DISCUSSION
cancer
CANCER, DISEASE
Participation in cancer clinical trials is consistently and persistently low, reflecting inequitable access to high‐quality care. This study is among the first to examine multilevel enrollment barriers and to examine an intervention to increase enrollment among Black and White patients who are potentially eligible for an available therapeutic trial.The first barrier we examined was eligibility, a system‐level barrier. Findings showed that less than a quarter of participants qualified for an available trial over the two‐year period they were enrolled in the study. This small proportion was surprising, given that the study participants were receiving care at major academic institutions and had a disease associated with many therapeutic trials. Also, despite research suggesting that trial participation is associated with age, race, and other sociodemographic characteristics,Together, these findings provide further evidence that the greatest barrier to enrollment may be restrictive eligibility criteria—most patients do not qualify.The second enrollment barrier we addressed was interpersonal: patient–physician communication quality in interactions with potentially eligible patients. This low‐cost, patient‐focused communication intervention was based on the assumption that, while patient–physician clinical communication is the most central and proximal influence on invitations to participate and actual trial participation, communication about trials may be infrequent or of low‐quality, especially for Black patients.This study should be interpreted within its limitations. The sample size was small due to the COVID‐19 pandemic disruptions,Additionally, the study included only Black and White men with one type of cancer, and was conducted at major academic centers, limiting the generalizability of the study. Future studies should include a broader population, such as patients receiving care at community cancer centers,Despite these limitations, this study suggests ways to improve equitable clinical trial enrollment. Suggested strategies include broadening trial eligibility criteria to better reflect and include diverse patient populations; reporting trial enrollment rates not just among all people with cancer, but also among those potentially eligible for an available trial as a way to identify potential intervention targets; and implementing low‐cost communication interventions, such as the one described here—a low‐cost, highly scalable intervention that may improve patient‐provider communication and invitations to participate in clinical trials, and shows specific benefit for Black patients, who have been historically excluded from or mistreated in clinical trials.