Related Experiment Video
Updated: Jul 15, 2025
E-Patient Counseling Trial E-PACO: Computer Based Education versus Nurse Counseling for Patients to Prepare for Colonoscopy
Published on: August 1, 2019
Evaluating a Physician Audit and Feedback Intervention to Increase Clinical Trial Enrollment in Radiation Oncology in
Nicholas P Verdini1, Daphna Y Gelblum1, Emily A Vertosick2
1Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
Purpose:
Clinical trial participation continues to be low, slowing new cancer therapy development. Few strategies have been prospectively tested to address barriers to enrollment. We investigated the effectiveness of a physician audit and feedback report to improve clinical trial enrollment.
Methods And Materials:
We conducted a randomized quality improvement study among radiation oncologists at a multisite tertiary cancer network. Physicians in the intervention group received quarterly audit and feedback reports comparing the physician's trial enrollments with those of their peers. The primary outcome was trial enrollments.
Results:
Among physicians randomized to receive the feedback report (n = 30), the median proportion of patients enrolled during the study period increased to 6.1% (IQR, 2.6%-9.3%) from 3.2% (IQR, 1.1%-10%) at baseline. Among those not receiving the feedback report (n = 29), the median proportion of patients enrolled increased to 4.1% (IQR, 1.3%-7.6%) from 1.6% (IQR, 0%-4.1%) at baseline. There was a nonsignificant change in the proportion of enrollments associated with receiving the feedback report (-0.6%; 95% CI, -3.0% to 1.8%; P = .6). Notably, there was an interaction between baseline trial accrual and receipt of feedback reports (P = .005), with enrollment declining among high accruers. There was an increase in enrollment throughout the study, regardless of study group (P = .001).
Conclusions:
In this study, a positive effect of physician audit and feedback on clinical trial enrollment was not observed. Future efforts should avoid disincentivizing high accruers and might consider pairing feedback with other patient- or physician-level strategies. The increase in trial enrollment in both groups over time highlights the importance of including a comparison group in quality improvement studies to reduce confounding from secular trends.
Insights
Physician audit and feedback reports did not significantly improve cancer clinical trial enrollment. Strategies should avoid discouraging high enrollers and may need to combine multiple approaches for better results.
Area of Science:
- Oncology
- Clinical Trials
- Healthcare Quality Improvement
Background:
- Low clinical trial participation hinders the development of new cancer therapies.
- Prospective strategies to address enrollment barriers are infrequently tested.
- Physician audit and feedback is a potential quality improvement method.
Purpose of the Study:
- To investigate the effectiveness of physician audit and feedback reports in improving clinical trial enrollment rates.
- To assess the impact of comparative performance data on physician trial recruitment.
Main Methods:
- A randomized quality improvement study was conducted among radiation oncologists across a multisite cancer network.
- Physicians in the intervention group received quarterly audit and feedback reports comparing their enrollment rates to peers.
- The primary outcome measured was the proportion of patients enrolled in clinical trials.
Main Results:
- The median enrollment proportion increased in both the feedback group (3.2% to 6.1%) and the control group (1.6% to 4.1%).
- There was no significant change in enrollment associated with receiving feedback reports (-0.6% difference; P = .6).
- An interaction effect (P = .005) indicated declining enrollment among high-accruing physicians in the feedback group.
Conclusions:
- Physician audit and feedback alone did not demonstrate a positive effect on clinical trial enrollment.
- Future interventions should consider strategies that do not disincentivize high-performing physicians.
- Pairing feedback with other patient- or physician-level strategies may be more effective.
More Related Videos
Related Concept Videos
01:11Clinical Trials: Overview
01:16Clinical Trials
There are four phases in a clinical trial. A phase one...
01:23Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...
02:56Treatment Resistant Cancers
01:21Cancer Survival Analysis
01:11Blinding