Department of Health Policy & Management, University of Kansas School of Medicine, Kansas City, KS; University of Kansas Cancer Center, Kansas City, KS.
School of Journalism and Mass Communications, University of Kansas, Lawrence, KS; University of Kansas Cancer Center, Kansas City, KS.
Urol Oncol. 2019 Aug;37(8):529.e9-529.e18. doi: 10.1016/j.urolonc.2019.03.004. Epub 2019 Mar 29.
Engaging community urologists in referring patients to clinical trials could increase the reach of cancer trials and, ultimately, alleviate cancer disparities. We sought to identify determinants of referring patients to clinical trials among urology practices serving rural communities.
We conducted semistructured qualitative interviews based on the Theoretical Domains Framework at nonmetropolitan urology practices located in communities offering urological cancer trials. Participants were asked to consider barriers and strategies that might support engaging their patients in discussions about urological cancer clinical trials and referring them appropriately. Recorded interviews were transcribed and coded using template analysis.
Most participants were not aware of available trials and had no experience with trial referral. Overall, participants held positive attitudes toward clinical trials and recognized their potential roles in accrual, but limited local resources reduced opportunities for offering trials. Most participants expressed a need for increased human, financial, and other resources to support this role. Many participants requested information and training to increase their knowledge of clinical trials and confidence in offering them to patients. Participants highlighted the need to build efficient pathways to identify available trials, match eligible patients, and facilitate communication and collaboration with cancer centers for patient follow-up and continuity of care.
With adequate logistical and informational support, community urology practices could play an important role in clinical trial accrual, advancing cancer research and increasing treatment options for rural cancer patients. Future studies should explore the effectiveness of strategies to optimize urology practices' role in clinical trial accrual.
让社区泌尿科医生参与患者转介至临床试验，可能会增加癌症试验的覆盖范围，并最终减轻癌症的差异。我们试图确定服务于农村社区的泌尿科实践中，将患者转介至临床试验的决定因素。
我们在提供泌尿科癌症试验的社区中的非大都市泌尿科实践中进行了基于理论领域框架的半结构化定性访谈。要求参与者考虑可能支持他们与患者讨论泌尿科癌症临床试验并适当转介他们的障碍和策略。记录的访谈使用模板分析进行转录和编码。
大多数参与者不知道可用的试验，也没有试验转介经验。总体而言，参与者对临床试验持有积极的态度，并认识到他们在入组方面的潜在作用，但有限的本地资源减少了提供试验的机会。大多数参与者表示需要更多的人力、财务和其他资源来支持这一角色。许多参与者要求提供信息和培训，以增加他们对临床试验的了解，并增强他们为患者提供临床试验的信心。参与者强调需要建立有效的途径，以确定可用的试验、匹配合格的患者，并促进与癌症中心的沟通和协作，以进行患者随访和连续性护理。
在获得充足的后勤和信息支持的情况下，社区泌尿科实践可以在临床试验入组方面发挥重要作用，推进癌症研究并为农村癌症患者提供更多治疗选择。未来的研究应探讨优化泌尿科实践在临床试验入组中的作用的策略的有效性。
