Integrating Clinical Trials into Clinical Care: Aligning Patient and Physician Perspectives
DOI:
https://doi.org/10.37506/2r75b906Keywords:
Clinical trials, Patient-centered care, Physician perspectives, Shared decision-making, patient centricityAbstract
Background:
Clinical trials have traditionally been framed as experimental tools rather than therapeutic options, and the doctor–patient relationship has largely been paternalistic. The emergence of precision medicine and the shift toward patient-centred care challenge this dichotomy, suggesting that clinical trials could be considered part of routine treatment pathways.
Methods:
A narrative synthesis of published literature was conducted to examine patient and physician perspectives on clinical trials when offered as treatment choices. Evidence was analysed to identify key motivators, barriers, and areas of alignment and divergence between patients and physicians.
Results:
Patients value access to advanced therapies, close monitoring, and a sense of hope, while physicians emphasise therapeutic innovation and ethical responsibility. Barriers include therapeutic misconception, limited clinician awareness, workload constraints, and logistical challenges. Despite these obstacles, both groups support transparent discussion of clinical trials within clinical care.
Conclusion:
Integrating clinical trials into treatment frameworks, with informed patients and physicians, ethical safeguards, and institutional support, can make them a legitimate and patient-centred treatment option.
References
1. Riedel S. Edward Jenner and the history of smallpox
and vaccination. Proc (BaylUniv Med Cent). 2005
Jan;18(1):21–5.
2. Ferrell B, Williams AC, Borneman T, Chung V, Smith
T. Clinical Trials: Understanding Patient Perspectives
and Beliefs About Treatment. Clin J Oncol Nurs. 2019
Dec 1;23(6):592–8.
3. Van de Beek H. Clinical research as a care option:
optimizing approaches. Appl Clin Trials [Internet].
2019 Jun;32–5.
4. Li A, Bergan RC. Clinical trial design: Past, present,
and future in the context of big data and precision
medicine. Cancer. 2020 Nov 15;126(22):4838–46.
5. Bagai P, Sharma P, Ansari A, Singh N, Sharma S,
Singh P, et al. Patient Advocates for Clinical Research
(PACER): A Step Toward Ethical, Relevant, and Truly
Participatory Clinical Research in India. Cureus. 2024
Apr;16(4):e58454.
6. Grover S, Xu M, Jhingran A, Mahantshetty U, Chuang
L, Small W, et al. Clinical trials in low and middleincome
countries - Successes and challenges. Gynecol
Oncol Rep. 2017 Feb;19:5–9.
7. Desai M. Recruitment and retention of participants in
clinical studies: Critical issues and challenges. Perspect
Clin Res. 2020;11(2):51–3.
8. Pan M, Lee ATC, Seaward SA, Ilano A, House K,
Duran E, et al. Impact of early engagement of patients
with clinical trial information in a system-based
multidisciplinary breast cancer clinic on clinical trial
enrollment. Journal of Clinical Oncology. 2012 Dec
1;30(34_suppl):149–149.
9. Miller FG, Brody H. A Critique of Clinical Equipoise:
Therapeutic Misconception in the Ethics of Clinical
Trials. Hastings Cent Rep. 2003 May;33(3):19.
10. Lee GE, Kim S, Chu SH, Seok JH, Kim SY, Kim S.
Improving patient satisfaction based on service quality
in clinical trials: A cross-sectional study. PLoS One.
2024;19(12):e0313340.
11. Udrea G, Dumitrescu B, Purcarea M, Balan I, Rezus
E, Deculescu D. Patients’ perspectives and motivators
to participate in clinical trials with novel therapies for
rheumatoid arthritis. J Med Life. 2009;2(2):227–31.
12. Avery J, Bell JAH, Baryolay K, Rodin G, Nissim R,
Balneaves LG. Decision-making and autonomy among
participants in early-phase cancer immunotherapy trials:
a qualitative study. BMC Cancer. 2024 Mar 25;24(1):373.
13. Estcourt S, Epton J, Epton T, Vaidya B, Daly M.
Exploring the motivations of patients with type 2
diabetes to participate in clinical trials: a qualitative
analysis. Res InvolvEngagem. 2016 Dec 12;2(1):34.
14. Shah JY, Phadtare A, Rajgor D, Vaghasia M, Pradhan
S, Zelko H, et al. What leads Indians to participate in
clinical trials? A meta-analysis of qualitative studies.
