HonorHealth Research Institute’s First Steps to Approaching Decentralized Clinical Trials (DCTs)

HonorHealth is a nonprofit health care system in Arizona serving the greater Phoenix metropolitan area in Maricopa County. Seventeen locations across the city and surrounding suburbs offer cancer care to the region’s diverse population, including a large Hispanic/Latino community, Native American patients from nearby tribal nations, and patients who travel from across the country for expert opinions from HonorHealth oncologists.

At present, all clinical trials for the health system occur at HonorHealth Research Institute in Scottsdale, northeast of Phoenix. Founded in 2005, the Research Institute offers about 70 oncology clinical trials at any given time with a focus on phase one, first-in-human trials. This centralized location provides each component of the clinical research process, from screening to treatment, under 1 roof. While this hub offers convenience and consistency for some, it poses access challenges for patients living in the far reaches of HonorHealth’s catchment area. Repeated trips to the facility are required for most early-phase clinical trials, but are not feasible for all patients and create a barrier to enrollment. In 2024, 338 oncology patients were enrolled in clinical trials, but institutional leadership identified an opportunity to increase that number and reach more eligible individuals.

Decentralized clinical trials (DCTs) are designed to distribute trial activities across multiple settings rather than relying solely on a single investigative site. Although study oversight and administrative management remain centralized, elements such as consent, screening, safety assessments, treatment administration, and follow-up can occur through a combination of telemedicine, local health care providers, home-based services, and digital technologies. This flexible model reduces travel burden, broad­ens geographic reach, and enables participation by patients who face barriers to enrolling in traditional single-site–based trials. Emerging evidence also suggests that data completeness and trial retention may improve when DCT elements are implemented in ways that align with patient needs and preferences.

HonorHealth Research Institute identified DCTs as a promising approach to expand clinical trial access for patients across the health system. However, leadership and research staff also recog­nized that a new structure could not be implemented overnight. A pilot program served as a vital first step to establishing a successful, large-scale research program that could meet patients in their own communities.

DCT Pilot Design
For HonorHealth’s first foray into DCTs, the Research Institute began sending an oncology clinical investigator to one of HonorHealth’s cancer care locations in Peoria, a suburb north­west of Phoenix. This individual serves as a resource for both patients and oncologists, offering consults on difficult cases, educating patients about the clinical trial process, and alerting the multidisciplinary team at Peoria about patients who may be a good fit for trials active at the Research Institute in Scottsdale. Importantly, patients are not yet being screened for or enrolled in clinical trials at the Peoria satellite location. Rather, the visiting clinical researcher aims to increase interest and awareness of trial availability for both oncologists and patients.

Since beginning this initiative in summer 2025, Erin Pierce, MSN, APRN, FNP-C, associate clinical investigator and nurse practitioner at HonorHealth Research Institute, has already seen benefits. “This has been enhancing the interest in trials in the community, but it also allows patients to get an understanding of clinical trials in their known environment,” she explained. Patients are more open to learning about trials when they are in a familiar setting and their trusted oncologist is present to answer questions.

Collaboration among clinicians has also had a positive impact on the clinical trial ecosystem. The relationship between community oncologists and the research oncologist “is definitely being strengthened,” Pierce said. “We’re seeing them reach out to us more frequently, and those interactions are occurring earlier.” While these outcomes do not eliminate the distance barrier, both patients and physicians are more eager to consider clinical trials and more motivated to travel to the Research Institute in Scotts­dale to formally kick off the screening process.

Tackling Staffing Hurdles

When designing the first steps toward incorporating decentral­ized elements into research protocols, HonorHealth Research Institute faced a nearly universal hurdle in the cancer care landscape: staffing shortages. As the population of patients diagnosed with cancer in the US grows, the oncology workforce has struggled to keep up. In this case, dedicated research oncologists have been a limiting factor in clinical trial capacity. “We’re seeing a decrease in the number of oncologists who are trained and committed to doing clinical research,” Pierce said. HonorHealth’s solution has been to champion advanced practice providers (APPs) and provide the training they need to be leaders in clinical trials. APPs, including Pierce, work as principal investiga­tors, maximizing the available workforce. “The physician shortage is not going anywhere, but APPs are ready and capable to step into that role,” she said.

At the outset of the DCT pilot, program administrators worried that they could not spare even 1 oncologist to travel to the oncology clinic in Peoria. Thus, the initiative was made possible by enlisting qualified APPs, and this strategy will continue to be important for future growth of DCTs at HonorHealth.

Moving Forward and Key Takeaways
HonorHealth Research Institute’s DCT pilot is a small but import­ant first step to creating a larger decentralized infrastructure. The next step is to identify metrics of success. Referral volume, screening failure rates, diverse research subject enrollment, patient satisfaction, and time to enrollment are all factors that need to be understood to drive the expansion of DCTs.

Future goals for this initiative involve moving some clinical trial activities into the community. The staff is planning to offer phase 2 and 3 trials at community cancer centers within the HonorHealth system.

For other cancer programs interested in employing a DCT model, Pierce recommended starting small. “You don’t have to jump in all at one time,” she said.

Now that HonorHealth Research Institute has achieved initial suc­cess, it can use the knowledge gained from this pilot to accelerate growth and expand clinical trial access to more patients.

ACKNOWLEDGEMENTS
Nadine J. Barrett, PhD, MA, MS, FACCC^1,2; Shaalan Beg, MD, MBA, FASCO³; Al B. Benson III, MD, FACP, FASCO⁴; Lora Black, RN, MPH, CCRP⁵; Christa Braun-Inglis, DNP, APRN-Rx, FNP-BC, AOCNP⁶; Carrie Friedman RN, BSN, OCN⁷; Una Hopkins, DNP, MSN, RN, FNP-BC, NE-BC, FACCC⁸; Michele Lacy, RN, BSN, OCN⁹; Marc Matrana, MD, Sc, FACP¹⁰; Jane Myles, MSc¹¹; Amy Peterson, PhD, GPC¹²; Wyatt Pickner¹³; Lawrence Wagman, MD¹⁴; Gabrielle Stearns¹⁵

¹Wake Forest University School of Medicine, ²Advocate Health; ³ConcertAI; ⁴Robert H. Lurie Comprehensive Cancer Center of Northwestern University Hospital; ⁵Sanford Health; ⁶University of Hawaii Cancer Center; ⁷Virginia Cancer Specialists; ⁸Montefiore Health System ⁹Metro Minnesota Community Oncology Research Consortium; ¹⁰Ochsner Cancer Institute; ¹¹Decentralized Trials & Research Alliance; ¹²Munson Healthcare; ¹³American Indian Cancer Foundation; ¹⁴City of Hope ¹⁵Association of Cancer Care Centers

The Association of Cancer Care Centers (ACCC) provides education and advocacy for the cancer care community. For more information, visit accc-cancer.org.

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