The results were obtained from analysing 30 of the 32 questions in the questionnaire, since two of them did not offer significant information (question 5, which referred to the most important weaknesses in extrapolating the results of clinical trials to the work environment, and question 26, which asked about the specialists' prior participation in clinical trials).
Following the quantitative analysis, with the results shown in table 1, and the qualitative analysis, which gathers the testimony of the experts reviewed in their cognitive, social and hospital context, the main finding observed in the study was a lack of correspondence between the people who take part in CT and the patients who come for consultation, so almost half of the oncologists (43%) did not consider the information from them to be sufficient for therapeutic decision-making concerning their patients.
In cases in which a CT was not being conducted in their hospital (see the testimony in table 2), the information from CT was not considered sufficient for decision-making, since the indications in the CT are individualised according to the patient to be treated (testimony 1 [T1]), and it was also stated that it is difficult to find specific evidence for some diseases or certain treatment stages (T2). Therefore, it was observed that CT are not adapted to the needs of their patients (T3), their state of health or the contextual realities in which they work (T4, T5). So they all agreed with the need for real world data (RWD) studies as a complement to CT to assess the efficacy of treatment (T6).
Generally speaking, the majority of the experts stated that it was necessary to confirm probable diagnoses in the real population or a population with similar characteristics to those they saw in consultation.
In cases in which there was a CT in the hospital (see the testimony in table 3), more than half of the interviewees (65%) denied receiving any kind of compensation for including patients in a CT, but if there was any financial compensation, they mentioned that the researchers do not receive it directly (T7).
With regard to the usefulness of CT, it was stated that they were useful in clinical practice and using them as a basis offered more benefits than risks. In addition, they made it possible to find new solutions to existing problems and the fact of studying those problems in their own patients was an extra incentive (T8).
It was also detected that CT could change the paradigms of clinical practice in the short to medium term, such as when a new treatment alternative is offered (T9).
It was argued that the interest in performing a CT was normally due to patient need (T10), although on some occasions it was due to private interests.
In spite of the majority considering that the personnel were qualified to be monitors or responsible for supervising a CT, some of them had doubts about this (T11, T12) and said that, sometimes, monitors were not sufficiently trained, due to several factors: the profile of the people performing the task (inexperienced young people) and poor working conditions, which brought about a continual change in personnel (T13, T14).
With regard to logistics for the performance of CT, the majority mentioned that they have a data manager and a management unit in their centre (71%), but they complained about lack of support from the hospital, in spite of the fact that it could receive benefits from performing this kind of activity (T15), and they recognised that external groups are entrusted with performing the analysis (T16, T17).
In the case of a CT being performed in a hospital, no change or improvements in the logistics or infrastructure of the hospital were perceived as a consequence of it, so it also had no effect on recruitment or inclusion of patients (T18).
Among the factors that may influence the participation of patients in CT, they mentioned the patients' socio-economic situation (T19) and the number of tests to be performed on patients and their comorbidities (T20, T21).
With regard to the criteria for selecting patients, lack of alternatives or treatment is what motivated most of the specialists to include their patients in a CT, due to considering it to be the best option for them (T23, T24). Almost all of them had recommended a CT at some time since they were convinced that it was the most beneficial therapeutic option (86%), based on the medical principle of primum non nocere (T25, T26). They stated that they did not consider themselves conditioned by financial incentives (T22).
More than half of the interviewees (64%) commented that it is difficult to find the ideal patient to include in a CT and that they found it hard to recruit patients who met all of the criteria and, also, that they were not likely to accept.
One of the reasons they all recognised as a motivation for performing a CT was the importance of being the author of a CT, since it benefits them from the viewpoint of their CV (T27) and because being an author of a publication is form of recognition of their work and a reward for it (T28, T29), although the majority did not consider it to be an indispensable requirement (T30), instead the important thing was to offer a possible better treatment alternative to patients (T31).
More than half of them had issued a publication prior to their first CT (65%); almost 30% of these had published during the resident stage.
One influential factor in the decision to participate in a clinical trial, according to 43% of the interviewees, was the financial incentive (T32, T33, T34), but this had a different influence depending on whether they were patients or professionals. In the case of patients, their poor economic situation was mentioned and, among health professionals, the main reason was to provide a better treatment option to the patient. Almost all of them agreed that CT are useful when they offer new alternatives to patients (93%) and when they provide data about treatment sequences or subpopulations (T35, T36).
Regarding their knowledge of CT (see the testimonies in table 4), the majority were aware of biological markers and some research techniques such as biases, although only 57% of the specialists managed to mention selection bias and very few mentioned a different type of bias (15%). Some of them were even mistaken regarding evaluations of biases.
When they were asked about which parts of a CT are analysed before deciding to take part in a study, the specialists mentioned the following in order of priority:
Characteristics of the population studied (93%).
Ethical considerations of the study (86%).
Representativeness of the study (64%).
Almost half of them admitted that they do not have sufficient ability to analyse a CT (43%), and 50% of these recognised that they were lacking in statistical skills.
It was found that just 29% of the specialists analyse clinical protocols before prescribing new drugs in order to find out whether the population is similar to the one being treated or if the study was well-produced methodologically; 64% do this sometimes.
Finally, some of them said that during the performance of a CT they had identified groups applying pressure for the use of a particular treatment (T37, T38).