Referral processes for cancer clinical trials: a qualitative study of community and academic oncology clinicians

Cancer clinical trials are essential to advancing oncology care, yet participation remains low, particularly among populations served in community oncology settings. Referral from community practices to academic cancer centers is a key pathway to trial access, but referral processes are complex and poorly understood. This study examined clinician experiences with referral to academic cancer centers for trial consideration and identified barriers, facilitators, and opportunities to support referral processes. We conducted semi-structured interviews with cancer clinicians practicing in academic ( n = 13) and community ( n = 10) settings in Florida as part of formative research for a multi-level implementation study to improve equitable access to cancer clinical trials. Interviews explored referral experiences, communication practices, and clinician-suggested strategies to improve referral processes. We analyzed interview transcripts using thematic analysis. Clinicians described referral decision-making as shaped by clinical judgement, system-level constraints, and anticipated patient burden. Referrals were most often motivated by the need for second opinions, exhaustion of standard treatment options, access to specialized care, or consideration of clinical trials. Barriers included uncertainty about trial availability and eligibility, inefficient intake and communication processes, and patient-level constraints. Facilitators of effective referral included reliable relationships across sites, timely scheduling, navigation support, and shared expectations regarding care continuity. Referral to academic cancer centers for trial consideration is a nuanced process shaped by clinical, relational, and structural factors. Interventions to improve trial access should account for existing community research capacity and prioritize communication, coordination, and infrastructure that reduce clinical uncertainty and patient burden.