Poor provider engagement drives low patient recruitment, says Tufts

Kenneth Getz, Associate Professor and Director, CSDD, Tufts University, told Outsourcing-Pharma.com that there were several major surprises in the study.

“We were surprised to see such a large percentage of physicians and nurses indicating their familiarity and comfort level with clinical research information​,” he said, as the industry has “typically attributed the lack of health care provider engagement to poor familiarity and low comfort levels​.”

However, according to the study, based on a survey of 2,000 physicians and nurses primarily in the US and Europe, nearly all physicians (91%), and the majority of nurses (72%) feel “somewhat” or “very” comfortable discussing the opportunity to participate in a clinical trial with patients.

The researchers were also surprised to find that most health care providers believe they are actively referring patients, despite what Getz said is a “very low actual referral volume​” – less than 0.2% for physicians and even less for nurses.

Miscommunication​

Physicians and nurses cited the inability to access information, insufficient information, and time, as the main reasons for not referring patients into clinical trials.​

“They have that comfort to speak to it, but they just don’t have the knowledge [about specific clinical trials]​,” Stewart H. Rosen, MD, Vice President of Medical Affairs at QuintilesIMS Health Management Solutions group, told us.

However, amid the sheer volume of research conducted, which has only increased over the years, Rosen told us clinical trial sites are stressed. “It’s a matter of bandwidth of the site being able to reach out​,” he said.

The study reported nearly 30% of physicians and 45% of nurses never receive initial or follow-up contact from investigative site staff following a referral. Even more reported never receiving a patients’ clinical trial results.

“It’s become an obligation of the sponsor, and the outsourcing companies to the sponsor, to really assist these sites in getting out and having outreach to their referring locations where the patients first present​,” Rosen said.

To help address this bandwidth issue, many companies have deployed field-based educators to help facilitate recruitment. These educators are often nurses or experts in a certain therapeutic areas. At QuintilesIMS, this position is called the Clinical Trial Educator (CTE), a position that the company introduced more than a decade ago.

“We really think this is a way to help accelerate how we can get these patients enrolled into the trials,” ​Rosen said.

Misperception​

Historically, there has also been an industry misperception that providers didn’t refer patients to clinical trials because they were afraid of losing patients – a theory which Getz’s research has proved to the contrary.

“They want to do what’s best for their patients​,” said Rosen, “they just weren’t knowledgeable on the opportunity for the clinical trial​.”

In fact, according to the study, only 9% of physicians and 2% of nurses say the fear of losing patients influences their decision not to refer patients to clinical trials.

“Physicians and nurses are the most trusted sources for information about health care options and they are facilitators in the clinical research process​,” said Getz, who ultimately said that there are “ample​” opportunities for clinical research professionals to communicate more frequently and meaningfully with health care providers.

“Addressing these communication opportunities will greatly improve overall engagement​.”