The research team, led by Naomi D. Parker of the University of Florida College of Medicine, conducted semi-structured interviews with 23 cancer clinicians: 13 practicing in academic settings and 10 in community oncology practices. The interviews were part of formative research for a larger, multi-level implementation study aimed at improving equitable access to cancer clinical trials. Rather than measuring referral rates with numbers, the researchers used thematic analysis, a qualitative method that systematically codes interview transcripts to identify recurring patterns and themes in what clinicians describe. This approach is well suited to a process like referral, which unfolds differently in every clinic and depends heavily on individual judgment and local circumstances.

What emerged first from the interviews was a picture of when and why referrals happen at all. Clinicians described referring patients to academic cancer centers most often for a handful of reasons: to obtain a second opinion, when standard treatment options had been exhausted, to access specialized care that was not available locally, or specifically so the patient could be considered for a clinical trial. In other words, trial referral is rarely the default. It tends to be triggered by clinical complexity or by the end of conventional options, which means many patients who might benefit from trial enrollment earlier in their disease course may never be flagged for referral at all. The decision to refer, the clinicians explained, is shaped by a combination of clinical judgment, system-level constraints, and an anticipation of how much burden the referral process will place on the patient and family.

That anticipated burden is a recurring and emotionally significant theme. Community oncologists often serve patients who live far from academic centers, who may have limited transportation options, rigid work schedules, or caregiving responsibilities. Sending a patient to a large academic institution for a trial screening can mean hours of travel, repeated visits, and a maze of appointments, all with no guarantee of enrollment. Clinicians in the study reported weighing these practical costs against the potential benefit, and in some cases deciding that the referral was not worth the strain. This calculus, repeated thousands of times across the state and the country, constitutes a quiet but powerful filter on who reaches clinical trials, and it helps explain why participation remains especially low among populations served primarily in community settings.

Uncertainty emerged as a second major barrier, and it operates on both sides of the referral equation. Community clinicians described not knowing which trials were actually open at nearby academic centers, or whether a given patient would meet the intricate eligibility criteria that govern modern oncology trials, which often specify prior treatments, biomarker status, organ function, and disease characteristics in exacting detail. Without reliable, real-time information about trial availability, a referral can feel like a shot in the dark. On the academic side, inefficient intake and communication processes compounded the problem: records that did not arrive, unclear points of contact, and slow feedback loops that left community clinicians unsure whether their patient had even been evaluated. Each point of friction increases the chance that a potentially eligible patient falls out of the pipeline before screening is complete.

Patient-level constraints added a further layer of difficulty. Clinicians noted that comorbidities, insurance questions, language barriers, and the sheer complexity of trial protocols could make referral impractical even when a suitable trial existed. But the study is careful to frame these not simply as patient problems; they are structural problems that the referral system fails to absorb. A well-designed referral pathway, the researchers suggest, would anticipate these constraints and provide navigation support to help patients and families overcome them, rather than leaving individual clinicians to improvise solutions with limited time and information.

Against these barriers, the interviews also illuminated what makes referrals work. The most consistent facilitators were relational: reliable, personal connections between community practices and academic centers, built over years of collaboration, made clinicians far more willing and able to send patients across. When a community oncologist knows exactly whom to call, trusts that the academic team will respond quickly, and expects clear communication back about the outcome, the referral process becomes dramatically smoother. Timely scheduling mattered as well, since delays can be clinically consequential in oncology, where treatment windows can be narrow. Navigation support, in which dedicated staff help coordinate appointments, records, and logistics, was another frequently cited enabler, as were shared expectations about continuity of care, so that patients who traveled for trial screening could return to their local team for ongoing treatment without falling through the cracks.

These findings arrive at a moment when the structure of American cancer care makes them especially consequential. A large share of cancer patients in the United States receive treatment in community oncology practices rather than academic centers, and clinical trials remain heavily concentrated in the latter. That geographic and institutional mismatch means the referral pathway from community clinic to academic center is, for many patients, the only realistic route to trial participation. If that route is opaque, slow, or burdensome, the result is a systematic skew in who enrolls in research, with well-resourced patients who live near academic centers overrepresented and rural, minority, and lower-income populations underrepresented. Poor representation in trials, in turn, limits the generalizability of the very evidence that guides cancer care for everyone.

The study’s conclusions point toward concrete design principles for interventions. The authors argue that efforts to improve trial access should account for existing research capacity within community practices, rather than treating community oncology as a passive feeder for academic programs. Many community clinics already participate in research networks or have investigational experience, and interventions that ignore this capacity risk duplicating infrastructure or undermining local relationships. The findings also prioritize communication and coordination: clear points of contact, timely follow-up, and shared expectations between sites emerged from the interviews as the practical ingredients of a functioning referral system. Finally, the researchers emphasize infrastructure that reduces both clinical uncertainty and patient burden, such as tools that help community clinicians identify open trials and match patients to eligibility criteria before a referral is even initiated.

It is worth noting the scope and limits of the work. The study involved clinicians in a single state, Florida, and drew on a relatively small sample of 23 interviews, so the themes it identifies may not capture every regional or institutional variation. As qualitative formative research, it is designed to generate hypotheses and guide the design of implementation interventions, not to quantify how often referrals occur or how many patients are lost at each step. Even so, its central insight is difficult to dismiss: the path from a community infusion chair to a clinical trial runs through a web of human relationships, information gaps, and logistical hurdles that no single actor controls. Improving cancer trial access, the study suggests, will require treating referral not as a paperwork step but as a system in its own right, one that can be measured, redesigned, and supported so that the decision to send a patient for trial consideration becomes easier, faster, and fairer for clinicians and patients alike.

Subject of Research: Referral processes from community oncology practices to academic cancer centers for clinical trial consideration

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

Article References: Parker, N. D., Lunsford, K., Thomas, J. D., Staras, S. A., Michaels, M., Mulaparthi, S., George, T. J., Crispen, P. L., & Bylund, C. L. (2026). Referral processes for cancer clinical trials: a qualitative study of community and academic oncology clinicians. BMC Cancer. https://doi.org/10.1186/s12885-026-17056-1

Image Credits: AI Generated

DOI: 10.1186/s12885-026-17056-1

Keywords: cancer clinical trials, clinical trial referral, community oncology, academic cancer centers, qualitative research, oncology referral pathways, health equity, trial access, patient navigation, thematic analysis, implementation science, BMC Cancer