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Verhoef NC, Blomme RJ. Burnout among general practitioners, a systematic quantitative review of the literature on determinants of burnout and their ecological value. Front Psychol 2022; 13:1064889. [PMID: 36591073 PMCID: PMC9798333 DOI: 10.3389/fpsyg.2022.1064889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
Burnout is a major social and economic problem, specifically among general practitioners (GPs). The amount of literature on generic determinants of burnout is impressive. However, the size of the library on occupation-specific determinants of burnout among GPs are minimal. With the present study, we aim to gain insight into the existing academic literature on generic and occupation-specific determinants of burnout among GPs. Moreover, we aim to contribute to the ecological validity of this study by emphasizing occupation-specific determinants. We conducted a systematic quantitative literature review in which we followed the PRISMA statement and performed quality assessments according to the AXIS, CASP, MMAT, and 3-MIN procedures. Furthermore, we assessed frequency effect sizes (FES) and intensity effect sizes (IES). By performing Fisher's exact tests, we investigated whether the quality of the studies influenced the outcomes. An extensive literature search revealed 60 eligible studies among which 28 strong studies, 29 moderate studies, and 3 weak studies were identified. Analyzing those studies delivered 75 determinants of burnout, of which 33 were occupation-specific for GPs. According to the average FES, occupation-specific determinants play a significant role in acquiring burnout compared to the generic determinants. The results of the Fisher exact tests provided evidence that the quality of the 60 studies did not affect the outcomes. We conclude that it is surprising that a profession with such an important social position and such a high risk of burnout has been so little researched.
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Affiliation(s)
- Nicolaas Cornelis Verhoef
- Faculty of Management, Open University of the Netherlands, Heerlen, Netherlands,*Correspondence: Nicolaas Cornelis Verhoef,
| | - Robert Jan Blomme
- Faculty of Management, Open University of the Netherlands, Heerlen, Netherlands,Faculty of Leadership and Management, Nyenrode Business University, Breukelen, Netherlands
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Garnett A, Northwood M. Recruitment of Community-Based Samples: Experiences and Recommendations for Optimizing Success. Can J Nurs Res 2021; 54:101-111. [PMID: 34841904 PMCID: PMC9109582 DOI: 10.1177/08445621211060935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Recruitment in health and social science research is a critically important but often
overlooked step in conducting successful research. The challenges associated with
recruitment pertain to multiple factors such as enrolling groups with vulnerabilities,
obtaining geographic, cultural, and ethnic representation within study samples,
supporting the participation of less accessible populations such as older adults, and
developing networks to support recruitment. Purpose This paper presents the experiences of two early career researchers in recruiting
community-based samples of older adults, their caregivers, and associated health
providers. Methods Challenges and facilitators in recruiting two community-based qualitative research
samples are identified and discussed in relation to the literature. Results Challenges included: identifying potential participants, engaging referral partners,
implementing multi-methods, and achieving study sample diversity. Facilitators included:
making connections in the community, building relationships, and drawing on existing
networks. Conclusions Findings suggest the need for greater recognition of the importance of having clear
frameworks and strategies to address recruitment prior to study commencement as well as
the need to have clear outreach strategies to optimize inclusion of marginalized groups.
Recommendations and a guide are provided to inform the development of recruitment
approaches of early career researchers in health and social science research.
