As clinical trial decentralization gains traction, there is one bottleneck limiting equitable access: inconsistent patient identification. Becker’s spoke to 14 oncology industry leaders about which strategies are most critical to expanding access — and where gaps remain.
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Editor’s note: Responses have been lightly edited for clarity and length.
Question: Clinical trials are becoming more decentralized, but participation gaps persist. What is the most effective lever health systems can pull to expand equitable trial access at scale?
Sachin Apte, MD. Chief Clinical Officer and Physician-in-Chief at Huntsman Cancer Institute (Salt Lake City): Clinical trials are critical to unlocking novel discoveries and advancing the science of clinical oncology. Real-world data in all populations is necessary to truly translate innovation for all — not just a subset of cancer patients.
There are a myriad of barriers to achieving equitable trial access. Examples include distance, rurality, social, financial, gender and race. There are many potential levers to expand access, which include navigation, embedding trial coordinators at partner sites, automation of administrative tasks and broadening eligibility criteria.
To fully realize equitable access, health systems should first work to engender more public trust and understanding of clinical trials and help create the conditions where all cancer patients view clinical trials as an opportunity for personal impact.
Dhruv Bansal, MD. Director of Immunotherapy and Thoracic Oncology at Endeavor Health (Evanston, Ill.): Although clinical trials are increasingly decentralized, participation gaps persist. The most effective way for health systems to expand equitable trial access at scale is to embed trial eligibility assessment directly within routine clinical workflows, rather than handling trials as a separate process. This involves systematic prescreening using structured electronic health record data, molecular results and real-time point-of-care alerts. By automatically assessing every patient for trial eligibility, access becomes proactive rather than dependent on referrals.
Decentralization tools — such as remote consent, local laboratories and tele-visits — can only improve equity if the initial identification process is reliable. Investment in trial infrastructure, shared staffing models and standardized workflows across community sites is crucial for reducing geographic and socioeconomic disparities. Ultimately, equity improves not simply by increasing the number of trials but by making trial consideration the default for every eligible patient.
Richard Barakat, MD. Physician-in-Chief and Executive Director at Northwell Health Cancer Institute (New Hyde Park, N.Y.): The most effective lever health systems can pull to expand equitable clinical trial access at scale is to systematically integrate clinical trial identification, education and support into routine clinical practice throughout their entire service area. This shifts trial participation from an isolated event to an embedded component of every patient’s ongoing healthcare journey, extending beyond just flagship sites.
Implementing this requires strategic investment in decentralized resources for patient identification and consent at all points of care, supported by a centralized infrastructure that establishes clear protocols for data collection, follow-up and administrative tasks, thereby minimizing burden on frontline clinical staff.
Furthermore, dedicated clinical trial navigators are vital to provide comprehensive patient education, logistical assistance and continuous communication, while working together with the overall care team.
Finally, ensuring culturally and linguistically appropriate trial information and delivery is imperative to guarantee that all diverse communities served have equitable access to the most advanced care and clinical trials.
Frantz Berthaud. Senior Vice President of Oncology Services at University Medical Center of El Paso (Texas): While decentralization helps with logistics, the real barrier to equitable access is that trials remain a parallel system to regular clinical workflows. It has separate tools, separate teams, separate workflows and separate patient identification pathways. We need to hardwire trial identification and referral into everyday oncology care.
So often patients are never told about a trial, whether it’s unconscious bias or workflow friction. We’ve put clinicians in the role of gatekeeper. I’m more interested in seeing a sustainable engine of equity built into our oncology ecosystem.
Of course, to scale something like this requires work. EHR integration for trial matching, centralized trial navigation, default scripting for clinicians and more integration with community clinics. I believe the most effective lever here is embedding universal and automated trial prescreening into standard oncology workflows.
Natasha Carrera. Associate Director of Service Line Management at Fred Hutchinson Cancer Center (Seattle): Despite growing interest in decentralized clinical trials, participation gaps persist because many patients are never screened or offered a trial in the first place. The most effective lever health systems can pull is embedding clinical research directly into routine care pathways across community sites, supported by universal eligibility screening and dedicated patient navigation. By expanding trial infrastructure beyond academic centers and into the settings where patients already receive care, health systems can meaningfully reduce geographic and socioeconomic barriers while improving equitable access at scale.
Praneeth Chebrolu, MD. Director of Clinical Research at OSF HealthCare Saint Francis Medical Center (Peoria, Ill.): The most effective lever health systems can pull to expand equitable clinical trial access at scale is the deployment of AI-enabled clinical trial matching integrated into routine care workflows. While decentralization has reduced geographic barriers, the primary challenge remains identifying eligible patients. Many patients are never considered for trials due to complex and fragmented eligibility criteria that are difficult to operationalize in busy clinical settings.
AI-driven matching addresses this gap by continuously analyzing EHR data, standardizing eligibility assessment and embedding trial options directly into clinical workflows. This ensures that every patient, regardless of location or background, is systematically evaluated for trial participation.
At scale, this approach transforms trial access from an opportunistic process into a system-level capability, improving enrollment efficiency, expanding access to underrepresented populations and accelerating drug development.
In short, decentralization addresses where trials occur and AI-enabled clinical trial matching determines who gets considered.
