Subjects in this arm will receive the standard of care, either routine screening for clinical trials or no screening, according to standard institutional protocol. Potential clinical trials, if identified, will be offered to subjects according to the usual institutional process.

Subjects assigned to this arm will have deidentified data elements transferred from their EHR to the Blue-button tool for identification of clinical trials for which they may be eligible. After review by clinical research staff, appropriate trials will be offered to subjects.

Patients will be screened for clinical trial matches using the Blue-button tool

Blue-button screening

Mark Fleury, PhD

Enrollment in clinical trials predicts better survival in the most common cancer types including breast cancer, and testing and proving the efficacy of new treatments relies on successfully conducting clinical trials. However, approximately one fifth of cancer clinical trials fail due to insufficient patient enrollment, and only about 6% of adult cancer patients are enrolled onto clinical trials. Barriers remain for patient participation in clinical trials, especially for cancer patients. One specific barrier is trial identification and awareness of trial availability for both patients and providers.

This trial tests the hypothesis that by integrating clinical trial eligibility screening into part of routine care in a way that requires little effort and by making that screening site agnostic, the Blue-Button matching functionality will increase overall cancer clinical trial enrollment, and may also result in more diverse clinical trial participants that better reflect the U.S. cancer population. Moreover, regardless of changes in enrollment, the Blue-button screening may allow screening to be done more quickly with fewer human resources when compared to current methods. Identification of potential trial opportunities, however, is only the first barrier to trial enrollment, so this study includes additional examination of barriers subsequent to the identification of relevant trials by cataloging patient-level barriers that prevent enrollment of patients in identified trials.

The conduct of cancer clinical trials represents a key final step in testing and proving the efficacy of new treatments relies on successfully conducting clinical trials. However, one in five cancer clinical trials fail due to insufficient patient enrollment, and only about 6% of adult cancer patients are enrolled onto clinical trials, despite the fact that the majority of Americans view clinical trial participation favorably.

The large gap between the willingness of patients to participate in trials and actual trial participate rates suggests the prevalence of many barriers to participation in clinical trials, especially for cancer patients. One specific barrier is trial identification and awareness of trial availability for both patients and providers. Identification and recruitment to clinical trials can be difficult and time consuming. Matching cancer patients with trials requires a challenging amount of manual entry and/or manual review of trials, and frequently this is not integrated into existing clinical workflows. As a result, for many patients, a locally available trial may not be identified, or patients who are eligible to participate may not be asked to enroll. Taken together, only about one in four cancer patients will even have the option to participate in a clinical trial at their institution. Providers do not have the means to easily identify trials for their patients that are conducted outside the treating healthcare institution. One solution to help alleviate this problem is to provide basic site-agnostic trial screening capabilities using electronic health records (EHRs), which already exist in nearly all care settings.

ACS CAN, through a collaboration with the MITRE organization, has developed open-source integrated clinical trial screening functionality ("Blue-button") to address a lack of in-workflow tools for providers to prescreen cancer patients for clinical trials. Blue-button was developed through the Common Oncology Data Elements Extensions (CodeX) application of MITRE's Fast Healthcare Interoperability Resource (FHIR) accelerator (FHIR is a draft data standard developed by HL7 International). The Blue-button functionality works within existing EHRs to enable patients or providers to initiate a prescreen for relevant trials for a given patient within a specified radius of the practice. This is done by automatically extracting and sending eight, deidentified single-patient data elements to existing trial matching services which return potential trial matches. The eight patient data elements used for prescreening, referred to as the optimized patient data elements (OPDE), include age, cancer type, cancer subtype, presence of metastasis, stage, biomarkers, prior treatments, and performance status. The user of the application has the ability to add/edit any of the eight data elements that may be missing or incorrect prior to sending to services. The Blue-button tool (more formally known as the Clinical Trial Matching SMART on FHIR App) then sends the patient OPDE to Minimal Common Oncology Data Elements (mCODE) enabled clinical trial matching services.

