Role of minority physicians in community practice as gatekeepers for clinical research

METHODS: We conducted qualitative interviews in Winter 2009-2010 to explore African American physicians' attitude toward and experience with clinical research. “Research” included a range from clinical trials to health services research. Inclusion criteria: AA provider of clinical care in minority communities in greater Hartford, CT. Exclusion criteria: not a minority; not in active practice. Interview results were hand tabulated by the interviewer (HN). The interview assessed the role of providers as gatekeepers to clinical research; their experience as referees of research; the access that their patients have to clinical research; their attitudes toward research; the barriers and gaps to access for themselves and their patients; and their ideas about solving the needs, gaps and barriers. RESULTS: We interviewed 11 African American physicians, seven females and four males, age from 30 to 56, averaging 40.6 y/o, with an average of 12.6 years experience. Four were in primary care and seven were specialists. All had some training in clinical research during post-MD education; two were principal investigators in the past. Eight had referred patients to research protocols at some point during practice. All indicated that participating in clinical research was positive; no physician thought that referral to a trial would disrupt relationships with patients. The expressed barriers to research participation among the community of minority physicians interviewed were diffuse: time, money, staff, availability of appropriate studies, record keeping, and exclusion from the process. Their discussion of patients' barriers was tightly focused: money, trust/distrust, transportation, and lack of education. Six did not think that their patient's access to research would be improved if the providers participated in educational programs about clinical research. CONCLUSION: In overviews of access to research, minority participation is almost universally described as underrepresented. However, few people are looking at the role of community-based providers as gatekeepers. Our results indicate that the major barriers to access are structural, not a matter of provider education. To ameliorate the barriers will require greater effort to solve the problems of time, access, direct funding and paperwork. Improved community-based minority provider/patient inclusionary strategies could ultimately strengthen the development of research questions, process and interpretation.