PLoS One. 2010 May 20;5(5):e10730.
15. Hrna Z. The Role of Oncology Clinical Trials in
Advancing Cancer Treatment. J Oncol Med &Pract.
2024 Sep;252.
16. Freedman B. Equipoise and the Ethics of Clinical
Research. New England Journal of Medicine. 1987 Jul
16;317(3):141–5.
17. Vermeulen SF, Hordijk M, Visser RJ, Bunnik EM.
Do Physicians Have a Duty to Discuss Expanded
Access to Investigational Drugs with their Patients?
A Normative Analysis. Journal of Law, Medicine &
Ethics. 2023 May 25;51(1):172–80.
18. Rahman S, Majumder A, Shaban S, Rahman N, Ahmed
SM, Abdulrahman K, et al. Physician participation in
clinical research and trials: issues and approaches.
Adv Med EducPract. 2011 Mar;85.
19. Engelbak Nielsen Z, Eriksson S, Schram Harsløf LB,
Petri S, Helgesson G, Mangset M, et al. Are cancer
patients better off if they participate in clinical trials?
A mixed methods study. BMC Cancer. 2020 Dec
8;20(1):401.
20. Durden K, Hurley P, Butler DL, Farner A, Shriver SP,
Fleury ME. Provider motivations and barriers to cancer
clinical trial screening, referral, and operations: Findings
from a survey. Cancer. 2024 Jan 18;130(1):68–76.
21. Kengia JT, Kalolo A, Barash D, Chwa C, Hayirli TC,
Kapologwe NA, et al. Research capacity, motivators
and barriers to conducting research among healthcare
providers in Tanzania’s public health system: a
mixed methods study. Hum Resour Health. 2023 Sep
5;21(1):73.
22. Christopher PP, Stein MD, Springer SA, Rich JD,
Johnson JE, Lidz CW. An exploratory study of
therapeutic misconception among incarcerated
clinical trial participants. AJOB EmpirBioeth. 2016 Jan
2;7(1):24–30.
23. Chichua M, Mazzoni D, Marzorati C, Pravettoni
G. The journey of patients in cancer clinical trials:
A qualitative meta-synthesis on experiences and
perspectives. Patient Educ Couns. 2025 Jan;130:108469.
24. Mills EJ, Seely D, Rachlis B, Griffith L, Wu P, Wilson K,
et al. Barriers to participation in clinical trials of cancer:
a meta-analysis and systematic review of patientreported
factors. Lancet Oncol. 2006 Feb;7(2):141–8.
25. Williams CP, Deng L, Caston NE, Gallagher K, Angove
R, Pisu M, et al. Understanding the financial cost of
cancer clinical trial participation. Cancer Med. 2024
Apr 17;13(8).
26. Aabdien M, Abdallah I, Bougmiza MI, Siepmann
T, Illigens B. Perceptions and attitudes toward
participation in clinical research in the Eastern
Mediterranean Region: A systematic review. Medicine.
2022 Aug 19;101(33):e29959.
27. Sofaer N, Thiessen C, Goold SD, Ballou J, Getz KA,
Koski G, et al. Subjects’ views of obligations to ensure
post-trial access to drugs, care and information:
qualitative results from the Experiences of Participants
in Clinical Trials (EPIC) study. J Med Ethics. 2009
Mar;35(3):183–8.
28. In drug research, guinea pigs of choice are humans.
Times of India. 2004 Aug 4;
29. Ghotankar SS, Devkar R, Deshmukh M. Bridging the
Divide: Tackling Recruitment Challenges in Indian
Clinical Trials: A Narrative Review. JOURNAL OF
CLINICAL AND DIAGNOSTIC RESEARCH. 2024;
30. Wong AR, Sun V, George K, Liu J, Padam S, Chen BA,
et al. Barriers to Participation in Therapeutic Clinical
Trials as Perceived by Community Oncologists. JCO
Oncol Pract. 2020 Sep;16(9):e849–58.
31. Kumar G, Chaudhary P, Quinn A, Su D. Barriers
for cancer clinical trial enrollment: A qualitative study
of the perspectives of healthcare providers. Contemp
Clin Trials Commun. 2022 Aug;28:100939.
