title: Effect of medical oncologists' attitudes on accrual to clinical trials in a community setting.
abstract: OBJECTIVE
  Oncology clinical trials (OCTs) are crucial in evaluating new cancer treatments, but only 2% to 3% of US adult patients with cancer enter OCTs. This study assessed barriers to participation in clinical trials among oncologists in a large integrated health care delivery system with an active clinical trials program. Although many studies have identified major physician barriers to enrollment, few have examined how these barriers affect actual trial accrual.
  
  
  METHODS
  Using information from a mailed survey, we examined the effect of oncologists' attitudes, beliefs, experiences, sociodemographic factors, and practice characteristics on clinical trial accrual in the 2 years following the survey. We identified relationships between these variables and subsequent clinical trial accrual using correlations and mixed effects models.
  
  
  RESULTS
  A construct combining questions that assessed oncologist attitudes, beliefs, and experiences substantially influenced OCT enrollment (r = .51; P < .0001). This construct included awareness of open clinical trials and specific eligible patients, as well as the practice of initiating a discussion about OCTs with most eligible patients. This broad concept of awareness had the greatest correlation with enrollment and mediated the effect on enrollment of other values and beliefs, such as welcoming a patient's initiation of a trial discussion and valuing the support of research nurses and coordinators.
  
  
  CONCLUSIONS
  Even in a health care setting with an active clinical trials program, substantial research personnel, infrastructure support, and widespread access to trials among oncologists and patients, oncologists' participation remains quite variable. Oncologist values, beliefs, and awareness of clinical trials play an important role in OCT accrual.
authors.affiliation: Kaiser Permanente Northern California, Oakland; and Kaiser Permanente Medical Center, Vallejo, CA.
authors.forename: Carol P
authors.initials: CP
authors.lastname: Somkin
authors.forename: Lynn
authors.initials: L
authors.lastname: Ackerson
authors.forename: Gail
authors.initials: G
authors.lastname: Husson
authors.forename: Vicky
authors.initials: V
authors.lastname: Gomez
authors.forename: Tatjana
authors.initials: T
authors.lastname: Kolevska
authors.forename: Desiree
authors.initials: D
authors.lastname: Goldstein
authors.forename: Louis
authors.initials: L
authors.lastname: Fehrenbacher
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008495:Medical Oncology; D008875:Middle Aged; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011446:Prospective Studies; D011795:Surveys and Questionnaires