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Is clinical trial accrual and enrollment a challenge for your site?

  • 1.  Is clinical trial accrual and enrollment a challenge for your site?

    Posted 07-17-2019 14:37

    Patient accrual and enrollment onto clinical trials is a challenge for many research sites. Many barriers exist such as overly restrictive protocol eligibility criteria, logistical limitations, and lack of provider and patient education among many others. Is clinical trial accrual a challenge for your site?

    Has your site established best practices to overcome challenges with clinical trial accrual? Will you share your best practices and strategies to overcome barriers?



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    Mehmet Copur MD, FACP
    Morrison Cancer Center Mary Lanning Healtcare
    Hastings, NE
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  • 2.  RE: Is clinical trial accrual and enrollment a challenge for your site?

    Posted 07-18-2019 09:38

    Dr. Copur,

    Yes, enrollment is a major issue - and appreciate your consideration of the multiple factors. We (and our patients) wrestle with geographic distance to the site. As a result we've started to conduct trials via telemedicine, however struggle to have Sponsors agree with this model at times.

    What is your biggest struggle? Any helpful hints?

    Thanks,
    Lora​



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    Lora Black RN, MPH, OCN, CCRP
    Sanford Research
    Sioux Falls, SD
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  • 3.  RE: Is clinical trial accrual and enrollment a challenge for your site?

    Posted 07-25-2019 00:51
    Hi Dr.Copur,

    I'm from Intermountain healthcare in SaltLake CIty. Similar to other sites we face the challenges as you outlined above. Some of the barriers and solutions we are working on are -

    1) For lack of provider and patient education - It is difficult to remember right trial for right patient at right time. So we recently implemented clinical pathways at our site. It gives the option of all potentially available clinical trials for the patients at our site. Just the awareness of available trials has helped us improve out clinical trial enrollment so far.
    2) As Lora mentioned below we are also using telemedicine to bring the clinical trials into more rural communities and tele-consenting has helped minimize the long distance travel for our patients

    I'm interested in learning what other sites any novel strategies they are implementing at their sites that helped with clinical trial enrollment -

    Thank you for posting the question. Look forward to hear from other sites-

    Ramya Thota,
    Medical Oncologist
    Intermountain Healthcare
    Salt lake City, Utah

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    Ramya Thota MBBS
    Intermountain Healthcare
    Murray, UT
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  • 4.  RE: Is clinical trial accrual and enrollment a challenge for your site?

    Posted 07-25-2019 11:49
    Ramya,

    May I ask what Pathway system you are using?

    Thanks
    Lora​

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    Lora Black RN, MPH, OCN, CCRP
    Sanford Research
    Sioux Falls, SD
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  • 5.  RE: Is clinical trial accrual and enrollment a challenge for your site?

    Posted 07-25-2019 23:53

    Thank you Dr. Tahota. Yes, this is a universal problem. This depends on the clinical trial portfolio you want to have. In my personal experience what works best but also kind of hard to do is as a providers  knowing your clinical trial portfolio well. What do I mean by this? I had the wonderful opportunity of  having access to  72 NCORP clinical trials. I knew all of them well because every time we would activate a new trial I had to present that trial to the entire group. I would also designate some to my colleagues to present. We would have monthly meetings and go over new trials. I would go over a list of existing trials, their current status, how well or not  they are accruing if they are  coming to a close how soon etc.

    The difficult part is that the  providers should be on top of their game and they should constantly check what their portfolio includes and they should all attend and pay attention to these meetings. Well, this is not always that easy in the real world. Most  providers are TOO BUSY and most providers do not have a BIG PASSION to do clinical  trials even though they always say "oh yes we love clinical trials we want them etc." Getting them attend these meeting and present some of new trials not as straightforward or easy and expecting all providers to know all the trials they have is not realistic unfortunately.

    There is a tendency to take  shortcuts depend on research nurses, or algorithms, or electronic lists etc. but yield is always not great in these venues. Several times, I have seen a new or follow up patient who was  marked as "no clinical trials available" by research nurses/associates and yet I knew there is a trial and I call research team and tell them what it is and why the patient eligible etc. .By doing this next time research staff hopefully remembers and do not miss it. I try share it with my providers colleagues at every opportunity including our  cancer conferences. In our cancer conferences,  purposely pick and  present cases who are or will be going  on trials and give a short slide presentation about that trial during cancer conferences to bring awareness to trials. I ask research staff to  attend all cancer conferences and make a slide of available trials for every cancer conference patient presented.   

    This is how best I can tell what is the right trial for right patient at the right time.This is how you enroll at  high levels. It takes a  culture change in your entire practice and it is a constant and a dynamic process. At the end of the day it comes down to providers passion about clinical trials and willingness to "sacrifice" whatever extra time needed from their busy schedule.

    Mehmet Sitki Copur, MD,FACP
    Medical Oncology/Hematology
    MORRISON CANCER CENTER
    Mary Lanning Healthcare
    Hastings, NE
    Adjunct Professor University of Nebraska Medical Center
    Omaha, NE
    O:402/460-5899 ext. 5068
    C:308/390-3493
    F:402/460-5898
    mehmet.copur@marylanning.org



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  • 6.  RE: Is clinical trial accrual and enrollment a challenge for your site?

    Posted 07-26-2019 00:51
    I completely agree with you Dr. Copur. You are doing great work to bring awareness of these clinical trials. Every site needs a champion like you to overcome some of the barriers of clinical trial enrollment. It definitely needs a change in culture!!

    You had some great suggestions. Similar to what you were doing, we are hoping to have bi annual oncology clinical trial campaign at our site to review the clinical trial portfolio and highlight the trials(that are not doing well and those that are doing really well) for our oncologists in community.

    One suggestion we had at our site for physician engagement is some sort of recognition or incentive for enrolling patients on trial. We haven;t implemented this at our site yet. But I can imagine if clinical trial enrollment is made part of the KPI for salary bonus or something like that, there will definitely be a lot more motivation from community oncologists. But to implement such things is not easy and need buy-in from administration!!

    As you very aptly pointed, it requires a passionate physician and research team for clinical trials to be successful!!

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    Ramya Thota MBBS
    Intermountain Healthcare
    Murray, UT
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  • 7.  RE: Is clinical trial accrual and enrollment a challenge for your site?

    Posted 07-26-2019 00:25
    We are using Via pathway. One thing I don't like about it is,  it is not fully integrated to our EMR.

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    Ramya Thota MBBS
    Intermountain Healthcare
    Murray, UT
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