Unpacking clinical trial referral processes: A qualitative study of community and academic oncologists

Purpose: The purpose of this study was to examine how oncology clinicians, particularly those in community settings where the majority of patients receive care, navigate referrals to academic centers, including for clinical trial enrollment, by identifying factors that influence their referral practices, with the ultimate goal of improving partnerships between community and academic centers. Methods: We conducted semi-structured interviews (N=23) with community oncology clinicians (oncologists, n=8; nurse practitioner, n=1; physician assistant, n=1) and academic oncologists at an NCI-designated cancer center (n=13) to examine their experiences and perspectives across the referral process to academic centers, including connecting patients to appropriate clinical trials. Both groups were included to capture the diverse contexts in which trial referrals occur and to understand how organizational environments shape referral practices. Transcripts were thematically analyzed. Results: Oncology clinicians described three key considerations shaping the clinical trial referral process: (1) reasons to refer to academic centers, or reasons referrals were received to academic centers; (2) perceived barriers to referrals, such as logistical and financial barriers, and lack of communication; and (3) referral facilitators, including institutional support, scheduling efficiency, and strong communication between oncologists and trial teams. Oncology clinicians concluded by providing suggestions for improvement, such as streamlining referral pathways, reducing logistical or structural barriers, and improving patient education on clinical trials. Conclusions: Oncology clinicians' engagement in the academic center referral process, including referrals to clinical trials, is shaped by multiple interrelated factors, including motivations, barriers, and facilitators for referrals. The oncology clinicians in our sample outlined several opportunities for improvement in the referral process. Understanding these considerations across both community and academic settings can inform strategies to streamline referrals, enhance trial participation, and improve patient access to novel therapies. Our findings highlight the importance of addressing context-specific barriers to enhance trial accessibility and participation. Strengthening communication channels and providing tailored institutional support may strengthen alignment between community and academic settings, thereby expanding equitable access to oncology clinical trials.