Health literacy, language access, and outreach at NCORP sites: Insights from the 2022 landscape assessment on equitable trial participation.

129 Background: Disparities in clinical trial participation persist across racial, ethnic, and socioeconomic groups. Health literacy limitations, language barriers, and inadequate outreach infrastructure are recognized but understudied contributors to inequitable access. The National Cancer Institute Community Oncology Research Program (NCORP) aims to improve trial access in community settings. Methods: Data were drawn from the 2022 NCORP Cancer Care Delivery Research (CCDR) Landscape Assessment, a national survey of community oncology practice groups. We analyzed responses from 271 NCORP practices, focusing on health literacy screening, availability of language services, and staffing for community outreach. Associations between site characteristics and service availability were evaluated using univariable and multivariable logistic regression. Differences in patient demographics by language service availability were assessed using nonparametric tests. Statistical significance was defined as p < 0.05. Results: Only 74 (27%) sites reported routinely screening patients for health literacy. Minority/Underserved NCORP sites were significantly less likely to screen compared to others (OR 0.42, 95% CI 0.19–0.92). Language services were reported by 238 (87%) sites, with 83 (35%) using bilingual staff. Sites with bilingual staff served higher proportions of Hispanic or non-white patients (median 36% vs. 12%, p < 0.001), though language services were not associated with health literacy screening. Just 52 (19%) sites had dedicated outreach staff to recruit underrepresented populations. Outreach staffing was more common at Minority/Underserved sites (OR 3.33, 95% CI 1.61–6.92) and larger practices. Conclusions: Substantial variability exists in site-level capacity to support inclusive trial participation. Health literacy screening remains underutilized, particularly at sites serving underrepresented populations. Language services are more commonly available throughout the NCORP as compared to health literacy screening. Outreach staffing is limited, despite its potential to address access barriers. Standardizing screening practices, strengthening language infrastructure, and investing in outreach may enhance equity in oncology trial enrollment across diverse communities.