Understanding Cancer Clinical Trial Participation in Rural Communities: A Qualitative Focus Group Study

BACKGROUND: Participation in cancer clinical trials is essential for advancing oncologic care, yet enrollment among rural populations remains disproportionately low. These communities face many hurdles including geographical distance from medical centers, healthcare workforce shortages, and deep-seated medical mistrust that may contribute to survival inequities. AIMS: To address these gaps, a Research Navigator program was launched through the Florida Cancer Specialists & Research Institute to engage rural Florida residents in focus group sessions to identify barriers to trial participation. METHODS: Utilizing the Integrated Behavioral and Socioecological Framework (IBSF), the study conducted five semi-structured focus groups with 30 participants recruited from rural Florida counties. Participants included cancer survivors, advocates, caregivers, and those currently in treatment. Discussions centered on knowledge, experiences, perceived barriers, and willingness to participate in cancer clinical trials. RESULTS: Although most participants expressed awareness of cancer clinical trials, focus group discussions revealed misconceptions regarding trial purpose, process, and accessibility. Across groups, commonly reported barriers to participation included limited access to reliable transportation, financial concerns, and mistrust of medical professionals and healthcare systems. Thematic analysis of focus group transcripts yielded four themes: (A) perception and lived experience, (B) trial information dissemination, (C) enrollment impediments, and (D) intervention strategies and implementation. CONCLUSION: In rural settings, decisions regarding cancer clinical trial participation are shaped by a complex interplay of trust, logistics, and information access. This study emphasizes the importance of viewing trials as routine care and suggests that navigator-led outreach and patient-centric technology are essential for creating equitable access.