I see offering clinical trials as an integral part of the delivery of cancer care. For my patients, clinical trials are an opportunity to access therapies and diagnostics that may improve quality and potentially duration of life. Clinical trials shape our standards of care.
Yet, participants in cancer research continue to not reflect the patients diagnosed with cancer in the United States. These inequities are a result of a healthcare system that creates circumstances of advantage for few, and disadvantage for many.
In order to change these dynamics, I spun out Trial Library, a public benefit company, from the University of California San Francisco. At Trial Library, we are committed to improving clinical trial access for all, especially for communities that have been previously underrepresented.
Through my practice and research, I learned three key lessons that inform Trial Library’s innovative approach.
About thirteen percent of U.S. oncologists participate in clinical research, the majority of whom practice at large, urban, academic medical centers. Yet, eighty-five percent of patients with cancer are diagnosed and treated in community settings. We also know about 8 out of 10 clinical trial participants learn about clinical trials through their provider, demonstrating that oncology healthcare providers serve as gatekeepers to trial access. Putting this all together, it is clear that providers working in community settings need solutions to identify clinical trial opportunities for their patients in an efficient manner.
As a researcher, I tested the underlying hypothesis that providers need tools to identify clinical trials at the point of care. This study observed a provider satisfaction rate of 89% and changed the standard for communicating trial availability to the provider workforce.
At Trial Library, our software helps providers identify clinical trials for their patients which enables trial access to a previously seldom approached community of patients with cancer. We believe there has to be a better way and that we can use technology to improve education and awareness of clinical trials at the point of care.
My prior research has shown that most online clinical trial content is not well-suited for the average consumer, lacks diversity, and is of poor quality. My studies tested consumer-facing clinical trial matching tools for patients in three different ways: (1) on a population level integrated with a state-wide cancer registry, (2) in-clinic, and (3) through targeted advertising. These studies sought to better understand how content influences behavior and attitudes towards clinical trials. We generally observed that access to consumer-facing content regarding clinical trials can increase interest in and willingness to start a conversation about clinical trials with providers. The key learnings from these published studies influence our approach to digital content developed to support patients exploring their cancer treatment options.
My research has shown that human support plays an important role in solving the perennial problem of the “last mile”: How do interested patients actually enroll in a clinical trial? I led a multi-site randomized control trial integrating patient navigators with resources to address SDoH. According to the Centers for Disease Control and Prevention, SDoH are defined as “conditions in places where people live, learn, work, and play that affect a wide range of health and quality-of-life-risks and outcomes.” We observed that the intervention (navigator and SDoH-guided resources) primarily served patients from diverse socioeconomic backgrounds. Separately, we also observed that this type of intervention increases cancer clinical trial recruitment particularly among late phase clinical trials. At Trial Library, we combine our software with 24/7 technology-enabled navigation to help address the “last mile” and support patients when they need it the most. We believe that applying an SDoH framework with human support is essential to achieving inclusion in clinical research.
We are guided by evidence and our mission.
I feel fortunate to have been joined by my Co-Founder and Chief Product Officer, Steve Buck, who was previously a part of the founding team at GoodRx. Our company is a growing team of experts from diverse backgrounds committed to health equity.
Together, we believe Trial Library is addressing barriers experienced by all stakeholders in our research ecosystem - the patients, providers and researchers.
Our products and services are provided at no cost to patients and providers. We partner with study sponsors to help achieve equity in whom clinical trials serve today.
Curious and want to learn more? Contact us at firstname.lastname@example.org
Dr. Josephson is a practicing Urologic Oncologist and partner at Tower Urology, a Los Angeles-based private practice of 10 physicians treating patients across Southern California. Dr. Josephson is one of the leading experts in robotic surgery, ...