Early Phase Clinical Trials: Referral Barriers and Promoters among Physicians.

Background: Physician referral is among the most effective means of recruiting patients into cancer clinical trials. Therefore, to increase minority representation in early-phase clinical trials (EPCTs), specifically accrual of Latinos, it is first necessary to examine physicians' attitudes and practices regarding these studies and factors that influence physicians' referral decisions.

Methods: This study surveyed oncologists (N=111) from a Texas Medical Association mailing list to examine barriers and promoting factors associated with physician referral of patients to EPCTs and identify areas for intervention to increase accrual of Latinos and other minorities into clinical research. Exploratory factor analysis was conducted to identify underlying dimensions, and significant factors that promote or deter physicians from referring patients to EPCTs were assessed through multiple logistic regression.

Results: Burden of the clinical trial process was the only significant dimension associated with referring patients to EPCTs. Physicians who agreed with this set of logistical barriers-such as diverting time and resources away from their practice-were less likely to refer patients than physicians with opposing opinions (OR= 0.28, 95% CI= 0.08-0.94).

Conclusion: This study, one of the first to identify physician barriers for referring patients to EPCTs in Texas, highlights potential focal areas for physician and community-based education and communication to promote clinical trial opportunities among both minority and non-minority patients. Given that Texas physicians deal with a large proportion of Latino patients, such efforts could also address ethnic disparities in clinical trial participation, which will become increasingly important as the Latino population continues to grow.