Currently, many patients who would be willing to participate in a clinical trial are either not currently being screened or are only screened against limited onsite trials. Thus, the goal of this study is to examine whether the use of a Blue-button trial screening tool can increase the participation of patients in cancer clinical trials. The hypothesis is that the routine use of the site agnostic Blue-button matching functionality will make clinical trial screening easier for both sites and patients. In so doing, its use will not only increase overall cancer clinical trial enrollment but will be especially advantageous for increasing enrollment for historically underrepresented populations, resulting in more diverse clinical trial participants that better reflect the U.S. cancer population. Moreover, regardless of changes in enrollment, the Blue-button screening tool may allow screening to be done more quickly with fewer human resources when compared to current methods. Additionally, because this study follows patients longitudinally over time to record key details about trial decision-making, the study will examine patient-level barriers for individuals eligible for an available trial who decline to participate.

Blue-Button Regional Trial Screening

Evaluating the Effectiveness of Blue-Button Automated Clinical Trial Prescreening on Regional Enrollment: A Randomized Trial

We will share all IPD that underlie results in a publication.

To evaluate the effectiveness of an automated clinical trial prescreening tool ("Blue-button") in increasing enrollment in clinical trials compared to standard practice.

Providers and research coordinators will complete surveys to report the ease of use of the Blue-button prescreening tool as well as the time and effort involved..

Patients who are offered matched clinical trials but choose not to enroll will complete a survey describing the reasons for their choice to not enroll.

American Cancer Society Cancer Action Network

Neoplasms

Digestive System Diseases

All Conditions

Symptoms and General Pathology

Diseases and Abnormalities at or Before Birth

Nutritional and Metabolic Diseases

Rare Diseases

Rectal Neoplasms

Adenocarcinoma

Syndrome

Colorectal Neoplasms

Colonic Neoplasms

Colorectal Neoplasms, Hereditary Nonpolyposis

Intestinal Neoplasms

Gastrointestinal Neoplasms

Digestive System Neoplasms

Gastrointestinal Diseases

Colonic Diseases

Intestinal Diseases

Rectal Diseases

Neoplastic Syndromes, Hereditary

Genetic Diseases, Inborn

DNA Repair-Deficiency Disorders

Metabolic Diseases

Familial Colorectal Cancer

Enrolled participants will watch three educational videos in Spanish pertaining to: (1) Colorectal Cancer (CRC) symptoms; (2) CRC risk factors and (3) CRC screening, treatment, and Cancer Clinical Trials (CCT).

Enrolled participants will watch three educational videos on Colorectal Cancer (CRC) in Spanish. Knowledge on CRC symptoms, risk factors, screening and treatment will be assessed before and immediately after the educational video and at 30 +/- 7 days. In addition, the association between increase in CRC knowledge and willingness to participate in Cancer Clinical Trials (CCT) will be explored.

Colorectal Cancer Educational Videos in Spanish

José G. Guillem, MD, MPH, MBA

Dimitrios Varvoglis, MD

Jose G Guillem, MD, MPH, MBA

The study aims to recruit 60 Spanish speaking individuals who identify as Latinos, are older than 18 years old and attend the Saint Thomas More (STM) Church in Chapel Hill. Study participants will be asked to attend an educational session at STM Church during which their baseline knowledge on colorectal cancer (CRC) and willingness to participate in cancer clinical trials (CCT) will be assessed through a questionnaire in Spanish. Following this, participants will watch three educational videos on CRC in Spanish. After watching the videos, CRC knowledge and willingness to participate in CCTs will be reassessed. Thirty +/- 7 days after participation in the educational session, participants will be invited back at STM Church in order to complete a follow-up questionnaire assessing CRC knowledge, willingness to participate in CCTs and perceived barriers preventing Latinos from participating in CCTs. Twenty of the 60 recruited participants will be asked to participate in a qualitative one-on-one interview aimed at identifying barriers preventing Latinos from participating in CCTs.

