ONCOLOGY NURSING FORUM – VOL 33, NO 5, 2006
Key Points . . .
➤ All of the high-performing Community Clinical Oncology
Programs (CCOPs) have established clear criteria for deciding
which cancer prevention protocols are most feasible for imple-
mentation in their communities.
➤ Many high-performing CCOPs have assigned RNs to
prevention trials to gain fl exibility in task assignments and to
prepare for future molecular studies of cancer risk and targeted
prevention that are likely to require nursing expertise.
➤ Most of the high-performing CCOPs have sought and received
grants from local entities to help cover participant recruitment
➤ Varied recruitment strategies are needed to achieve and sustain
high levels of prevention trial participation.
Recruiting Participants to Cancer Prevention
Clinical Trials: Lessons From Successful
Community Oncology Networks
Martha M. McKinney, PhD, Bryan J. Weiner, PhD, and Virginia Wang, MSPH
Martha M. McKinney, PhD, is the president of Community Health
Solutions, Inc., in Richmond, KY; and Bryan J. Weiner, PhD, is an
associate professor and Virginia Wang, MSPH, is a doctoral student,
both in the Department of Health Policy and Administration at the
School of Public Health at the University of North Carolina at Chapel
Hill. This study was supported by the Division of Cancer Prevention,
National Cancer Institute (contract no. 263-MQ-404175). (Submitted
October 2005. Accepted for publication November 29, 2005.)
Digital Object Identifi er: 10.1188/06.ONF.951-959
Purpose/Objectives: To describe the organizational designs and task
environments of community oncology networks with high accrual rates
to cancer prevention clinical trials.
Design: Replicated case study design; structural contingency theory.
Setting: Local Community Clinical Oncology Programs (CCOPs)
funded by the National Cancer Institute to test preventive and therapeutic
interventions in community settings.
Sample: Primary sample: oncology professionals affi liated with four
CCOPs ranking among the top 10 in earned cancer control accrual credits
in fi scal years 1999–2003. Secondary sample: oncology professionals af-
fi liated with three CCOPs ranking among the top 10 three to four times dur-
ing the study period. A total of 63 people participated in the interviews.
Methods: Primary sample: on-site interviews with CCOP investiga-
tors, clinical research staff, and nononcology physicians. Secondary
sample: telephone interviews with each CCOP’s nurse administrator and
at least one prevention research nurse.
Main Research Variables: Staffing patterns, organizational pro-
cesses, recruitment strategies, and environmental characteristics.
Findings: All of the CCOPs employed dedicated prevention research
staff. Recruitment through media publicity, mass mailings, or group
information sessions worked best when prevention trials had fl exible
eligibility requirements and evaluated interventions with few health risks.
Prevention trials evaluating agents with known toxicities in high-risk
populations required more targeted recruitment through cancer screen-
ing programs, physician referral networks, and one-on-one discussions
with protocol candidates.
Conclusions: High-performing CCOPs confi gured their structures,
processes, and recruitment strategies to fi t with accrual goals. They also
benefi ted from stable and supportive task environments.
Implications for Nursing: Nurse-coordinated research networks have
great potential to generate new knowledge about cancer prevention that
can reduce cancer incidence and mortality signifi cantly.
an exceptionally promising area for scientifi c investigation
and clinical practice (Lippman & Levin, 2005). Although
expanded treatment options and improved medical manage-
ment are helping patients with cancer live longer and bet-
ter, interventions designed to prevent, arrest, or reverse the
carcinogenesis process offer the greatest hope for reducing
cancer incidence, morbidity, and mortality (Ford et al., 2003).
Byers et al. (1999) estimated that, with accelerated efforts to
develop and implement preventive interventions, the United
States could achieve a 19% decline in cancer incidence rates
by 2015 and a 29% decline below the 1990 levels in cancer
ajor advances in the molecular study of neoplasia,
cancer risk assessments, and molecular-targeted drug
development have established cancer prevention as
mortality rates. In absolute numbers, such interventions could
prevent approximately 100,000 cases of cancer and 60,000
deaths from cancer each year.
The expanding scope of cancer prevention research has
created opportunities for oncology nurses to lend their exper-
tise to prevention clinical trials and to educate patients about
evidence-based prevention strategies (Bailey, Bieniasz, Kmak,
Brenner, & Ruffi n, 2004; Jennings-Dozier & Mahon, 2000;
Loescher, 2004; Oncology Nursing Society, 2001). Cancer
centers and clinical cooperative groups increasingly are part-
nering with local networks of oncology professionals to assess
the effectiveness of chemopreventive agents in reducing cancer
risk and the diagnostic effi cacy of new screening technolo-
gies (Hawk, Umar, & Viner, 2004; Lippman & Hong, 2002;
Weiner, McKinney, & Carpenter, 2006). Community oncol-
ogy networks already engaged in cancer treatment research
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