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Affiliation(s)
- Anna Garnett
- Arthur Labatt School of Nursing, 6221Western University, London, Ontario, Canada
| | - Melissa Northwood
- School of Nursing, 3710McMaster University, Hamilton, Ontario, Canada
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Azar M, Bradbury-Jones C, Kroll T. Middle-aged Lebanese women's interpretation of sexual difficulties: a qualitative inquiry. BMC Womens Health 2021; 21:203. [PMID: 34001078 PMCID: PMC8127220 DOI: 10.1186/s12905-020-01132-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 11/19/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The study explores women's perception and experience of sexual difficulties. The need to address the subject was triggered by the scarcity of research that reflects on women's subjective views on sexual difficulties. This is particularly crucial for middle-aged women who frequently experience hormonal and psychosocial changes that may affect their sexual life. METHODS Using in-depth individual and focus groups interviews, 52 Lebanese women aged 40-55 years discussed their thoughts, feelings and behaviours concerning sexual difficulties. Women were recruited purposefully from clinical and non-clinical settings to get maximum sampling variation that provided rich information and deep understanding of the subject. Recordings were transcribed verbatim and analysed about the framework analysis. Many strategies were adopted to ensure rigour. RESULTS Women's narratives led to four themes: women's inability to communicate sexual desires and concerns; male sexual difficulties; marital conflicts; and sexual difficulties as context-bound. Women's sexual difficulties are driven by double standards and inhibiting sexual socialisation. Once married, many women had very challenging sexual experiences. They were obliged to silently bear their husbands' poor sexual performance to protect their masculinity and thus their social image and identity. Women's narratives also showed that marital conflicts, daily life problems as well as physical and psychological burdens further challenged their sexual wellbeing and contributed to their sexual difficulties. CONCLUSION The study makes a unique contribution to voicing women's views and concerns as sexuality is insufficiently researched and reported in Lebanon. It emphasises the multidimensional nature of female sexual difficulties, particularly the gender-based norms that inhibit their sexual selves and profoundly affect their sexual wellbeing and capacity to claim their sexual likes and dislikes. Findings have implications on research and practice to help women prevent and overcome their sexual difficulties.
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Affiliation(s)
- Mathilde Azar
- Faculty of Health Sciences - University of Balamand. St George Health Complex, Youssef Sursock Street. P.o. Box. 166378 Ashrafieh, Beirut, 1100-2807, Lebanon.
| | | | - Thilo Kroll
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4, UK
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Grady K, Gibson M, Bower P. Can a 'consent to contact' community help research teams overcome barriers to recruitment? The development and impact of the 'Research for the Future' community. BMC Med Res Methodol 2019; 19:195. [PMID: 31640600 PMCID: PMC6805518 DOI: 10.1186/s12874-019-0843-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 09/27/2019] [Indexed: 11/10/2022] Open
Abstract
Background Recruitment to health research remains a major challenge. Innovation is required to meet policy commitments to help patients take part in health research. One innovation that may help meet those policy goals is the development of ‘consent to contact’ systems, where people give generic consent to be contacted about research opportunities. Despite their potential, there are few empirical assessments of different ways of recruiting patients to such communities, or of the value of such communities to local research teams. Main text We describe the development of the ‘Research for the Future‘consent to contact community, outline the recruitment of patients to the community, and present data on their participation in research. Discussion Over 5000 people have been registered across 3 clinical areas. A range of recruitment strategies have been used, including direct recruitment by clinicians, postal invitations from primary care, and social media. In a 1 year period (2016–2017), the community provided over 1500 participants for a variety of research projects. Feedback from research teams has generally been positive. Summary The ‘Research for the Future‘consent to contact community has proven feasible and useful for local research teams. Further evaluation is needed to assess the cost-effectiveness of different recruitment strategies, explore patient and researcher experience of its advantages and disadvantages, and explore how the community can be more reflective of the wider population.
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Affiliation(s)
- Katherine Grady
- Research & Innovation, Salford Royal NHS Foundation Trust, Salford, UK
| | - Martin Gibson
- NIHR Clinical Research Network, Greater Manchester, UK
| | - Peter Bower
- NIHR Clinical Research Network and Centre for Primary Care and Health Services Research, University of Manchester, Greater Manchester, UK.
