A National Survey of the barriers and facilitators to conducting clinical trials in radiotherapy

Abstract

Purpose or Objective NHS England’s Radiotherapy service specification calls for a 15% increase in clinical trial activity. To identify the opportunities, barriers, and enablers for achievement a survey was undertaken. This identified the UK’s current provision of radiotherapy trials, workforce resources and the trials management processes. This information will inform strategies to increase recruitment to clinical trials and translation of those trials into standard of care. Materials and Methods A survey including a mixture of binary, self-ranking and free text questions was developed. The survey captured the current provision of trials by complexity, strategic position and barriers and facilitator to conducting clinical trials. Respondents were asked to complete a supplementary section, containing tables to complete capturing workforce resources and timelines for setting up and recruiting to clinical trials. The survey was distributed by email to 43 UK radiotherapy departments between May and June 2021 where a clinical trials lead was identified. Results were analysed in excel using descriptive statistics and thematic analysis of free-text responses. Results 32 unique responses (76%) were returned, of which 22 (52%) departments provided the supplementary information. The findings of the main survey were divided into three themes; strategy, trial participation and facilitators/barriers. The supplementary section was analysed separately. 69% of radiotherapy departments either did not have or were unsure if a research strategy existed within their trust. Those trusts that did have a strategy reported more open trials with a larger share of patient participation. All trusts reported that they recruited to trials, although 32% of trusts couldn’t quantify the number of patients recruited. Common barriers to trials uptake include lack of strategy that contributes to resource, awareness of available trials and clear processes. Workforce resources varied in terms of number, role and type of contact. A number of trial positions were identified as secondments or fixed term contracts and funded through a variety of sources. Departments with more resources had more open trials. Clinician preference was reported as the most common facilitator to translating trials to standard of care. Free text responses advocate more regional and national collaboration to identify and support objectives. Conclusion It is apparent that there are many barriers to increasing trial participation by 15%. This study identified:-Lack of strategy, resource, accurate reporting and awareness of available trials locally and regionally. These will be key areas to focus in order to deliver a 15% increase in clinical trials activity.