title: Factors that predict the referral of breast cancer patients onto clinical trials by their surgeons and medical oncologists.
abstract: OBJECTIVE
  To improve understanding of physicians' reluctance to refer patients to clinical trials.
  
  
  METHODS
  This study was conducted in a large metropolitan region from 1993 to 1995 using a two-staged population-based sampling strategy. A total of 147 physicians discussed 245 patient cases and their own knowledge, attitudes, and practices toward clinical trials.
  
  
  RESULTS
  Ninety-three patients (38. 0%) were offered a trial, and 49 (52.7%) of them agreed to participate. Forty-five patients (18.4%) actually received their adjuvant therapy on trial. Older patients and those with a poorer prognosis were less likely to be referred. Patients who delayed their decision were more than three times as likely to participate in a trial and more than eight times as likely to participate when they were reported to be actively involved in making the decision. Generally, physicians in university settings and who had formal support from a cooperative group were more likely to refer patients to trials. More specifically, surgeons referred more patients to trials when they felt comfortable explaining trials or believed that treatment should not stray from protocol. Oncologists were less likely to make referrals if they perceived the paperwork to be onerous or entry requirements to be too stringent. Surgeons' participation in recommending adjuvant therapy to patients resulted in more trial referrals unless they treated their patients with tamoxifen.
  
  
  CONCLUSIONS
  (1) Physicians still need to overcome attitudinal and practical barriers to trial participation, (2) more support for physicians is needed, (3) surgeons may play a pivotal role in the recruitment of patients to adjuvant therapy trials, and (4) garnering patient enthusiasm for trial participation and involving them in the choice of adjuvant therapy may be key components to increasing trial enrollment.
authors.affiliation: Case Western Reserve University, Cleveland, OH 44106-4961, USA. LAS5@po.cwru.edu
authors.forename: L A
authors.initials: LA
authors.lastname: Siminoff
authors.forename: A
authors.initials: A
authors.lastname: Zhang
authors.forename: N
authors.initials: N
authors.lastname: Colabianchi
authors.forename: C M
authors.initials: CM
authors.lastname: Sturm
authors.forename: Q
authors.initials: Q
authors.lastname: Shen
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000628:therapy*; D002986:Clinical Trials as Topic; D003657:Decision Making; D005260:Female; D013502:General Surgery; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D010414:Pennsylvania; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D012044:Regression Analysis