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Sunderji N, Ion A, Zhu A, Perivolaris A, Rodie D, Mulsant BH. Challenges in conducting research on collaborative mental health care: a qualitative study. CMAJ Open 2019; 7:E405-E414. [PMID: 31201177 PMCID: PMC6579651 DOI: 10.9778/cmajo.20180172] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND We sought to understand poor uptake of the Primary Care Assessment and Research of a Telephone Intervention for Neuropsychiatric Conditions with Education and Resources study (PARTNERs), a pragmatic randomized controlled trial of a collaborative care intervention for people experiencing depression, anxiety or at-risk drinking. We explored primary care providers' experience with PARTNERs, and preferences regarding collaborative care models and trials. METHODS In this qualitative study, we interviewed primary care providers across Ontario who had participated in PARTNERs, using stratified sampling to reach high-, low- and nonreferring providers in urban and rural settings. We audio-recorded, transcribed and thematically analyzed the interviews between May and December 2017, collecting and analyzing data concurrently until achieving saturation. RESULTS We interviewed 23 primary care providers. They valued the unique availability of telephone-based coaching for patients but desired greater integration of the coach into their practice. They appreciated expert psychiatric recommendations but rarely changed their practices. Sites varied in organizational adoption and implementation of the study, including whether they designated a local champion, proactively identified eligible patients, integrated the study into existing workflows and reflected on (and revised) practices. These behaviours affected continuing awareness of the study and referral rates. INTERPRETATION Study uptake was influenced by the limited relationship between PARTNERs coaches and primary care providers, and variable attention to leadership, training and quality improvement as vital elements of collaborative care. Study designs focusing on implementation could promote reach and penetration of novel interventions in the practice setting and more successfully advance collaborative care implementation.
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Affiliation(s)
- Nadiya Sunderji
- Waypoint Centre for Mental Health Care (Sunderji), Penetanguishene, Ont.; Li Ka Shing Knowledge Institute (Sunderji), St. Michael's Hospital; Department of Psychiatry (Sunderji, Rodie, Mulsant), University of Toronto, Toronto, Ont.; Waypoint Research Institute (Sunderji), Penetanguishene, Ont.; St. Michael's Hospital Mental Health Research Group (Ion), Toronto, Ont.; School of Social Work (Ion), McMaster University, Hamilton, Ont.; Faculty of Medicine (Zhu), University of Toronto; Medical Psychiatry Alliance & Collaborative Care (Perivolaris), Telepsychiatry (Rodie) and Campbell Family Mental Health Research Institute (Mulsant), Centre for Addiction and Mental Health, Toronto, Ont.
| | - Allyson Ion
- Waypoint Centre for Mental Health Care (Sunderji), Penetanguishene, Ont.; Li Ka Shing Knowledge Institute (Sunderji), St. Michael's Hospital; Department of Psychiatry (Sunderji, Rodie, Mulsant), University of Toronto, Toronto, Ont.; Waypoint Research Institute (Sunderji), Penetanguishene, Ont.; St. Michael's Hospital Mental Health Research Group (Ion), Toronto, Ont.; School of Social Work (Ion), McMaster University, Hamilton, Ont.; Faculty of Medicine (Zhu), University of Toronto; Medical Psychiatry Alliance & Collaborative Care (Perivolaris), Telepsychiatry (Rodie) and Campbell Family Mental Health Research Institute (Mulsant), Centre for Addiction and Mental Health, Toronto, Ont
| | - Annie Zhu
