{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T19:17:07Z","timestamp":1788463027451,"version":"build-2803163510"},"reference-count":25,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Telemed Telecare"],"abstract":"<jats:p>Decentralized clinical trial (DCT) methods have evolved globally to improve access to clinical trials for rural, regional, and other underserved populations. Several countries, including Australia, have implemented DCT approaches with variable success.<\/jats:p>\n                  <jats:p>In Australia, the Australian Teletrial Model was developed and adopted as a national policy initiative to improve equitable access to clinical trials. The Australian Teletrial Program, funded by the Commonwealth Government, supported implementation across jurisdictions and health services.<\/jats:p>\n                  <jats:p>The program achieved several important outcomes, including the development of harmonized templates and processes, standard operating procedures, and education and training programs. It also improved patient access to trials and strengthened workforce capability across participating sites.<\/jats:p>\n                  <jats:p>Despite these achievements, several barriers continue to limit broader implementation and sustainability. These include workforce turnover, cumbersome approval processes, variable uptake across different levels of the health system and sponsors, and inconsistent leadership engagement and ownership. Such challenges have constrained scale and productivity.<\/jats:p>\n                  <jats:p>To fully realize the benefits of DCT models and support health equity objectives, a whole-of-system approach is required. Streamlined policies and processes, aligned governance, and sustained leadership commitment are needed to embed decentralized clinical trial models into routine healthcare delivery and ensure long-term sustainability, productivity, and equitable access to clinical research.<\/jats:p>","DOI":"10.1177\/1357633x261475898","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T15:14:14Z","timestamp":1788275654000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Whole-of-system approach for program implementation: Lessons from the Australian Teletrial Program"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9068-8755","authenticated-orcid":false,"given":"Sabe","family":"Sabesan","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Townsville Cancer Centre"},{"name":"College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia"},{"name":"Queensland Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shivan","family":"Pathmanathan","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Townsville Cancer Centre"},{"name":"College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie","family":"Poxton","sequence":"additional","affiliation":[{"name":"Queensland Health"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,1]]},"reference":[{"key":"e_1_3_2_2_2","volume-title":"Assessing the impact of clinical trials: a scoping literature review","author":"Tuffaha H","year":"2021","unstructured":"Tuffaha H, Oakley P, Birch S. Assessing the impact of clinical trials: a scoping literature review. Australian Clinical Trials Alliance, 2021."},{"key":"e_1_3_2_3_2","unstructured":"National Comprehensive Cancer Network (NCCN) Guidelines NCCN USA. https:\/\/www.nccn.org\/guidelines\/nccn-guidelines."},{"key":"e_1_3_2_4_2","unstructured":"The Australian Commission on Safety and Quality in Health Care. Economic evaluation of investigator-initiated clinical trials conducted by networks. Canberra Australia 2017."},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.55770"},{"key":"e_1_3_2_6_2","unstructured":"FDA. Conducting clinical trials with decentralized elements. Guidance for industry investigators and other interested parties. 2024. https:\/\/www.fda.gov\/regulatoryinformation\/ search-fda-guidance-documents\/conducting-clinical-trials-decentralizedelements (accessed May 18 2026)."},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.35145"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/1357633X211017805"},{"key":"e_1_3_2_9_2","doi-asserted-by":"crossref","unstructured":"Munhoz R Sabesan S Thota R et al. Revolutionizing Rural Oncology: Innovative Models and Global Perspectives. Am Soc Clin Oncol Educ Book 2024;44.","DOI":"10.1200\/EDBK_432078"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/1357633X20950180"},{"issue":"1","key":"e_1_3_2_11_2","first-page":"1","article-title":"Impact of the COVID-19 pandemic mitigation strategies on cancer treatment trials: A metanalysis of industry and NCI studies","volume":"2","author":"Unger M","year":"2025","unstructured":"Unger M, Andrews H, Levit L, , et al. Impact of the COVID-19 pandemic mitigation strategies on cancer treatment trials: A metanalysis of industry and NCI studies. JCO Oncol Adv 2025; 2(1): 1\u20139. https:\/\/doi.org\/10.1200\/OA-25-00021","journal-title":"JCO Oncol Adv"},{"key":"e_1_3_2_12_2","unstructured":"Australian Government Department of Health and Aged Care. The national standard operating procedures for clinical trials in Australia. 2023. https:\/\/www.health.gov.au\/ resources\/collections\/the-national-teletrials-compendium (accessed May 18 2026)."},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.3390\/curroncol28050329"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2026.17204"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.4324\/9780203557334-3"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-025-01450-7"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1111\/ajco.14209"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12961-024-01270-z"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/1357633X221107995"},{"key":"e_1_3_2_20_2","unstructured":"Successful implementation of policy initiatives Better Practice Guide Department of Prime Minister and Cabinet Commonwealth of Australia Canberra Australia 2014. 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