Jennifer Litton, MD. Chief Clinical Research Officer at the University of Texas MD Anderson Cancer Center (Houston): Decentralized trials — or those that allow patients to participate without being seen at the coordinating site — have been deployed across multiple study types, with the goal of expanding further into interventional and treatment trials. While these models have been discussed for many years, the devil remains in the details of implementation, particularly around data collection and use, especially for trials with registrational intent.
Successfully executing these trials will require dedicated, well-funded personnel and infrastructure, including regulatory oversight, budgeting, clinical trial operations, remote data access, investigational pharmacies, shipping logistics and coordination with local physicians and laboratories. At the same time, it will be intriguing to see continued improvements in how AI-based trial matching tools can securely leverage electronic medical records and clinical trial data. These tools could help patients and their local physicians identify and access a broader variety of trials.
It will also be interesting to see how these technologies evolve to incorporate patient-generated data, such as inputs from wearables and smartphone-based interfaces. AI is already being used in several aspects of the clinical trial startup process, and these capabilities will need to continue adapting to support decentralized trial structures where appropriate.
Arturo Loaiza-Bonilla, MD. System Chief of Hematology and Oncology at St. Luke’s University Health Network (Bethlehem, Pa.): The most effective lever health systems can pull is embedding clinical trial eligibility assessment directly into routine care workflows. When trial matching is automated, guideline-anchored and triggered at key clinical decision points — such as diagnosis, progression or biomarker results — access scales naturally and more equitably. Decentralized trials help, but the real unlock is operational integration that removes the cognitive and logistical burden from both clinicians and patients, ensuring trials are considered as care, not as an afterthought. The efforts of patient-centered trial activation using AI such as American Cancer Society’s ACS ACTS are key and the future.
Ruben Mesa, MD. President of the Cancer National Service Line and Senior Vice President at Advocate Health (Charlotte, N.C.) and Executive Director of Atrium Health Wake Forest Baptist Comprehensive Cancer Center (Winston-Salem, N.C.) and Nike Onifade. Senior Vice President of the National Cancer Service Line at Advocate Health: Clinical trials in cancer are essential to every advance we have seen in cancer care and to the progress still ahead. Recently, the American Cancer Society reported that 70% of cancer patients are now surviving five years or more past their diagnosis, a milestone achievable only through clinical trials. Yet historically, well under 10% of adult cancer patients have participated, and many populations remain underrepresented due to barriers such as access, trust, transportation and distance, financial constraints and bias.
The most effective lever that health systems can pull to expand equitable access at scale is to embed clinical trials into routine care, making trial consideration a standard and expected part of the clinical workflow, not a separate activity. This requires moving beyond individual sites or investigators and building system-level infrastructure that supports trials wherever patients receive care.
Expanding trial access at scale is a central goal for Advocate Health, where we recently launched the National Center for Clinical Trials. We are increasing awareness and participation by using AI to help identify potential trial candidates and by alerting treating care teams.
Amar Rewari, MD. Chief of Radiation Oncology at Luminis Health (Annapolis, Md.): The biggest lever isn’t decentralization itself, it’s embedding trials into routine care pathways.
Most participation gaps exist because trials are still operationally separate from where patients actually receive care. Health systems that win here are integrating trial eligibility screening into the EHR, aligning incentives for physicians to offer trials as a standard option and building partnerships with community sites rather than expecting patients to travel.
Decentralized tools matter but they only work at scale when trials are treated as part of care delivery, not an add-on.
Urshila Shah, PharmD. Chief Pharmacy Officer at Westchester Medical Center Health Network (Valhalla, N.Y.): The most effective lever is embedding clinical trial identification and referral directly into routine oncology care. This includes equipping pharmacists, advanced practice providers, navigators and front-line clinicians with EHR‑integrated eligibility tools, real‑time alerts and streamlined referral pathways. Decentralized options — like remote consent, home‑based labs, specialty pharmacy support and mobile nursing — only expand equitable access when tied to embedded decision support and aligned workflows.
Walter Stadler, MD. Chief Clinical Officer at City of Hope Chicago: The entire clinical trial system is built on a premise that sponsors and institutions should collaboratively manage the process, which in turn has led to marked increase in bureaucracy. Physicians are the key individuals for enrolling patients and their most important role is to assure that the patient’s interests are protected. Making it as simple as possible for physicians with “just-in-time” processes and providing only the information necessary to protect the patient’s interests are key.
Sai Yendamuri, MD. Chief Strategy Officer and Senior Vice President of Business Development and Outreach at Roswell Park Comprehensive Cancer Center (Buffalo, N.Y.): Decentralization of cancer care, in general, is being adopted and driven by consolidation of health systems. While this provides greater access to routine care, attempts have been made to push out clinical trials into existing networks. This has led to clinical trial enrollment of varying success.
Barriers that we have experienced include network providers who focus on routine care primarily and do not have the expertise or support to conduct trials, and the legacy processes that make clinical trial screening, eligibility verification, trial conduct and monitoring very cumbersome. The best way for physicians to adopt a process is to make it easy. Routine clinical care has become onerous enough. Asking these providers to participate in trials is possible only if something is taken off their plate.
Fortunately, technology is now available that, in the future, should enable this. For example, AI-powered tools to screen and flag patients that are eligible will be increasingly important. Remote consenting will hopefully become standard. Decentralizing the conduct of all elements of the study that are possible to be performed by telehealth should move the processes toward becoming frictionless. Engineering these frictionless processes relevant to each system or geography are necessary to scale trial access and recruitment.
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