***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Objective To evaluate a training intervention aim ed at improving healthcare professionals ' communication with cancer patients about r and omised clinical trials . Design Before and after evaluation of training programme . Setting Members of the National Cancer Research Network , Scottish Trials Network , and the Welsh Cancer Trials Network Participants 101 healthcare professionals ( 33 clinicians and 68 research nurses ) . Intervention Four modules delivered by a trained facilitator using videotapes and interactive exercises to cover general issues about discussing r and omised clinical trials with patients , problems specific to adjuvant trials , trials with palliation as the goal , and trials where patients had a strong preference for one treatment arm . Main outcome measures Before and after the intervention , participants were videotaped discussing a trial with an actor portraying a patient . These consultations were assessed for presence of information required by good clinical practice guidelines . The actor patients gave an assessment after each interview . Participants reported their self confidence about key aspects of trial discussion . Results Analysis of the videotaped consultations showed that , after intervention , significantly more participants displayed key communication behaviours such as explaining r and omisation ( 69 v 81 , odds ratio 2.33 , P = 0.033 ) , checking patients ' underst and ing ( 11 v 31 , odds ratio 3.22 , P = 0.002 ) , and discussing st and ard treatment ( 73 v 88 , odds ratio 4.75 , P = 0.005 ) and side effects ( 69 v 85 , odds ratio 3.29 , P = 0.006 ) . Participants ' self confidence increased significantly ( P < 0.001 ) across all areas . Actor patients ' ratings of participants ' communication showed significant improvements for 12/15 key items . Conclusion This intensive 8 hour intervention significantly improved participants ' confidence and competence when communicating about r and omised clinical trials Abstract Objective To assess whether publicly funded adult cancer trials satisfy the uncertainty principle , which states that physicians should enrol a patient in a trial only if they are substantially uncertain which of the treatments in the trial is most appropriate for the patient . This principle is violated if trials systematic ally favour either the experimental or the st and ard treatment . Design Retrospective cohort study of completed cancer trials , with r and omisation as the unit of analysis . Setting Two cooperative research groups in the United States . Studies included 93 phase III r and omised trials ( 103 r and omisations ) that completed recruitment of patients between 1981 and 1995 . Main outcome measures Whether the r and omisation favoured the experimental treatment , the st and ard treatment , or neither treatment ; effect size ( outcome of the experimental treatment compared with outcome of the st and ard treatment ) for each r and omisation . Results Three r and omisations ( 3 % ) favoured the st and ard treatment , 70 ( 68 % ) found no significant difference between treatments , and 30 ( 29 % ) favoured the experimental treatment . The average effect size was 1.20 ( 95 % confidence interval 1.13 to 1.28 ) , reflecting a slight advantage for the experimental treatment . Conclusions In cooperative group trials in adults with cancer , there is a measurable average improvement in disease control associated with assignment to the experimental rather than the st and ard arm . However , the heterogeneity of outcomes and the small magnitude of the advantage suggest that , as a group , these trials satisfy the uncertainty principle Background : The Royal Australasian College of Surgeons ( RACS ) SNAC trial is a r and omized controlled trial of sentinel node biopsy ( SNB ) versus axillary clearance ( AC ) . It opened in May 2001 and is recruiting rapidly with good acceptance by consumers OBJECTIVE To compare attitudes of Australian physicians and paediatricians about treatment and r and omised controlled trial ( RCT ) participation . DESIGN AND PARTICIPANTS A cross-sectional survey using the vali date d " Physician Orientation Profile " ( POP ) , with 250 physicians and 250 paediatricians surveyed . OUTCOME MEASURES Five indices - primary allegiance , decision making under uncertainty , professional activities , perceived rewards , and peer-group influence - with scores for each participant ranging along a continuum from clinician-oriented to research -oriented and expressed as a number between 0 and 1 . RESULTS Overall response rate was 60 % , with 135 physicians ( 54 % ) and 165 paediatricians ( 66 % ) responding . Paediatricians and physicians were similar in their attitudes to RCT participation , being generally clinician-oriented rather than research -oriented and less inclined to participate in RCTs when there is uncertainty about the best treatment . Most assign limited time to research , with 26.9 % not currently involved in research and 31.5 % having no