It should be noted that cancer is the leading cause of death in the United States (US) Latino community, with CRC accounting for 10% of this overall mortality. Despite this, Latinos suffer from disparities in access to care, cancer screening, treatment, and representation in CCTs. In fact, although Latino individuals are among the largest and fastest growing communities of color in the US, currently comprising 18.7%, their representation in CCTs remains low. This is of concern because: 1) advances arising from trials with limited Latino representation may not be applicable to the Latino population, and 2) decreased Latino participation in CCTs may delay Latino access to novel therapies in a timely fashion. The investigators conducting this study believe that low cancer-specific health knowledge may be impacting Latino representation and willingness to participate in CCTs and can be addressed through culturally and linguistically appropriate community-based educational interventions. Latino CCT underrepresentation is a multifaceted phenomenon and bidirectional barriers at the physician-, healthcare system-, and patient-level are significant contributors. Therefore, understanding the multiple driving forces and barriers is essential to identifying potential targets for improvement.

This pilot project aims to address the Clinical and Translational Science (CTS) roadblock of underrepresentation of Latinos in cancer clinical trials (CCTs) through a community-based, culturally, and linguistically appropriate educational intervention aimed at increasing health knowledge on a specific cancer. Colorectal cancer (CRC) will be the "use case" and the church will be the venue for Latino recruitment. This project will lead to the identification of novel Latino-perceived barriers to CCT enrollment, which will be applicable in other fields of medicine aiming to increase Latino CCT enrollment. The investigators believe that one barrier to recruitment for CCTs is low health education, specifically regarding cancers affecting the community, such as CRC, a commonly diagnosed cancer in the US Latino population. Therefore, the hypothesis that an increase in health knowledge in Latinos on a specific cancer mediates a change in their willingness to participate in CCTs will be tested. To do this, three educational CRC videos in Spanish will be created. The first video will review CRC symptoms, the second video will review CRC risk factors while the third video will provide information on CRC screening, treatment and CCTs. In addition, a translated, non-validated questionnaire based on 3 sub-scales from 2 CRC knowledge questionnaires previously validated in English will be developed and pilot tested. Therefore, the Specific Aims of this Pilot Project are to:

1. Identify novel Latino-perceived barriers to participation in CCTs.
2. Assess the association between an educational video and CRC knowledge.
3. Explore the potential relationship between an increase in health knowledge of a specific cancer via an educational video in Spanish and willingness to participate in CCTs.
4. Demonstrate that engagement with Latino communities via the church setting is a viable option for the recruitment and retention of Latinos.
5. Translate into Spanish and pilot test 3 health knowledge sub-scales as a preliminary step in the creation and validation of a novel Spanish CRC knowledge questionnaire.

To achieve these aims, recruit 60 Latino, Spanish speaking attendees of the Saint Thomas More (STM) Church in Chapel Hill will be recruited. The study will consist of three Study Days:

1. Study Day 1: Enrolled participants will be asked to attend an educational session at STM Church. During the educational session their baseline knowledge on CRC and their baseline willingness to participate in CCTs will be assessed through a questionnaire in Spanish. Following this, participants will watch three educational CRC videos in Spanish and then their CRC knowledge as well as their willingness to participate in CCTs will be reassessed.
2. Study Day 2: Thirty +/- 7 days after the educational session, participants will be asked to return to STM Church in order to complete a follow-up questionnaire in Spanish. The questionnaire will assess their level of retainment of CRC knowledge, their willingness to participate in CCTs as well as assess in an open-ended fashion their perceived barriers to CCT participation.
3. Study Day 3: Twenty of the 60 enrolled participants will be asked to participate in a qualitative one-on-one interview aimed at identifying Latino perceived barriers to CCT participation.

PeLear CCC: Proyecto Latino Contra Cancer Colorectal

A Colorectal Cancer Educational Intervention in the Latino Community Assessing the Feasibility of Recruitment & Retention Via a Church-Based Approach: Identification of Novel Barriers to Cancer Clinical Trial Enrollment

Qualitative, semi-structured, one-on-one interviews will be performed in Spanish. The interviews will be recorded and transcribed. The ATLAS.ti software will be used for the transcript analysis. The top 2 conceptual themes within each section of the interview-attitudes regarding general clinical trials, attitudes regarding cancer clinical trials, and perceptions of the Hispanic/Latino community-and the top 3 higher-level, holistic themes across the sections will be reported in terms of percentage of participants.