- Waypoint Centre for Mental Health Care (Sunderji), Penetanguishene, Ont.; Li Ka Shing Knowledge Institute (Sunderji), St. Michael's Hospital; Department of Psychiatry (Sunderji, Rodie, Mulsant), University of Toronto, Toronto, Ont.; Waypoint Research Institute (Sunderji), Penetanguishene, Ont.; St. Michael's Hospital Mental Health Research Group (Ion), Toronto, Ont.; School of Social Work (Ion), McMaster University, Hamilton, Ont.; Faculty of Medicine (Zhu), University of Toronto; Medical Psychiatry Alliance & Collaborative Care (Perivolaris), Telepsychiatry (Rodie) and Campbell Family Mental Health Research Institute (Mulsant), Centre for Addiction and Mental Health, Toronto, Ont
| | - Athina Perivolaris
- Waypoint Centre for Mental Health Care (Sunderji), Penetanguishene, Ont.; Li Ka Shing Knowledge Institute (Sunderji), St. Michael's Hospital; Department of Psychiatry (Sunderji, Rodie, Mulsant), University of Toronto, Toronto, Ont.; Waypoint Research Institute (Sunderji), Penetanguishene, Ont.; St. Michael's Hospital Mental Health Research Group (Ion), Toronto, Ont.; School of Social Work (Ion), McMaster University, Hamilton, Ont.; Faculty of Medicine (Zhu), University of Toronto; Medical Psychiatry Alliance & Collaborative Care (Perivolaris), Telepsychiatry (Rodie) and Campbell Family Mental Health Research Institute (Mulsant), Centre for Addiction and Mental Health, Toronto, Ont
| | - David Rodie
- Waypoint Centre for Mental Health Care (Sunderji), Penetanguishene, Ont.; Li Ka Shing Knowledge Institute (Sunderji), St. Michael's Hospital; Department of Psychiatry (Sunderji, Rodie, Mulsant), University of Toronto, Toronto, Ont.; Waypoint Research Institute (Sunderji), Penetanguishene, Ont.; St. Michael's Hospital Mental Health Research Group (Ion), Toronto, Ont.; School of Social Work (Ion), McMaster University, Hamilton, Ont.; Faculty of Medicine (Zhu), University of Toronto; Medical Psychiatry Alliance & Collaborative Care (Perivolaris), Telepsychiatry (Rodie) and Campbell Family Mental Health Research Institute (Mulsant), Centre for Addiction and Mental Health, Toronto, Ont
| | - Benoit H Mulsant
- Waypoint Centre for Mental Health Care (Sunderji), Penetanguishene, Ont.; Li Ka Shing Knowledge Institute (Sunderji), St. Michael's Hospital; Department of Psychiatry (Sunderji, Rodie, Mulsant), University of Toronto, Toronto, Ont.; Waypoint Research Institute (Sunderji), Penetanguishene, Ont.; St. Michael's Hospital Mental Health Research Group (Ion), Toronto, Ont.; School of Social Work (Ion), McMaster University, Hamilton, Ont.; Faculty of Medicine (Zhu), University of Toronto; Medical Psychiatry Alliance & Collaborative Care (Perivolaris), Telepsychiatry (Rodie) and Campbell Family Mental Health Research Institute (Mulsant), Centre for Addiction and Mental Health, Toronto, Ont
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6
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Snowden A, Young J. A screening tool for predicting gatekeeping behaviour. Nurs Open 2017; 4:187-199. [PMID: 29085645 PMCID: PMC5653390 DOI: 10.1002/nop2.83] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 03/28/2017] [Indexed: 11/30/2022] Open
Abstract
AIM To develop a typology and screening tool for gatekeeping behaviours by nurses responsible for recruitment in palliative care research. DESIGN Concurrent analysis. METHOD Two focus groups were conducted in 2015 with nine qualified hospice community nurses involved in recruitment to a trial in palliative care. The literature was searched for research into gatekeeping from 2000-2016. All narrative examples of gatekeeping activity were coded using gerunds. Common codes were then grouped and interpreted as a social process. RESULTS Gatekeeping is normal and should be expected. A continuum typology emerged, ranging from unintentional to active disengagement. Justification ranged from forgetting to deliberately not mentioning the study for fear of burdening patients. Viewing gatekeeping as a continuum allowed for the creation of a screening tool designed to collaboratively discuss and hence mitigate specific types of gatekeeping behaviour before they occur. This is a unique international contribution to this persistent issue.
