Background: In the US, effective recruitment of diverse and representative patients in rheumatology clinical trials remains a challenging goal, underscoring the differences between research findings and clinical outcomes. Most industry sponsored studies are conducted in academic centers as opposed to the community setting [1] and can lead to nonrepresentative cohort sampling. Physicians and nurses express willingness to refer patients to clinical trials, but less than 1% of providers are active participants in the referral process [2], likely exacerbated by poor communication and engagement of community providers. Nearly 30% of physicians and 45% of nurses reported never receiving follow-up contact from investigative site staff following a referral, including receiving their patients’ clinical trial results [2]. To bridge the gap between clinical trial processes and the participation of community rheumatologists, it is essential to identify and understand the underlying barriers.

Objectives: To assess the perceived barriers to participation in industry-sponsored clinical trials among rheumatologists in non-academic practices.

Methods: A survey exploring the attitudes, knowledge and skills of US based rheumatologists in non-academic practices toward clinical trial referral and participation consisted of 24 items. The survey was deployed to the listserv of the Association of Women in Rheumatology, a non-profit professional rheumatology organization with an active and diverse community rheumatologists, advanced practitioners and pharmacists in varied practice settings. Descriptive statistics were used to report the results.

Results: The survey was distributed to 8,075 email recipients, achieving a 39.5% open rate (3,176 opens). 38 U.S.-based nonacademic practitioners completed the survey. A response rate for the targeted participants was not calculated because the mailing list comprised rheumatologists from academic and nonacademic settings, as well as international members. Most respondents [68.4% (26/38)] operated in solo practice or private single specialty group practices. Median age category of respondents was 46-55 years. Over two-thirds of respondents [65.8% (25/38)] had received training in conducting clinical trials, typically post- fellowship training. More than 80% reported caring for patients who had participated in a clinical trial (32/37) or had referred a patient to a study (31/37). A significant majority of rheumatologists (>80%) were open to referring patients to clinical trials, however more than 1/3 were unsure of how to facilitate a referral (13/38) and did not have an established relationship with a clinical trialist (19/38). Additionally, participants were more likely to refer patients to investigators that they knew and trusted, or when patients were refractory to known treatments irrespective of clinical trial inclusion criteria. 50% (19/38) of respondents expressed interest in being an investigator for a clinical trial and another 30% (12/38) would consider participation. Of those rheumatologists willing to participate (29/36), the primary motivating factors were contributing to scientific advancement (17/25) and having additional treatment options for their patients (22/27). The major barriers to participation overall were 1) strict clinical trial inclusion and exclusion criteria (18/31), 2) lack of time (22/31), and 3) lack of clinical support (11/36). However, none of these surpassed the interest in participating. Respondents preferred in-person education at their practice location or a videoconference call to learn about clinical trials rather than meeting offsite, telephone calls or educational fliers.

Conclusion: Rheumatologists show a strong interest in participating in clinical trials, particularly in forming connections with clinical trialists. However, many lack these relationships, revealing an educational gap and presenting an opportunity to engage community rheumatologists in recruiting more patients for clinical trials. Additionally, this study underscores the importance of involving community practitioners at multiple levels of participation to enhance diversity among both investigators and participants in rheumatology clinical trials.

REFERENCES: [1] Claiborne AB, English RA, Weisfeld N. Envisioning a transformed clinical trials enterprise in the United States: establishing an agenda for 2020: workshop summary . National Academies Press; 2012.

[2] CSDD T. Poor Physician and Nurse Engagement Driving Low Patient Recruitment. Impact Report . 1. Tufts Center for the Study of Drug Development; 2017;19. Jan/Feb 2017.

Acknowledgements: NIL.

Disclosure of Interests: Maria Bacalao: None declared, Grace Wright AbbVie, AstraZeneca, Bristol Myers Squibb, Eli Lilly, Johnson & Johnson, Novartis, Pfizer, Scipher Medicine, UCB, AbbVie, Bristol Myers Squibb, Johnson & Johnson, Pfizer, Gail Kerr AstraZeneca, Bristol Myers Squibb, Johnson & Johnson, Pfizer, Sanofi, UCB, CSL Behring, Horizon, Sharon Dowell Johnson & Johnson.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.