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Background: Cancer patients(pts)have knowledge and attitudinal barriers to participation in clinical trials(CT).We developed PRE-ACT(Preparatory Education About Clinical Trials),a tailored,interactive,web-based intervention to address these barriers and improve preparation for consideration of CT as a treatment option.Methods: We conducted a prospective,randomized,multicenter,phase Ⅲ clinical trial of PRE-ACT vs.control(general text about CT excerpted from NCI materials).All assessments and interventions were conducted online.Cancer pts >18 years old were enrolled before initial oncologist consultation.Pts completed a baseline assessment including CT knowledge(19-item); CT attitudes(28-item); preparation for decision making(10-item); and validated measures of preferences for shared decision making and quality/length of life.PRE-ACT pts received a summary of their preferences and a list of their top CT barriers.Based on ranking of individual barriers,pts were presented with a video library of 30-90 second clips addressing their top barriers(10 maximum).After the educational intervention a follow up survey reassessed CT barriers and preparation.Results: 1255 pts were randomized; median age 59(range 20-88); 58%female; 12%non-white/2%Hispanic; 76.4%some college education.1081 pts completed baseline and post-intervention assessments.The control and PRE-ACT groups both had improved knowledge,reduced attitudinal barriers,and improved preparation(p<.0001 for all comparisons).PRE-ACT was more effective than control in improving knowledge(p=.0006)and attitudes(p<.0001).Furthermore,pts in the PRE-ACT arm were more satisfied with the amount(p=.002)and format(<.0001)of information,and felt more prepared to consider CT(p=.0003).Conclusions: This large-scale randomized trial of a tailored,web-based,video intervention demonstrates that educational information delivered online before the oncologist visit can significantly reduce knowledge barriers and attitudinal barriers and improve preparation for consideration of clinical trials.Both text and PRE-ACT are effective,with greater improvements and satisfaction in the PRE-ACT group.