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Affiliation(s)
| | - Jenny Young
- Edinburgh Napier UniversityEdinburghEH11 4BNUK
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7
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Powell K, Wilson VJ, Redmond NM, Gaunt DM, Ridd MJ. Exceeding the recruitment target in a primary care paediatric trial: an evaluation of the Choice of Moisturiser for Eczema Treatment (COMET) feasibility randomised controlled trial. Trials 2016; 17:550. [PMID: 27855723 PMCID: PMC5114843 DOI: 10.1186/s13063-016-1659-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 10/15/2016] [Indexed: 11/22/2022] Open
Abstract
Background Recruiting to target in randomised controlled trials of investigational medicinal products (CTIMPs) in primary care and paediatric populations is notoriously difficult. More evidence is needed for effective recruitment strategies in these settings. We report on the impact of different recruitment strategies used in the Choice of Moisturiser in Eczema Treatment (COMET) study – a feasibility trial comparing the effectiveness of four emollients for the treatment of childhood eczema – recruiting via general practitioner (GP) surgeries. Methods Initially, 16 GP practices invited potentially eligible children to take part in the trial by sending an invitation letter (self-referral pathway) or by consenting and randomising them into the study during a visit to the practice (in-consultation referral). Measures implemented during the study to maximise accrual included signing up six additional GP practices, increasing the upper age limit eligibility criterion from 3 to 5 years, and permitting healthcare professionals other than doctors to confirm participant eligibility. We used descriptive statistics and univariate linear regression models to explore associations with practice recruitment rates. Results A total of 197 participants were recruited, exceeding the target of 160. Of these, 107 children entered via self-referral and 90 by in-consultation pathways. Of the recruited population, 12.6 % were aged between 3 and 5 years (the raised upper age limit). The six additional practices contributed 37.4 % (40 of 107) of participants recruited by self-referral. Only almost one-third (18 of 56 [32.1 %]) of potential recruiting clinicians recruited one or more participants in-consultation, which was a more problematic pathway because of data verification issues. Three research nurses and a pharmacist from four practices recruited 48.9 % (44 of 90) of participants via this pathway. Univariate linear regression models showed no evidence of association between the number of children recruited via the self-referral pathway by practice and practice list size (p = 0.092) or practice deprivation decile (p = 0.270), but practice deprivation was associated with a higher number of children recruited in-consultation (p = 0.020) by practice. Conclusions Self-referral and in-consultation recruitment yielded similar numbers, but the in-consultation pathway was more problematic. Future trials of this type should consider the condition, normal care pathway and number of potentially eligible children and be prepared to use multiple recruitment strategies to achieve recruitment targets. Trial registration ISRCTN21828118. Registered on 1 May 2014. EudraCT2013-003001-26. Registered on 23 Dec 2013.
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Affiliation(s)
- Kingsley Powell
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Victoria J Wilson
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Niamh M Redmond
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK.,National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Daisy M Gaunt
- Bristol Randomised Trials Collaboration, School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Matthew J Ridd
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
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8
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Minnaard MC, van der Zand J, van de Pol AC, de Wit NJ, Schierenberg A, Hopstaken RM, van Delft S, Verheij TJM, Broekhuizen BDL. Analysis of recruitment in a pragmatic observational study on C-reactive protein point-of-care testing in primary care. Eur J Gen Pract 2016; 22:219-224. [PMID: 27485531 DOI: 10.1080/13814788.2016.1208167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Failure to recruit all eligible study patients can lead to biased results. Little is known on selective patient recruitment in studies on implementation of diagnostic devices. OBJECTIVES The aim of this observational study was to measure recruitment of patients in an implementation study in primary care on use of point-of-care (POC) C-reactive protein (CRP) and to evaluate recruitment bias and its impact on the study endpoint. METHODS In a cross-sectional observational study on POC CRP implementation and related antibiotics prescribing, we compared included patients with all eligible patients to assess the representativeness of the included subjects. Eligible patients were adults presenting with acute cough in primary care between March and September 2012. The frequency of POC CRP testing and the proportion of prescribed antibiotics were compared between recruited and non-recruited patients. As measure of bias, odds ratios (ORs) with accompanying 95% confidence intervals (CIs) for the association between CRP level (<20 mg/l or not) and antibiotic prescribing were computed. RESULTS Of all 1473 eligible patients 348 (24%) were recruited. In recruited patients, POC CRP tests were conducted and antibiotics prescribed more frequently as compared to non-recruited patients (81% versus 6% and 44% versus 29%, respectively). The ORs were 18.2 (95%CI: 9.6-34.3), 30.5 (95%CI: 13.2-70.3) and 3.8 (95%CI: 0.9-14.8) respectively in all eligible patients, the recruited and the non-recruited patients. CONCLUSION Selective recruitment resulted in an overestimation of POC CRP test use and antibiotic prescribing.
