Clinical trials face challenges in US with underrepresentation of minorities, especially African Americans and Hispanics, due to barriers like mistrust, limited access, and socioeconomic factors. Despite policies by NIH, FDA, and CDC aiming to improve diversity, these efforts have not fully resolved underrepresentation. This issue can lead to less effective treatments for underrepresented groups and perpetuate healthcare disparities. The study identifies four main barriers from staff perspectives: lack of consistent decision-making structure, staff shortages, administrative burdens, and inadequate resources for recruitment and retention. Solutions include more systematic support from sponsoring agencies and cancer centers, use of AI for targeted recruitment, and community engagement strategies.