Table 3.

Barriers clinicians have identified regarding participation in clinical research

Addressing professional values:
Study questions	Study questions are not pertinent to topics of interest for clinicians, their practice, or their patients.
Study design feasibility	Study inclusion and exclusion criteria make most community practice patients ineligible.
Clinician's relationships with clinical/scientific communities	Clinicians need reassurance that research engagement does not threaten the doctor-patient relationship.
Clinician and patient distrust of research	Equitable access to research opportunities & to care reflecting research findings will help address longstanding mistrust by clinicians and patients for research endeavors.
Developing necessary infrastructure:
Data quality	Assuring data quality in office settings is challenging, particularly given the lack of uniformity of study design across studies.
Design efficiency	Adequate and efficient training for successful research participation is not readily available or pertinent to clinician practice settings.
Study costs	Costs and effort associated with transient research engagement are excessive.
Research training	Local research training efforts are not rigorous enough.
Assuring privacy	Accessing IRB and HIPAA certification is burdensome and time-consuming.
Research engagement	Research participation is isolating without systematic feedback about performance, data quality, and research findings.
Realigning financial incentives:
Scheduling	There is no time to do research in a busy practice.
Reimbursement	Clinical research participation will not be reimbursed adequately.
Liability	The adequacy of legal liability (insurance?) for research participation for practicing clinicians is murky.
Predictability	Unpredictable nature of research (sporadic study availability, changes in costs and reimbursement rates).
Information availability	Information is not readily available (study questions, protocols, reimbursement schedules, study-specific enrollment, data quality).