{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T13:35:31Z","timestamp":1786714531666,"version":"build-2736575974"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Canada\u2019s rural population faces higher rates of chronic disease, worse health outcomes and limited access to health services compared with urban residents. Clinical trials (CTs) can improve equity by expanding access to novel treatments and building healthcare infrastructure. However, rural participation in CTs remains limited. This review aimed to identify barriers and facilitators to the delivery of CTs in rural settings in high-income countries, with a focus on informing the Canadian rural research landscape.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A rapid review was conducted following Cochrane rapid review methods guidelines, incorporating input from key health system partners. Searches were performed in MEDLINE, CINAHL and Cochrane CENTRAL for studies published within the past five years. Inclusion criteria were peer-reviewed, empirical studies from high-income countries describing barriers to and\/or facilitators of rural CT delivery. Screening and data extraction were completed using Covidence, with narrative synthesis of results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Twenty-five studies were included. Barriers included geographic isolation, lack of research infrastructure, provider inexperience, regulatory complexity and patient-level challenges such as misconceptions and comorbidities that limit eligibility. Facilitators included community engagement, technology to support decentralisation, professional networks, provider education and financial support. Multiple definitions of rurality were identified, underscoring the lack of standardisation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Rural residents face unique barriers that restrict their participation in CTs, despite evidence of willingness and interest. Expanding rural CT programmes through professional networks, community engagement, technology integration and decentralisation of trial activities could reduce these barriers and help address persistent health inequities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>Obstacles et facteurs facilitants \u00e0 la r\u00e9alisation d\u2019essais cliniques en milieu rural: une revue rapide<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Au Canada, les populations rurales pr\u00e9sentent des taux plus \u00e9lev\u00e9s de maladies chroniques, de moins bons r\u00e9sultats de sant\u00e9 et un acc\u00e8s plus limit\u00e9 aux services de sant\u00e9 que les populations urbaines. Les essais cliniques peuvent contribuer \u00e0 une plus grande \u00e9quit\u00e9 en \u00e9largissant l\u2019acc\u00e8s \u00e0 de nouveaux traitements et en renfor\u00e7ant les infrastructures de soins. Toutefois, la participation des populations rurales aux essais cliniques demeure limit\u00e9e. Cette revue visait \u00e0 cerner les obstacles et les facteurs facilitants li\u00e9s \u00e0 la r\u00e9alisation d\u2019essais cliniques en milieu rural dans les pays \u00e0 revenu \u00e9lev\u00e9, afin d\u2019\u00e9clairer plus particuli\u00e8rement le contexte de la recherche rurale au Canada.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>M\u00e9thodes:<\/jats:title>\n                    <jats:p>Une revue rapide a \u00e9t\u00e9 men\u00e9e selon les lignes directrices de Cochrane pour les revues rapides, avec la contribution de partenaires cl\u00e9s du syst\u00e8me de sant\u00e9. Des recherches ont \u00e9t\u00e9 effectu\u00e9es dans MEDLINE, CINAHL et Cochrane CENTRAL afin de rep\u00e9rer les \u00e9tudes publi\u00e9es au cours des cinq derni\u00e8res ann\u00e9es. Les crit\u00e8res d\u2019inclusion visaient les \u00e9tudes empiriques, \u00e9valu\u00e9es par les pairs, provenant de pays \u00e0 revenu \u00e9lev\u00e9 et d\u00e9crivant les obstacles ou les facteurs facilitants li\u00e9s \u00e0 la r\u00e9alisation d\u2019essais cliniques en milieu rural. Le tri des articles et l\u2019extraction des donn\u00e9es ont \u00e9t\u00e9 r\u00e9alis\u00e9s \u00e0 l\u2019aide de Covidence, puis les r\u00e9sultats ont fait l\u2019objet d\u2019une synth\u00e8se narrative.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>R\u00e9sultats:<\/jats:title>\n                    <jats:p>Vingt-cinq \u00e9tudes ont \u00e9t\u00e9 retenues. Les obstacles relev\u00e9s comprenaient l\u2019isolement g\u00e9ographique, le manque d\u2019infrastructures de recherche, le manque d\u2019exp\u00e9rience des fournisseurs de soins en recherche, la complexit\u00e9 r\u00e9glementaire ainsi que des d\u00e9fis propres aux patients, notamment certaines id\u00e9es fausses et la pr\u00e9sence de comorbidit\u00e9s limitant l\u2019admissibilit\u00e9 aux essais. Les facteurs facilitants comprenaient la mobilisation des communaut\u00e9s, l\u2019utilisation de technologies pour soutenir la d\u00e9centralisation, les r\u00e9seaux professionnels, la formation des fournisseurs de soins et le soutien financier. Plusieurs d\u00e9finitions de la ruralit\u00e9 ont \u00e9t\u00e9 recens\u00e9es, ce qui met en \u00e9vidence l\u2019absence de standardisation dans ce domaine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Les personnes vivant en milieu rural font face \u00e0 des obstacles particuliers qui limitent leur participation aux essais cliniques, malgr\u00e9 des donn\u00e9es sugg\u00e9rant leur volont\u00e9 et int\u00e9r\u00eat \u00e0 y prendre part. Le d\u00e9veloppement de programmes d\u2019essais cliniques en milieu rural, appuy\u00e9s par des r\u00e9seaux professionnels, la mobilisation des communaut\u00e9s, l\u2019int\u00e9gration des technologies et la d\u00e9centralisation des activit\u00e9s de recherche, pourrait contribuer \u00e0 r\u00e9duire ces obstacles et \u00e0 s\u2019attaquer aux iniquit\u00e9s persistantes en sant\u00e9.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/cjrm.cjrm_73_25","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T12:00:48Z","timestamp":1786104048000},"page":"122-131","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Barriers and facilitators to rural clinical trials: A rapid review"],"prefix":"10.4103","volume":"31","author":[{"given":"Quinn","family":"Stewart","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deveshi","family":"Deveshi","sequence":"additional","affiliation":[{"name":"Department of Evaluation and Research Services, Fraser Health, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise","family":"Jaworsky","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada"},{"name":"Interior Health Authority, Kelowna, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"R2-20260814","doi-asserted-by":"crossref","first-page":"e0191151","DOI":"10.1371\/journal.pone.0191151","article-title":"Rural versus urban academic hospital mortality following stroke in Canada","volume":"13","author":"Fleet","year":"2018","journal-title":"PLoS One"},{"key":"R3-20260814","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/1472-6963-11-20","article-title":"An evaluation of access to health care services along the rural-urban continuum in Canada","volume":"11","author":"Sibley","year":"2011","journal-title":"BMC Health Serv Res"},{"key":"R4-20260814","doi-asserted-by":"crossref","first-page":"e33240","DOI":"10.2196\/33240","article-title":"Barriers to clinical trial participation: Comparative study between rural and urban participants","volume":"8","author":"Mudaranthakam","year":"2022","journal-title":"JMIR Cancer"},{"key":"R5-20260814","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.ygyno.2024.01.008","article-title":"How far is too far? 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