflict in its traditional form was rarely evident; however, other tensions were manifest. Professionals found the significant time costs of delivering trials difficult to reconcile with the increasing pressures on clinical services. They felt a responsibility to make prudent choices about the trials with which to engage. Guided by utilitarian principles, these choices were oriented towards benefiting the largest number of patients. This favoured trials in high volume diseases; as TYA tend to have rarer forms of cancer, professionals' support for-and TYA's access to-relevant trials was, by default, more limited. Conclusions: Neither lack of individual equipoise nor experiences of traditional forms of role conflict accounted for the low levels of involvement of TYA with cancer in clinical trials. However, prominent tensions around the management of scarce resources provided an alternative explanation for TYA's limited access to cancer trials. The prevailing approach to decision-making about whether and which trials to support was recognised as contributing to inequalities in access and care. Professionals' choices, however, were made in the context of scarcity, and structured by incentives and sanctions understood by them as signalling governmental priorities. A franker discussion of the extent and distribution of the costs and benefits of trials work is needed, for change to be achieved.

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“…Tensions preventing research in HIC are many, and largely unchanged over the past 30 years. [15][16][17][18][19][20][21][22] Although BMJ Global Health Clinical load. Advocacy at institutional level for dedicated research time.…”

Section: Tensions In Hic and Lmicmentioning

confidence: 99%

Fostering global primary care research: a capacity-building approach

et al. 2020

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The Alma Ata and Astana Declarations reaffirm the importance of high-quality primary healthcare (PHC), yet the capacity to undertake PHC research—a core element of high-quality PHC—in low-income and middle-income countries (LMIC) is limited. Our aim is to explore the current risks or barriers to primary care research capacity building, identify the ongoing tensions that need to be resolved and offer some solutions, focusing on emerging contexts. This paper arose from a workshop held at the 2019 North American Primary Care Research Group Annual Meeting addressing research capacity building in LMICs. Five case studies (three from Africa, one from South-East Asia and one from South America) illustrate tensions and solutions to strengthening PHC research around the world. Research must be conducted in local contexts and be responsive to the needs of patients, populations and practitioners in the community. The case studies exemplify that research capacity can be strengthened at the micro (practice), meso (institutional) and macro (national policy and international collaboration) levels. Clinicians may lack coverage to enable research time; however, practice-based research is precisely the most relevant for PHC. Increasing research capacity requires local skills, training, investment in infrastructure, and support of local academics and PHC service providers to select, host and manage locally needed research, as well as to disseminate findings to impact local practice and policy. Reliance on funding from high-income countries may limit projects of higher priority in LMIC, and ‘brain drain’ may reduce available research support; however, we provide recommendations on how to deal with these tensions.

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Barriers to Participation in Clinical Trials: a Physician Survey

Abstract: 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.

Cited by 57 publications

References 11 publications

Exploring international differences in ovarian cancer treatment: a comparison of clinical practice guidelines and patterns of care

Exploring international differences in ovarian cancer treatment: a comparison of clinical practice guidelines and patterns of care

Clinician–researchers and custodians of scarce resources: a qualitative study of health professionals’ views on barriers to the involvement of teenagers and young adults in cancer trials

Fostering global primary care research: a capacity-building approach

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