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Affiliation(s)
- Margaretha C Minnaard
- a University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care , Utrecht , the Netherlands
| | - Janna van der Zand
- a University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care , Utrecht , the Netherlands
| | - Alma C van de Pol
- a University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care , Utrecht , the Netherlands
| | - Niek J de Wit
- a University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care , Utrecht , the Netherlands
| | - Alwin Schierenberg
- a University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care , Utrecht , the Netherlands
| | - Rogier M Hopstaken
- b Saltro, Diagnostic Center for Primary Care , Utrecht , the Netherlands
| | - Sanne van Delft
- b Saltro, Diagnostic Center for Primary Care , Utrecht , the Netherlands
| | - Theo J M Verheij
- a University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care , Utrecht , the Netherlands
| | - Berna D L Broekhuizen
- a University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care , Utrecht , the Netherlands
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Berge E, Stapf C, Al-Shahi Salman R, Ford GA, Sandercock P, van der Worp HB, Petersson J, Dippel DWJ, Krieger DW, Lees KR. Methods to improve patient recruitment and retention in stroke trials. Int J Stroke 2016; 11:663-676. [DOI: 10.1177/1747493016641963] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Background The success of randomized-controlled stroke trials is dependent on the recruitment and retention of a sufficient number of patients, but fewer than half of all trials meet their target number of patients. Methods We performed a search and review of the literature, and conducted a survey and workshop among 56 European stroke trialists, to identify barriers, suggest methods to improve recruitment and retention, and make a priority list of interventions that merit further evaluation. Results The survey and workshop identified a number of barriers to patient recruitment and retention, from patients’ incapacity to consent, to handicaps that prevent patients from participation in trial-specific follow-up. Methods to improve recruitment and retention may include simple interventions with individual participants, funding of research networks, and reimbursement of new treatments by health services only when delivered within clinical trials. The literature review revealed that few methods have been formally evaluated. The top five priorities for evaluation identified in the workshop were as follows: short and illustrated patient information leaflets, nonwritten consent, reimbursement for new interventions only within a study, and monetary incentives to institutions taking part in research (for recruitment); and involvement of patient groups, remote and central follow-up, use of mobile devices, and reminders to patients about their consent to participate (for retention). Conclusions Many interventions have been used with the aim of improving recruitment and retention of patients in stroke studies, but only a minority has been evaluated. We have identified methods that could be tested, and propose that such evaluations may be nested within on-going clinical trials.
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Affiliation(s)
- Eivind Berge
- Dept of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Christian Stapf
- Dept of Neuroscience, CRCHUM, University of Montreal, Quebec, Canada
| | | | - Gary A Ford
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - Peter Sandercock
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - H Bart van der Worp
- Dept of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands
| | - Jesper Petersson
- Dept of Neurology and Rehabilitation, Skåne University Hospital and Lund University, Malmö, Sweden
| | - Diederik WJ Dippel
- Dept of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Kennedy R Lees
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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10
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White D, Hind D. Projection of participant recruitment to primary care research: a qualitative study. Trials 2015; 16:473. [PMID: 26482231 PMCID: PMC4615323 DOI: 10.1186/s13063-015-1002-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 10/08/2015] [Indexed: 01/06/2023] Open
Abstract
Background Recruitment to clinical trials remains a challenge, particularly in primary care settings. Initial projections of participant recruitment need to be as accurate as possible in order to avoid the financial, clinical and ethical costs of trial extensions or failures. However, estimation of recruitment rates is challenging and often poorly executed, if attempted at all. We used qualitative methods to explore the experiences and views of researchers on the planning of recruitment in this setting. Methods Participants had registered accrual to a UK-based primary care research study between April 2009 and March 2012. We conducted nine interviews with chief investigators or study managers, using a semi-structured topic guide. Analysis was conducted using the framework approach. Results Three themes are presented: 1) the factors affecting recruitment rates, 2) the use of planning techniques, and 3) influences on poor estimation. 