Best practices
Develop evidence-based training initiatives to improve provider communication when discussing a trial with a patient. Physician leaders should educate colleagues about such initiatives and serve as mentors in training new researchers and staff. Provide incentives for clinicians to participate in research. Incentives may include protected time, administrative support, training, and participation in professional meetings. Disseminate availability of local trials to primary care providers and other referring providers through the mechanisms most widely used in that community, using culturally appropriate material. Recruit investigators from minority/underserved communities. Provide ongoing feedback to referring physicians while their patients are on a trial. Adopt elements of recruitment planning and work with research teams to ensure commitment to such plans. Elements could include screening, enrollment, and retention rates; identification of sources for accrual; contingency strategies for slow accrual; and evaluation of those strategies. Use information technology, such as registries and electronic health records, to identify potentially eligible patients more efficiently and reduce chart-review time. Publish on strategies that led to successful accrual to trials. Methodologically rigorous studies of accrual interventions are needed in the literature.
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| Future research |
Physician/provider communication
Study physician and research team communication with prospective trial participants and identify the most successful and efficient methods for improving patient understanding of trials, accrual, and satisfaction with care. This could involve comparing the ways in which high- versus low-accruing physicians and/or research teams communicate with their patients. Test the effectiveness of training physicians and research teams in these communication methods and evaluate for improvements in patient understanding of trials, accrual, and satisfaction with care. Identify the optimal timing to offer and discuss clinical trials with patients, including timing relative to initial diagnosis and presentation of treatment options.
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Recruitment planning and evaluation by investigators
Determine which recruitment strategies are most helpful for specific types of studies. Embed accrual studies in appropriate Cooperative Group trials to generate evidence-based strategies for recruitment (ie, prospective testing of recruitment interventions). Identify meaningful metrics for evaluating recruitment strategies and the impact of correction plans, in real time, on improving accrual. Assess the impact on accrual of using documented, comprehensive recruitment plans. Test the use of screening logs as a recruitment evaluation tool. Evaluate the utility of patient registries, databases, and electronic tools for increasing accrual, such as those offered through NIH's Clinical and Translation Science Awards ResearchMatch176,177 and NCI's AccrualNet,172,173 which may have potential benefit for busy sites.
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