experience of RCT participation . Doctors perceive few rewards and little peer-group influence regarding trial participation . Independent predictors of favourable attitudes to trial participation ( based on POP scores ) were the presence of allocated research time ( 0.37 for no allocated research time v 0.61 for > 70 % research time ; P < 0.0001 ) , previous experience enrolling a patient in an RCT ( 0.40 for no experience v 0.46 for experience ; P < 0.0001 ) , and articles published in the past 12 months ( 0.40 for no publications v 0.55 for > 3 publications ; P < 0.0001 ) . CONCLUSIONS This study highlights the minor importance of research for most Australian physicians . Research plays only a small role in their professional activities , and the importance of research participation is not recognised . They are clinician-oriented in their attitudes to RCT participation . To encourage greater involvement in trials among physicians in Australia , clinical research needs to be restructured in a primarily clinical ly oriented setting with dedicated research time PURPOSE To identify factors significantly influencing accrual to clinical protocol s by analyzing radiation Patterns of Care Study ( PCS ) surveys of 3,047 r and omly selected radiotherapy ( RT ) patients . METHODS AND MATERIAL S Patterns of Care Study surveys from disease sites studied for the periods 1992 - 1994 and 1996 - 1999 ( breast cancer , n = 1,080 ; prostate cancer , n = 1,149 ; esophageal cancer , n = 818 ) were analyzed . The PCS is a National Cancer Institute-funded national survey of r and omly selected RT institutions in the United States . Patients with nonmetastatic disease who received RT as definitive or adjuvant therapy were r and omly selected from eligible patients at each institution . To determine national estimates , individual patient records were weighted by the relative contribution of each institution and patients within each institution . Data regarding participation in clinical trials were recorded . The factors age , gender , race , type of insurance , and practice type of treating institution ( academic or not ) were studied by univariate and multivariate analyses . RESULTS Overall , only 2.7 % of all patients were accrued to clinical protocol s. Of these , 57 % were enrolled on institutional review board-approved institutional trials , and 43 % on National Cancer Institute collaborative group studies . On multivariate analysis , patients treated at academic facilities ( p = 0.0001 ) and white patients ( vs. African Americans , p = 0.0002 ) were significantly more likely to participate in clinical oncology trials . Age , gender , type of cancer , and type of insurance were not predictive . CONCLUSIONS Practice type and race significantly influence enrollment onto clinical oncology trials . This suggests that increased communication and education regarding protocol s , particularly focusing on physicians in nonacademic setting s and minority patients , will be essential to enhance accrual This article review s recruitment and retention issues in a multisite , multistate ( California , New York , Connecticut , Georgia , Alabama ) 6-month prospect i ve cross-sectional study focused on  quality of life among 230 women with lung cancer . Recruitment of women into clinical trials and their retention are important , yet understudied . To date , few articles have described the challenges associated with recruiting women with lung cancer to participate in clinical research . Data from this trial were used to investigate the most effective strategies for recruitment across sites , to identify the most common reasons for refusal and attrition , and to identify challenges and potential solutions to recruitment and retention issues associated with multisite clinical research studies . Strategies for recruitment included letters from physicians , posters , announcements in community support groups , and newspaper and radio advertisements . Three sites allowed the research ers to contact potential participants directly , whereas 2 sites required the potential participants to contact the research ers for further information . Enrollment included 63 % of the women eligible for the study ( n = 230 ) . The most common reasons for refusal were health limitations ( n = 60 ) , lack of interest ( n = 46 ) , and inconvenience ( n = 16 ) . The most common reasons for attrition ( 24 % of the sample ) were death ( n = 21 ) and severity of illness ( n = 13 ) . Challenges related to recruitment and retention varied by geographic location Clinical trials are recognized as the st and ard of care for the cancer patient , and the r and omized , controlled trial represents the most definitive method to determine the effectiveness or ineffectiveness of a cancer treatment . However , less than 3 % of all eligible patients enter a clinical trial . Of the 437 physician members of the Illinois Cancer Center ( ICC ) , 244 responded to a survey design ed to determine factors that present a significant barrier to entering patients on