32. Nass SJ MHMJ. A National Cancer Clinical Trials
System for the 21st Century: Reinvigorating the NCI
Cooperative Group Program. Institute of Medicine
(US) Committee on Cancer Clinical Trials and the NCI
Cooperative Group Program. 2010;
33. Perez GK, Oberoi AR, Finkelstein-Fox L, Park ER,
Nipp RD, Moy B. Qualitative study of Oncology
Clinicians’ Perceptions of Barriers to Offering Clinical
Trials to Underserved Populations. Cancer Control.
2023;30:10732748231187828.
34. Alemayehu C, Mitchell G, Nikles J. Barriers for
conducting clinical trials in developing countriesa
systematic review. Int J Equity Health. 2018 Dec
22;17(1):37.
35. Nielsen ZE, Berthelsen CB. Cancer patients’ perceptions
of factors influencing their decisions on participation
in clinical drug trials: A qualitative meta‐synthesis. J
Clin Nurs. 2019 Jul 3;28(13–14):2443–61.
36. Fountzilas E, Tsimberidou AM, Vo HH, Kurzrock R.
Clinical trial design in the era of precision medicine.
Genome Med. 2022 Aug 31;14(1):101.
37. Dennstädt F, Putora PM, Iseli T, Treffers T, Panje C,
Fischer GF. Patient autonomy and shared decisionmaking
in the context of clinical trial participation. Eur
J Clin Invest. 2024 Nov 31;54(11).
38. Burt T, Dhillon S, Sharma P, Khan D, MV D, Alam
S, et al. PARTAKE Survey of Public Knowledge and
Perceptions of Clinical Research in India. PLoS One.
2013 Jul 16;8(7):e68666.
39. Sood A, Prasad K, Chhatwani L, Shinozaki E, Cha SS,
Loehrer LL, et al. Patients’ Attitudes and Preferences
About Participation and Recruitment Strategies in
Clinical Trials. Mayo Clin Proc. 2009 Mar;84(3):243–7.
40. Castillo BS, Boehmer L, Schrag J, Howson A, Oyer
R, Pierce L, et al. Oncologist-Reported Barriers and
Facilitators to Offering Cancer Clinical Trials to Their
Patients. Current Oncology. 2024 May 28;31(6):3017–
29.
41. Datta SS, Samanta B, Chatterjee S, Mallick I, Sharma
A, Gangopadhyay G, et al. Conduct of cancer
clinical trials: a qualitative study reporting views of
patients, caregivers, public and clinical researchers.
Ecancermedicalscience. 2025;19:1950.
42. Flynn KE, Kramer JM, Dombeck CB, Weinfurt KP.
Participants’ perspectives on safety monitoring in
clinical trials. Clinical Trials. 2013 Aug 3;10(4):552–9.
43. Barnes B, Stansbury N, Brown D, Garson L, Gerard
G, Piccoli N, et al. Risk-Based Monitoring in Clinical
Trials: Past, Present, and Future. Ther InnovRegul Sci.
2021 Jul 29;55(4):899–906.
44. Reyna VF, Nelson WL, Han PK, Pignone MP. Decision
making and cancer. Am Psychol. 2015;70(2):105–18.
45. Klein E, Solomon AJ, Corboy J, Bernat J. Physician
compensation for industry-sponsored clinical trials
in multiple sclerosis influences patient trust. Mult
SclerRelatDisord. 2016 Jul;8:4–8.
46. A. Gregersen T, Birkelund R, Wolderslund M, Dahl
Steffensen K, Ammentorp J. Patients’ experiences of the
decision‐making process for clinical trial participation.
Nurs Health Sci. 2022 Mar 21;24(1):65–72.
47. Dwyer CP, McAneney H, Rogers FM, Joyce R, Hynes
SM. Exploring the impact of ineligibility on individuals
expressing interest in a trial aimed at improving daily
functioning regarding perceptions of self, research
and likelihood of future participation. BMC Med Res
Methodol. 2021 Dec 27;21(1):264.
48. DasMahapatra P, Raja P, Gilbert J, Wicks P. Clinical
trials from the patient perspective: survey in an online
patient community. BMC Health Serv Res. 2017 Dec
27;17(1):166
49. Eldridge L, Goodman NR, Chtourou A, Galassi A,
Monge C, Cira MK, et al. Barriers and Opportunities
for Cancer Clinical Trials in Low- and Middle-
Income Countries. JAMA Netw Open. 2025 Apr
28;8(4):e257733
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Avni Tambi, Rhea Aggarwal, Adarsh Keshari, Khushboo Sharma

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.