1) A large number of factors affecting recruitment rates were discussed, including those relating to the study protocol, the clinical setting and the research setting. Use of targeted mail-outs to invite apparently eligible individuals to participate was preferred in order to eliminate some of the uncertainty in the recruitment rate associated with opportunistic clinician referrals. 2) The importance of pilot work was stressed. We identified significant uncertainty as to how best to schedule trial timelines to maximise efficiency. 3) Several potential sources of bias involved in the estimation of recruitment rates were explored and framed as technological, psychological or political factors. Conclusions We found a large number of factors that interviewees felt impact recruitment rates to primary care research and highlighted the complexity of realistic estimation. Suitable early planning of the recruitment process is essential, and there may be potential to improve the projection of trial timelines by reducing biases involved in the process. Further research is needed to develop formal approaches that would be suitable for use in this setting. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-1002-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David White
- Clinical Trials Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Daniel Hind
- Clinical Trials Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
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11
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Treweek S, Altman DG, Bower P, Campbell M, Chalmers I, Cotton S, Craig P, Crosby D, Davidson P, Devane D, Duley L, Dunn J, Elbourne D, Farrell B, Gamble C, Gillies K, Hood K, Lang T, Littleford R, Loudon K, McDonald A, McPherson G, Nelson A, Norrie J, Ramsay C, Sandercock P, Shanahan DR, Summerskill W, Sydes M, Williamson P, Clarke M. Making randomised trials more efficient: report of the first meeting to discuss the Trial Forge platform. Trials 2015; 16:261. [PMID: 26044814 PMCID: PMC4475334 DOI: 10.1186/s13063-015-0776-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 05/21/2015] [Indexed: 11/17/2022] Open
Abstract
Randomised trials are at the heart of evidence-based healthcare, but the methods and infrastructure for conducting these sometimes complex studies are largely evidence free. Trial Forge ( www.trialforge.org ) is an initiative that aims to increase the evidence base for trial decision making and, in doing so, to improve trial efficiency.This paper summarises a one-day workshop held in Edinburgh on 10 July 2014 to discuss Trial Forge and how to advance this initiative. We first outline the problem of inefficiency in randomised trials and go on to describe Trial Forge. We present participants' views on the processes in the life of a randomised trial that should be covered by Trial Forge.General support existed at the workshop for the Trial Forge approach to increase the evidence base for making randomised trial decisions and for improving trial efficiency. Agreed upon key processes included choosing the right research question; logistical planning for delivery, training of staff, recruitment, and retention; data management and dissemination; and close down. The process of linking to existing initiatives where possible was considered crucial. Trial Forge will not be a guideline or a checklist but a 'go to' website for research on randomised trials methods, with a linked programme of applied methodology research, coupled to an effective evidence-dissemination process. Moreover, it will support an informal network of interested trialists who meet virtually (online) and occasionally in person to build capacity and knowledge in the design and conduct of efficient randomised trials.Some of the resources invested in randomised trials are wasted because of limited evidence upon which to base many aspects of design, conduct, analysis, and reporting of clinical trials. Trial Forge will help to address this lack of evidence.
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Affiliation(s)
- Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Doug G Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Nuffield Orthopaedics Centre, Windmill Road, Oxford, OX3 7LD, UK.
| | - Peter Bower
- Medical Research Council North West Hub for Trials Methodology Research, Manchester Academic Health Science Centre, Centre for Primary Care, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Marion Campbell
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | | | - Seonaidh Cotton
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Peter Craig
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3QB, UK.
| | - David Crosby
- Medical Research Council, Methodology Research Programme (MRC MRP), London, UK.
| | - Peter Davidson
- Consultant in Public Health and Head of Health Technology Assessment, National Institute for Health Research, Evaluation, Trials, and Studies Coordinating Centre, University of Southampton, Alpha House, Enterprise Road, Southampton, SO16 7NS, UK.