clinical trials . Rigid protocol design was the primary deterrent to accrual , especially for medical oncologists . Surgeons , radiation oncologists , and medical oncologists differed with respect to several factors , including willingness to seek a clinical trial , tendency to treat patients off study , quality -of-life issues , and the belief that trials were too excessive in time commitment ( P less than .05 ) . Compared with hospital-based physicians , community oncologists had fewer patients on trial , were more likely to enter patients on the basis of age , and were more concerned about aspects of informed consent and the financial burden of a trial ( P less than .01 ) . One third of the physicians never pursued a clinical trial because of conflict with the priorities of individual care and excessive follow-up time . Fourteen percent indicated that they discouraged patients from participating in a clinical trial due to the risk of a patient receiving a placebo and patient follow-up requirements ( P less than .05 ) . Subgroups of physicians differ in their reluctance to accrue patients , and there are clusters of beliefs expressed by physicians concerning their clinical trial activity . Current conduct of clinical trials needs to be reassessed , and intervention studies are required to determine the best methodology to alter physician reluctance to pursue clinical trials PURPOSE Well-conducted cancer clinical trials are essential for improving patient outcomes . Unfortunately , only 3 % of new cancer patients participate in clinical trials . Barriers to patient accrual in cancer clinical trials must be identified and overcome to increase patient participation . MATERIAL S AND METHODS We prospect ively tracked factors that potentially affected patient accrual into cancer clinical trials at the University of California Davis Cancer Center . Oncologists seeing new out patients were asked to complete question naires regarding patient characteristics and the physician 's decision-making on patient eligibility , protocol availability , and patient opinions on participation . Statistical analysis was performed to correlate these parameters with subsequent protocol accrual . RESULTS There were 276 assessable patients . At the initial visits , physicians did not consider clinical trials in 38 % ( 105/276 ) of patients principally because of a perception of protocol unavailability and poor performance status . Physicians considered 62 % ( 171/276 ) of patients for participation in clinical trials . Of these , only 53 % ( 91/171 ) had an appropriate protocol available for site and stage of disease . Seventy-six of 90 patients ( 84 % ) with available protocol s met eligibility criteria for a particular study . Only 39 of 76 patients ( 51 % ) agreed to participate in cancer clinical trials , for an overall accrual rate of 14 % ( 39/276 ) . The remainder ( 37/76 , 49 % ) declined trial participation despite meeting eligibility criteria . The most common reasons were a desire for other treatment ( 34 % ) , distance from the cancer center ( 13 % ) , patient refusal to disclose reason ( 11 % ) , and insurance denial ( 8 % ) . Patients with private insurance were less likely to enroll in clinical trials compared to those with government-funded insurance ( OR , 0.34 ; P = .03 ; 95 % CI , 0.13 to 0.9 ) . CONCLUSION Barriers to cancer clinical trial accrual can be prospect ively identified and addressed in the development and conduct of future studies , which may potentially lead to more robust clinical trials enrollment . Investigation of patient perceptions regarding the clinical trials process and the role of third party-payers is warranted BACKGROUND Doctors ' discomfort with the r and omized trial process may significantly impact on accrual rates to clinical trials . However , there is little information regarding factors that influence accrual to clinical trials in Australia . The present study examines Australian cancer specialists ' attitudes towards and participation in current breast cancer clinical trials . METHODS All medical and radiation oncologists across Australia and surgeons listed as participants in the Australian and New Zeal and Breast Cancer Trials Group were sent question naires assessing attitudes towards and participation in current clinical trials for early stage breast cancer . RESULTS The response rate was 71 % ( 269/381 ) . The mean age of respondents was 45 years and 85 % were male . Respondents estimated that a mean of 5.2 ( SD = 8.2 ) of their patients had been enrolled in a breast cancer clin 
    Output:
    
Obstacles fall into three main categories - clinician , patient and system ; however , there are overlaps between categories .
Clinician behaviour is the most important of these .
Exclusion of patients for reasons other than defined eligibility criteria , concerns about increased time requirements , and suboptimal communication with patients all affect accrual .
Communication between clinician and patient appears to be a greater issue than previously recognised .