Perceived Barriers to Clinical Cardiovascular Research Involvement in Canada

Community cardiovascular practitioners face real barriers to clinical research involvement, which in turn affect patient representation and patient care.1Rahman S Majumder MAA Shaban SF et al.Physician participation in clinical research and trials: issues and approaches.Adv Med Educ Pract. 2011; 2: 85-93Crossref PubMed Scopus (69) Google Scholar The aim of this letter is to serve as a call to action to address potential barriers to clinical research involvement. In order to capture a range of perspectives, experiences, and perceived barriers, we conducted a survey, in French and English, from June 2018 until January 2019, and distributed it to all Canadian Cardiovascular Society members. We sought participation from those involved in clinical research, regardless of their current clinical status, in order to gain a variety of insights. Eligibility criteria included being a cardiologist, cardiac surgeon, cardiovascular medicine trainee, or cardiovascular practitioner or researcher in Canada. A total of 56 questionnaires were completed. Thirty-three respondents (58.9%) were current clinical medicine practitioners, 15 (26.8%) were not currently active clinicians, and 8 (14.3%) were trainees. A total of 40 and 16 respondents practiced in academic and community settings, respectively. The majority were from Ontario (69.6%), followed by Alberta (10.7%) and Atlantic Provinces (7.1%). In all, 95% of academic respondents were actively involved in research, compared with 81.3% of community respondents. Similarly, most respondents had been involved in one or more research studies within the past 5 years (95.5% vs 85.5%). Most of the respondents (82.5% academic, 93.5% community) indicated their desire to improve current research programs at their institution. Notably, 56.3% of community respondents had no formal research training, compared with 7.5% of academic respondents. Respondents in both academic and community centers considered lack of time (64.3%) and lack of resources (57.1%) to be the major barriers to research. Other important perceived barriers included lack of remuneration for research (32.1%) and lack of appropriate research collaboration (21.4%; Table 1).Table 1Barriers to research identified by survey respondents in academic and community centersBarrierAcademic (40*Maximum number of responses possible.)Community (16*Maximum number of responses possible.)Total (56*Maximum number of responses possible.)Lack of time241236Lack of resources (ie, research infrastructure, statistical support, research assistants)201232Lack of research remuneration12618Lack of research training437Lack of relevant research topics011Lack of appropriate research collaboration7512Lack of available and appropriate patients718Potential for negative influence on patient-doctor relationship101Loss of professional autonomy011Other415 Maximum number of responses possible. Open table in a new tab The survey results show that cardiovascular practitioners in the community have an interest in increasing their clinical research involvement, but many continue to face significant barriers to research participation. Our study has some limitations, including a small sample size and selection bias. Nevertheless, our findings shed light on an area that has received limited emphasis and provide a Canadian perspective to compare with similar studies from other countries.1Rahman S Majumder MAA Shaban SF et al.Physician participation in clinical research and trials: issues and approaches.Adv Med Educ Pract. 2011; 2: 85-93Crossref PubMed Scopus (69) Google Scholar, 2Caldwell PHY Craig JC Butow PN. Barriers to Australian physicians’ and paediatricians’ involvement in randomised controlled trials.Med J Aust. 2005; 182: 59-65Crossref PubMed Scopus (16) Google Scholar, 3Wong AR Sun V George K et al.Barriers to participation in therapeutic clinical trials as perceived by community oncologists.JCO Oncol Pract. 2020; 16: e849-e858Crossref PubMed Scopus (8) Google Scholar, 4Paskett ED Reeves KW McLaughlin JM et al.Recruitment of minority and underserved populations in the United States: the Centers for Population Health and Health Disparities experience.Contemp Clin Trials. 2008; 29: 847-861Abstract Full Text Full Text PDF PubMed Scopus (125) Google Scholar Further studies and initiatives are needed to study and address such barriers in a larger and more representative population, with special focus on funding, training, and infrastructure. This research has adhered to the relevant ethical guidelines. The authors have no funding sources to declare.

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