The challenges interviewees’ noted that they associated with CCOP participation were common across the CCOP organizations we studied, and were consistent with reports of recent research highlighting issues such as leadership support, patient recruitment, and physician participation (e.g., Minasian et al. 2010
; McKinney, Weiner, and Carpenter 2006
; Beckett, Quiter, Ryan et al. 2011
). Given the important role of the CCOP and growing interest in the potential of PBRNs to promote patient access to scientific advances by expanding the reach of clinical trials, our findings could be perceived as troubling to policy-makers and scientists. These challenges, however, may not be insurmountable.
While issues related to the bureaucratic requirements of the CCOP are factors that may be beyond the control of hospitals and clinicians who participate in CCOP organizations, the five challenges associated with appreciation of the CCOP’s value, limited understanding, needed workflow changes, CCOP operations, and sustaining administrative support can likely be addressed, and are explored further below in our discussion of the implications of these findings for management practice.
Our findings about the challenges these interviewees perceived to be associated with CCOP participation suggest important opportunities for the NCI to support providers’ involvement with CCOPs by perhaps reducing some of these identified participation barriers and emphasizing the benefits of participation. For instance, developing a means for organizations to document and quantify a business case could help these CCOP providers justify and sustain their participation in the CCOP. As the results of prior studies have shown the need for quality improvement and health programs to demonstrate a business case in order to generate or sustain support from their organizations (Leatherman, Berwick, Iles, Lewin, Davidoff, Nolan et al. 2003
; Reiter, Kilpatrick, Greene, Lohr, and Leatherman, 2007
; Song, Robbins, Garman, and McAlearney 2011), paying attention to the challenges associated with the perceived costs and operational impacts of CCOP participation may be especially important.
In this study we have also highlighted three factors that interviewees noted could facilitate CCOP participation: commitment, champions, and awareness. These suggested facilitators of CCOP participation are notably consistent with results reported from prior research focused on efforts to diffuse and implement innovations (e.g., Sales et al. 2006
; Rogers 2003
; Klein and Sorra 1996
), especially in health services (e.g., Helfrich, Weiner, McKinney and Minasian 2007
; Beckett et al. 2011
). For instance, the critical role of champions
in efforts to implement innovations has been emphasized in studies of technology implementation and organizational change in diverse health care settings (e.g., Poon, Blumenthal, Jaggi, Honour, Bates, and Kaushal 2004
; Miller and Sim 2004
; Nanji, Cina, Patel, Churchill, Gandhi, and Poon, 2009
). Similarly, the notion of commitment
is important for any change to succeed over time (e.g., Poon et al. 2004
; Miller and Sim 2004
What was particularly striking is our finding about the importance of awareness
. The notion of awareness is also consistent with diffusion of innovation theory that posits knowledge as the first of the five stages of the innovation-decision process (Rogers 2003
), and prior studies that have highlighted the role of awareness in promoting behavior change (Prochaska and DiClemente 1983
). More recently, Beckett and colleagues (Beckett et al. 2011
) conceptualized a decision-making model incorporating the work of Prochaska and colleagues (1983)
that emphasizes the importance of awareness in encouraging community physicians to participate in clinical trials research. The role of awareness
in helping to facilitate CCOP participation was noteworthy because of its potential link to the other facilitators of commitment
and the use of champions
that emerged. Emphasizing and building awareness may thus help to create new champions, and, ideally, enhance commitment to CCOP participation.
Although the facilitators of CCOP participation were not proposed as direct solutions to the challenges raised, focusing on these three factors could conceivably help hospitals and physicians overcome CCOP participation challenges. First, emphasizing commitment—both administrative and clinical—can help address the challenges associated with required workflow changes, managing patient recruitment and physician involvement, and sustaining administrative support. Second, the important role of champions can be leveraged when solutions to CCOP-related challenges require difficult changes, difficult conversations (e.g., about patient recruitment and physician involvement), and difficult budgetary decisions. Finally, awareness of the CCOP and its contributions to patient care may help build the support needed to implement and maintain the CCOP over time, particularly in the presence of financial challenges and competing demands. By taking these three factors into account, the challenges associated with CCOP participation may become less burdensome as the value of this participation is better recognized and promoted.
Our study has several limitations. First, given our sample of five purposively selected |CCOP organizations, our results represent the perceptions of the informants we interviewed, and may not be representative of informants’ perceptions from different providers or CCOP organizations. However, we attempted to interview a broad sample of informants, including both administrative and clinical interviewees, and have confidence that the findings we report fairly represent interviewees’ perspectives about challenges and facilitators of CCOP participation. Second, our study was constrained due to the time frame in which it occurred. While changes in CCOP participation, NCI funding, research experiences, and so forth are expected over time, we were unable to study any changes directly due to our study design involving interviews conducted at one point in time. Third, while we highlight several opportunities to overcome CCOP participation challenges, our study was not designed to determine whether focusing on these suggested facilitators would be effective in practice.
Future Research Opportunities
Future studies may be able to overcome some of the limitations of this study by considering different designs and methodological approaches. For instance, by studying CCOP organizations that have successfully navigated participation challenges over time, future research can be designed to learn more about the factors that facilitate participation, and those that lead to successful sustained performance for CCOP organizations.