Primary care (PCP) and oncology (ONC) provider perspectives on primary care involvement in cancer clinical trial discussions in a safety-net health system.

Abstract

e13592 Background: A collaborative model of care between PCPs and ONCs within safety-net systems may be needed to increase representative enrollment in cancer clinical trials. We evaluated provider attitudes toward PCP involvement in early clinical trial discussions, alignment and misalignment between PCP and ONC expectations. Methods: A cross-sectional survey of PCPs and ONCs at a safety-net healthcare system affiliated with a Comprehensive Cancer Center assessed attitudes, communication, and behaviors about clinical trials, barriers and facilitators to accrual, and utility of various supportive strategies. Two clinical vignettes (Spanish vs. English speaking patients) assessed provider approaches to communication and enrollment support using mixed-effects ordinal regression. Results: Respondents included 78 PCPs and 57 ONCs (35% and 39% attending physicians, 51% and 23% trainees, and 6% and 30% advanced practice providers, respectively). For the vignettes, there was no difference in responses between PCPs and ONCs (p > .05). Among vignette response choices (multiple allowed), most PCPs (64%) strongly agreed with referring patients to ONCs for further trial discussion whereas 52% reported indifference to recommending trial participation. Most ONCs strongly agreed with discussing trials themselves (58%) and referring patients to research staff (75%). Both PCPs and ONCs identified similar patient-, trial-, and system-level barriers and facilitators to trial discussions (Table). PCPs agreed they have an important role in informing patients about trials (56%), especially for increasing representative enrollment (73%). Although ONCs agreed that PCPs play an important role in patients’ cancer care (81%) and in enhancing trial diversity (56%), most (53%) reported that PCPs should not initiate trial discussions. In ranking strategies to support PCP-led trial discussions, PCPs and ONCs both prioritized access to centralized, up-to-date trial information. Incentive-based strategies ranked lowest among PCPs and mid-tier for ONCs. Conclusions: We identified provider-endorsed system-level strategies to normalize trial conversations and support equitable trial accrual that may be feasible and scalable across primary care and oncology settings. The absence of language effects suggests that these supports may be broadly applicable in safety-net settings. Provider-reported barriers and facilitators to cancer clinical trial discussions (Percent endorsing “strongly agreed”). Domain PCP (%) ONC (%) Facilitators Coverage of non-standard procedures 76 68 In-person interpreters 64 65 Research navigation NA 63 Financial support 60 58 Transportation 53 60 Barriers Personal knowledge of trial opportunities 85 NA Time constraints 53 14 Patient fear of research participation 44 28 Health literacy 41 23 NA: Not Applicable.