Looking back to move forward - lessons from clinical trial activity and growth in rural, regional and remote Australia: a scoping review and evidence map
4 affiliations
- 1College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
- 2Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
- 3Townsville Institute of Health Research and Innovation, Townsville University Hospital, Townsville Hospital and Health Service, Townsville, QLD, Australia
- 4Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
Abstract
Background: About one-third of Australians in rural, regional, and remote areas have limited access to clinical trials, leading to increased 2019 government funding to improve access.
Objectives: To review experiences of conducting clinical trials in these regions, describe efforts to develop activity, and identify gaps for future research.
Eligibility criteria: English-language peer-reviewed literature reporting on clinical trial activity, development, implementation, or lessons learned in rural, regional, and remote Australia. We excluded protocols, non-peer-reviewed literature, urban-focused studies, and outcome-focused clinical trial reports.
Sources of evidence: A systematic search of Scopus (MEDLINE), Informit Health Collection, and CINAHL electronic databases was conducted from inception to September 2024.
Charting methods: Data were extracted using a bespoke tool iteratively developed from previous literature and piloting.
Results: Of 466 records identified, 435 were screened, 84 underwent full-text review, and 24 were included. Eighteen were empirical with diverse research methodologies, and six were non-empirical. A third of publications (n = 8) reported on trials conducted in Victoria, and over half (n = 13) focused on oncology clinical trials. A hybrid deductive-inductive thematic analysis identified four key themes: 1) perceptions of clinical trials, 2) clinical trial activity and capability, 3) participant recruitment, and 4) clinical trials involving First Nations Australians. Clinicians and patients generally viewed clinical trials as important; however, limited clinical trial capability and maturity constrained local health services. Studies reporting economic analysis suggested that conducting clinical trials closer to participants could reduce costs for those who would otherwise need to travel to take part. Evidence indicates that First Nations Australians have been systematically excluded from clinical trials due to culturally inappropriate study designs.
Conclusion: While trials are viewed positively, more research is needed to explore capability-building approaches that strengthen recruitment, minimise research costs, and ensure culturally safe approaches that support meaningful participation by First Nations Australians.
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BibTeX
@article{graffini2026looking,
title = {{Looking back to move forward - lessons from clinical trial activity and growth in rural, regional and remote Australia: a scoping review and evidence map}},
author = {Jenna Graffini and Katri Malinen and Michelle A. Krahe and Karen Carlisle and Steven M. McPhail and Sarah Larkins},
journal = {Frontiers in Medicine},
year = {2026},
month = oct,
doi = {10.3389/fmed.2026.1977490},
url = {https://doi.org/10.3389/fmed.2026.1977490},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Looking back to move forward - lessons from clinical trial activity and growth in rural, regional and remote Australia: a scoping review and evidence map
AU - Jenna Graffini
AU - Katri Malinen
AU - Michelle A. Krahe
AU - Karen Carlisle
AU - Steven M. McPhail
AU - Sarah Larkins
PY - 2026
DA - 2026/10/29
JO - Frontiers in Medicine
DO - 10.3389/fmed.2026.1977490
UR - https://doi.org/10.3389/fmed.2026.1977490
AB - Background: About one-third of Australians in rural, regional, and remote areas have limited access to clinical trials, leading to increased 2019 government funding to improve access. Objectives: To review experiences of conducting clinical trials in these regions, describe efforts to develop activity, and identify gaps for future research. Eligibility criteria: English-language peer-reviewed literature reporting on clinical trial activity, development, implementation, or lessons learned in rural, regional, and remote Australia. We excluded protocols, non-peer-reviewed literature, urban-focused studies, and outcome-focused clinical trial reports. Sources of evidence: A systematic search of Scopus (MEDLINE), Informit Health Collection, and CINAHL electronic databases was conducted from inception to September 2024. Charting methods: Data were extracted using a bespoke tool iteratively developed from previous literature and piloting. Results: Of 466 records identified, 435 were screened, 84 underwent full-text review, and 24 were included. Eighteen were empirical with diverse research methodologies, and six were non-empirical. A third of publications (n = 8) reported on trials conducted in Victoria, and over half (n = 13) focused on oncology clinical trials. A hybrid deductive-inductive thematic analysis identified four key themes: 1) perceptions of clinical trials, 2) clinical trial activity and capability, 3) participant recruitment, and 4) clinical trials involving First Nations Australians. Clinicians and patients generally viewed clinical trials as important; however, limited clinical trial capability and maturity constrained local health services. Studies reporting economic analysis suggested that conducting clinical trials closer to participants could reduce costs for those who would otherwise need to travel to take part. Evidence indicates that First Nations Australians have been systematically excluded from clinical trials due to culturally inappropriate study designs. Conclusion: While trials are viewed positively, more research is needed to explore capability-building approaches that strengthen recruitment, minimise research costs, and ensure culturally safe approaches that support meaningful participation by First Nations Australians.
SN - 2296-858X
ER -