A Web-Based 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.

Abstract

Background: Recruitment to cancer clinical trials (CCTs) is low, particularly for underrepresented groups such as uninsured patients, those with low-income status, and racial and ethnic minoritized individuals. A significant barrier is that treating oncologists often fail to inform patients about the possibility of CCT participation as an option for quality cancer care. Therefore, 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 web-based CCT training intervention for PCPs, including practicing clinicians and trainees, to increase their ability to prepare patients for cancer treatment decisions and conversations with oncologists about clinical trials.

Methods: We conducted an evaluation of a pilot study using a self-guided, 1-hour web-based training intervention for PCPs with survey assessments before the intervention, immediately after the intervention, and at the 3-month follow-up. We used a mixed methods approach, incorporating quantitative and qualitative data collection and analysis. The evaluation was guided by the Kirkpatrick evaluation model, focusing on levels 1 (reaction), 2 (learning), and 3 (behavior).

Results: A total of 29 PCPs completed the intervention and pre- and postintervention measures, with 28 (97%) PCPs completing the 3-month follow-up assessment. Of these 28 PCPs, 8 (29%) participated in a qualitative interview after the 3-month follow-up assessment. Participants reported high levels of satisfaction with the course. CCT knowledge, as well as attitudes and beliefs, improved after 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 potential changes in referral practices. However, fewer PCPs had actually engaged in these conversations by the 3-month follow-up. In the interviews, PCPs cited limited interprofessional knowledge sharing and organizational constraints as barriers. Notably, PCPs reported changes in their communication behavior with patients: a higher proportion reported communicating with patients at the time of referral about cancer treatment options and clinical trials at the 3-month follow-up than at baseline. In the interviews, PCPs reported that they felt more comfortable and empowered to have these conversations.

Conclusions: This pilot study found that a self-guided, 1-hour web-based training intervention for PCPs resulted in improved knowledge, attitudes, and beliefs, as well as improved communication with patients, to prepare them for discussions with oncologists about cancer treatment and CCTs. Future dissemination of this course has the potential to make an impact on CCT accrual.