Use of appropriate statistical measures to compare total number of correct responses across three time points (at baseline, post-video and 30+/- 7 days follow-up) accounting for multiple observations within subjects. Knowledge pertaining to Colorectal Cancer (CRC) symptoms will be assessed using the "Knowledge of Warning Signs" questions from the "Bowel Cancer Awareness Measure". Potential answers include "Yes", "No" and "Don't Know". The overall score will range from 0 to 9 and it is anticipated that average scores will increase after the intervention. Higher scores imply greater knowledge of symptoms.

Use of appropriate statistical measures to compare mean proportion of correct responses across three time points (at baseline, post-video and 30+/- 7 days follow-up) accounting for multiple observations within subjects. Knowledge pertaining to Colorectal Cancer (CRC) risk factors will be assessed using the "Knowledge of Risk Factors" questions from the "Bowel Cancer Awareness Measure". This scale is measured using a Likert 1-5 scale with "1" corresponding to "Strongly Disagree" and "5" corresponding to "Strongly Agree". The overall score will range from 11 to 55 and it is anticipated that the average scores will increase after the intervention. Higher scores imply greater knowledge of risk factors.

Use of appropriate statistical measures to compare mean proportion of correct responses across three time points (at baseline, post-video and 30+/- 7 days follow-up) accounting for multiple observations within subjects. Knowledge of Colorectal Cancer (CRC) screening and general facts will be assessed using nine questions from the "Colorectal Cancer Screening Decision Quality Instrument (CRC-DQI)". The overall score will range from 0 to 9 and it is anticipated that average scores will increase after the intervention. Higher scores imply greater knowledge of symptoms.

Appropriate statistical measures on the paired responses of participants will be used to test the association between watching the video and willingness to participate in CCTs. The mediating effect of health knowledge levels (M) on the relationship between educational video (X) and willingness to participate in CCTs (Y) will be explored. In a structural equation model with a series of mixed-effects generalized linear models, Y will be predicted by both X and M, combining the estimated relationship of M and Y. The mediated indirect effect (from X to Y, through M) will then be estimated and tested using the bootstrapping method with 1,000 replications, and the proportion of the effect being mediated will be reported as the effect size.

North Carolina Translational and Clinical Sciences Institute

University of North Carolina, Chapel Hill

Patients receive a copy of the audio recorded information about the clinical trial directly after the clinical visit. This makes it possible to repeat the information before a decision is made to participate in the clinical trial or not.

Patients in the control arm receive no copy of the audio recording.

Access to the audio recorded information about the clinical trial the patient was information about and asked to consider. A copy of the audio recording is given to the patients directly after the clinical visit.

audio recorded information

Mia Bergenmar, PhD

The purpose of this study is to test if cancer patients who are informed about, and offered participation in a cancer clinical trial, are more knowledgeable about cancer clinical trials if they have access to an audio recording of their information visit.

Patients' Knowledge and Understanding of Cancer Clinical Trials - a Study of Audio Recorded Information

Patients' Knowledge and Understanding of Cancer Clinical Trials - a Randomised Study of Audio Recorded Information

The questionnaire is sent to patients within a week after consenting to the trial. One reminder is sent to those not responding within two weeks.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Blue-Button Regional Trial Screening	NCT05885880	Cancer	Blue-button scr...	18 Years -	American Cancer Society Cancer Action Network
Blue-Button Regional Trial Screening	NCT05885880	Cancer	Blue-button scr...	18 Years -	American Cancer Society Cancer Action Network
Blue-Button Regional Trial Screening	NCT05885880	Cancer	Blue-button scr...	18 Years -	American Cancer Society Cancer Action Network
PeLear CCC: Proyecto Latino Contra Cancer Colorectal	NCT06426927	Colorectal Canc... Rectal Cancer Colon Cancer Colon Rectal Ca... Rectal Neoplasm... Colon Adenocarc... Hereditary Nonp...	Colorectal Canc...	18 Years -	University of North Carolina, Chapel Hill
Patients' Knowledge and Understanding of Cancer Clinical Trials - a Study of Audio Recorded Information	NCT01502254	Cancer	audio recorded ...	18 Years -	Karolinska University Hospital

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