Identifying physician perspectives of facilitators and barriers in clinical trial accrual to inform implementation strategies for advancing equitable enrollment in a large comprehensive cancer center.

Abstract

e23030 Background: While robust infrastructure is established to support high quality clinical trials at USC Norris Comprehensive Cancer Center (NCCC), implementation strategies and maintenance of health equity goals remain critical to ensuring clinical trials align with catchment area communities. This study aims to assess current processes, facilitators, and barriers to trials enrollment across NCCC to inform provider and system-based strategies needed to achieve and sustain equitable trials enrollment. Methods: From September-December 2024, we administered a semi-structured survey with oncology providers, physicians and advance practice providers (APPs) at USC NCCC to understand their experiences enrolling patients to trials, beliefs and attitudes about referring patients to trials, clinic workflows, patient barriers, organizational culture and practice change opportunities to improve trial accrual. Surveys were administered via REDCap link to medical oncology, hematology, gynecologic oncology, and radiation oncology at cancer center or satellite clinic sites. Survey results were analyzed using descriptive statistics presented in frequencies and means. Results: Survey participants (n = 49) were 47% female, 96% oncologists/hematologists and 4% APPs. A large proportion (41%) have practiced for <5 years. While nearly 96% of providers reported clinical trials as an important part of patient care and 100% reported exposure to clinical trials training, 45% indicated they have gaps in their knowledge or understanding of accrual to trials. We noted inner and outer setting facilitators and barriers as opportunities for improvement in equitable enrollment. Inner setting opportunities include staffing (57%) and ongoing information about trials offered within specific clinic sites (65%). Outer setting barriers include patients' medical mistrust (74%) and limitations in available language translation (61%). Conclusions: Advancing health equity in clinical trials requires multi-stakeholder perspectives and co-design with providers and clinic teams to best align with inner setting (system process, roles, supports) and outer setting (community barriers, linguistic and cultural) factors that impact trials participation from diverse communities. Our results indicate barriers within the study population that lend themselves to targeted interventions such as broader education on clinical trials, dissemination and accessibility of information about trials amongst providers in various practice settings, and patient education.