Aims: Cancer clinical trials frequently report poor implementation outcomes, failing to meet recruitment targets or complete altogether. Healthcare professionals (HCPs) act as brokers between research and practice, playing a critical role in accelerating trial implementation. We conducted a scoping review to 1) identify the core processes involved in delivering cancer clinical trials, 2) determine the extent to which clinical and research roles/responsibilities overlap or are differentiable, and 3) explore factors influencing success of the dual HCP-researcher role in clinical trial and healthcare delivery.
Methods: We searched peer reviewed articles in PubMED and Embase and screened articles against predefined criteria. Population included any trained HCP, context limited to hospital/cancer centre settings undertaking clinical trials, and concepts related to HCPs’ trial experiences. Data extraction occurred in five steps: (1) extracting general study characteristics, (2) developing/refining a clinical trial process map to identify priority target behaviour areas (TBAs), (3) deductive thematic analysis using the Consolidated Framework for Implementation Research encompassing the Theoretical Domains Framework, (4) inductive thematic analysis, and (5) generating implementation strategies using the Expert Recommendations for Implementing Change and Behaviour Change Techniques.
Results: 4656 titles/abstracts were screened, 114 full texts assessed and 47 articles were included. Priority TBAs and respective barriers included: 1) General trial administration (lack of stable funding; limited workforce infrastructure including staffing levels, and dedicated research supports; time constrained by clinical load; lack of training and informational support; unclear roles and responsibilities), 2) Recruitment and consent (concerns that trials interfere/disrupt patient care; rigid/complex study protocols; difficulties determining patient suitability), 3) Randomisation (difficulties maintaining clinical equipoise), and 4) Administering intervention (challenges managing patients’ expectations; treatment toxicities).
Conclusions: Our scoping review provides a critical evaluation of the challenges faced by HCPs managing research and patient care. Knowledge gained will help to inform tailored strategies to address potential role conflicts.