There have always been significant barriers and challenges to recruitment to haematology trials.
• Rarity – the broad spectrum of numerous low incidence haematologic malignancies;
• Geographical challenges – regional/outer urban NSW, Australia and private haematology patients have poor access to clinical trials;
• Cost - it is too expensive to run all studies at all hospitals - often only 1- 2 sites in NSW;
• Registries are often out of date- and site contacts not listed, and so there is a problem for doctors which can take a lot of time.
The biggest barrier is this lack of knowledge management. Time-poor haematologists are unaware of what trials are currently recruiting and where. They lack of detailed knowledge of inclusion/exclusion criteria. This deters them from offering trials from another hospital to their patient with cancer.
Challenges for recruitment to trials have resulted in many initiatives in Australia, all aimed at overcoming these barriers. The links below describe the barriers and the initiatives including our own initiative ClinTrial Refer.
1. Education on its use. Younger haematologists are teaching their senior colleagues how to download and use the App, in the clinics and MDT meetings.
2. Knowledge of the app. We seek to promote the App to cancer communities nationally and internationally.
3. Upkeep of data. All sites in the network are dedicated to providing updated recruiting trial data to the App manager to ensure currency. Because of ease of update, the time spent maintaining currency is minimal.
4. Ability to transfer to other disciplines. Submit abstracts. Engage with other cancer collaboratives and demonstrate the utility of the app to study coordinators and physicians.
5. Concerns about cost of the App. As we have developed a template the costs of derivative Apps for other cancer disciplines is substantially lower.
We have had a >300% increase in cross-referrals of patients to other hospitals and a substantial increase in trials recruitment across NSW. We have been measuring cross-referral patterns for some time.
The aim of this project was to facilitate patient cross-referral to NSW Haematology trials by developing a smartphone App that was free, simple to use and effective.
• 1° endpoint – rate of trial cross-referrals
• 2 ° endpoints:
- rates of trial enrolment in NSW
- App usage metrics
- development of other ClinTrial Refer Apps
We think that the impact of adopting this technology by other cancer groups will be immediate. We believe that just as has happened locally, the immediate and accurate trials knowledge at their fingertips will prompt doctors to cross-refer. Specific and targeted knowledge.
By maintaining the emphasis on currency of data, and by changing doctor behaviour in cross-referring patients, we have seen a sustained and growing increase in trial recruitment in the State of NSW. It is the change in doctor behaviour that will sustain the increase in accrual. Through increased cross-referrals and recruitment, we anticipate a continued increase in trials being offered to sites in NSW, securing the growth and viability of many trials units. We would like to develop an within-App tool – ClinTrial Refer for real-time tracking of this increased referral.
Because the information is publically available, there was no IRB (HREC) approvals required. A license agreement was devised to ensure that we protect our IP, and easily replicate the app for other areas and disciplines. This App is a not-for profit enterprise with a single primary objective – increasing patient cross-referral for clinical trials.
Many knowledge management tools have been used to enable doctors to access information. Often, they are too large to be kept up to date, or too difficult to search. However, this is a local, discipline specific tool which is always current and comprehensive for recruiting studies. Used by haematologists across the state, this information about trials within a reasonable proximity can be accessed in seconds in front of the patient. We are now replicating it for other areas, and disciplines. We know that our doctors will refer across sites. We know that patients will travel. We know that information can be kept current and comprehensive.