title: Clinical trial discussion, referral, and recruitment: physician, patient, and system factors.
abstract: OBJECTIVE
  Patient participation in cancer clinical trials is imperative to the advancement of medical science. Physicians play an important role in recruitment by discussing clinical trials with their cancer patients. Patient-physician discussion is influenced by many factors relating to the physician, the patient, and the healthcare system.
  
  
  METHODS
  Physicians selected from the 2008-2009 American Medical Association Physician Masterfile who practiced in California, Florida, Illinois, or New York and specialized in medical oncology, surgery, or radiation oncology were surveyed about their attitudes and practices with respect to breast cancer clinical trials. Practice types were categorized according to the classifications provided by the American College of Surgeons, and clinical trial and practice addresses were geocoded.
  
  
  RESULTS
  Surveys were completed by 706 of 1,534 eligible physicians (46 %). Medical oncologists were more likely than surgical or radiation oncologists to discuss the possibility, benefits, and risks of clinical trial enrollment with their breast cancer patients. Physicians who spent the most time in patient care were least likely to discuss clinical trials with their patients. Distance from a physician's practice to the nearest clinical trial site was inversely associated with referral and recruitment. Perceived barriers to clinical trial participation were associated with greater referral activity suggesting that physicians who were more involved in trials were also more likely to understand barriers to participation.
  
  
  CONCLUSIONS
  Multilevel interventions may be successful at increasing participation of women in clinical trials.
authors: Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA 94143-0856, USA. celia.kaplan@ucsf.edu
authors: Celia P
authors: CP
authors: Kaplan
authors: Anna Maria
authors: AM
authors: Nápoles
authors: Daniel
authors: D
authors: Dohan
authors: E
authors: E
authors: Shelley Hwang
authors: Michelle
authors: M
authors: Melisko
authors: Dana
authors: D
authors: Nickleach
authors: Jessica Ann
authors: JA
authors: Quinn
authors: Jennifer
authors: J
authors: Haas
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000628:therapy; D002986:Clinical Trials as Topic; D003625:Data Collection; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D018579:Patient Selection; D010817:Physician-Patient Relations; D010820:Physicians; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D014481:United States