An online training intervention for primary care providers on preparing patients for cancer treatment decisions and conversations about clinical trials: Evaluation of a pilot study using mixed methods and follow up (Preprint)
Authors: Parker Naomi D. , Michaels Margo , Fisher Carla L. , Crowe Alyssa , Weiss Elisa S. , Sae-Hau Maria , Arnold Jason , Cassells Andrea , Durante Domenic , Lee Ji-Hyun , Vega Raymond Mailhot , Natale-Pereira Ana , Vasquez Taylor S. , Zhang Zhongyue , Bylund Carma L. 
Published: October 2024

BACKGROUND

Recruitment to cancer clinical trials (CCTs) is low, particularly for underrepresented groups such as uninsured or low-income patients and individuals of minoritized race and ethnicity. A significant barrier is that treating oncologists often fail to inform patients about the possibility of clinical trial participation as an option for quality cancer care. Thus, patient inquiries about trials before starting treatment should be normalized and encouraged, particularly for underrepresented groups. Primary care providers (PCPs) are uniquely suited to do this because they interact with patients at the time of cancer diagnosis, provide ongoing care, and are trusted sources of information.

OBJECTIVE

This study was designed to pilot an innovative online CCT training intervention for PCPs to increase their ability to preparing patients for cancer treatment decisions and conversations about clinical trials.

METHODS

We conducted an evaluation of a pilot study using a self-guided, interactive one-hour online training intervention for PCPs with survey assessments at pre-intervention, immediate post-intervention, and 3-month follow up. We employed a mixed methods approach, incorporating both quantitative and qualitative data collection and analysis. Guided by the Kirkpatrick Evaluation model, we focused on Levels 1 (reaction), 2 (learning), and 3 (behavior).

RESULTS

Twenty-nine PCPs completed the intervention and pre-and post- measures, with 28 PCPs completing the 3-month follow up. Eight of the 28 PCPs participated in a qualitative interview following the 3-month assessment. Participants reported high levels of satisfaction with the course. CCT knowledge and attitudes/beliefs improved following the course and were sustained at the 3-month follow up. PCPs reported willingness to communicate with patients about cancer treatment options, including CCTs, and willingness to talk with their colleagues about change in referral practices. However, fewer had actually engaged in these conversations by the 3-month follow-up. In interviews, PCPs cited limited inter-professional knowledge-sharing and organizational constraints as barriers. Notably, PCPs reported significant change in their communication behavior with patients; a higher percentage reported communicating with patients at time of referral about cancer treatment options and clinical trials at 3-month follow up than at baseline. PCPs reported in interviews that they now felt more comfortable and empowered to have these conversations.

CONCLUSIONS

This pilot study found that a self-guided, interactive one-hour online training intervention for PCPs resulted in improved knowledge, attitudes and beliefs, and communication with patients to prepare them for discussions with oncologists about cancer treatment and cancer clinical trials. Future dissemination of this course has the potential to make an impact on cancer clinical trial accrual.