| | - Declan Devane
- School of Nursing and Midwifery, National University of Ireland Galway, University Road, Galway, Ireland.
| | - Lelia Duley
- Nottingham Clinical Trials Unit (NCTU), Nottingham Health Science Partners, C Floor, South Block, Queens Medical Centre, Derby Road, Nottingham, NG7 2UH, UK.
| | - Janet Dunn
- Warwick Medical School, The University of Warwick, Coventry, CV4 7AL, UK.
| | - Diana Elbourne
- London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Barbara Farrell
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.
| | - Carrol Gamble
- North West Hub for Trials Methodology Research, University of Liverpool, 1st floor Duncan Building, Daulby Street, Liverpool, L69 3GA, UK.
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Kerry Hood
- South East Wales Trials Unit (SEWTU), School of Medicine, Cardiff University, Cardiff, UK.
| | - Trudie Lang
- The Global Health Network, Oxford University Centre for Tropical Medicine, University of Oxford, Oxford, UK.
| | | | - Kirsty Loudon
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Alison McDonald
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Gladys McPherson
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Annmarie Nelson
- Marie Curie Palliative Care Research Centre, Cardiff University School of Medicine, Heath Park, Cardiff, Wales, CF14 4YS, UK.
| | - John Norrie
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Craig Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK.
| | - Peter Sandercock
- Division of Clinical Neurosciences, The University of Edinburgh, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK.
| | | | | | - Matt Sydes
- Medical Research Council, Clinical Trials Unit (MRC CTU), London, UK.
| | - Paula Williamson
- North West Hub for Trials Methodology Research and Department of Biostatistics, University of Liverpool, 1st floor Duncan Building Daulby Street, Liverpool, L69 3GA, UK.
| | - Mike Clarke
- Institute of Clinical Sciences, Block B, Queens University Belfast, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK.
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Armstrong N, Price J, Geddes J. Serious but not solemn: Rebalancing the assessment of risks and benefits of patient recruitment materials. RESEARCH ETHICS REVIEW 2015. [DOI: 10.1177/1747016114552338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recruiting patients to participate in health research is challenging, and most studies struggle. Failure to recruit can jeopardise the quality of research, and threatens efforts to improve healthcare. Despite this, recruitment materials tend to be conservatively designed and unimaginative. One reason for this is ethical concerns regarding the risk of coercion and offence posed by recruitment materials. The OXTEXT research programme gave patients a leading role in the design of new recruitment materials, in an area (mental health) where stigma and discrimination make ethical risks particularly acute. We discovered that our patient-designed recruitment materials were much bolder than usual, and they put the existing ethical boundaries to the test. The materials were effective and well liked – patients regarded them as neither unacceptable nor coercive. This suggests we may need to rethink the ethics of recruitment to research such that we permit more creative recruitment materials. In addition, it suggests a new role for patient input into research as designers of recruitment materials.
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Rick J, Graffy J, Knapp P, Small N, Collier DJ, Eldridge S, Kennedy A, Salisbury C, Treweek S, Torgerson D, Wallace P, Madurasinghe V, Hughes-Morley A, Bower P. Systematic techniques for assisting recruitment to trials (START): study protocol for embedded, randomized controlled trials. Trials 2014; 15:407. [PMID: 25344684 PMCID: PMC4230578 DOI: 10.1186/1745-6215-15-407] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 09/29/2014] [Indexed: 11/10/2022] Open
Abstract
Background Randomized controlled trials play a central role in evidence-based practice, but recruitment of participants, and retention of them once in the trial, is challenging. Moreover, there is a dearth of evidence that research teams can use to inform the development of their recruitment and retention strategies. As with other healthcare initiatives, the fairest test of the effectiveness of a recruitment strategy is a trial comparing alternatives, which for recruitment would mean embedding a recruitment trial within an ongoing host trial. Systematic reviews indicate that such studies are rare. Embedded trials are largely delivered in an ad hoc way, with interventions almost always developed in isolation and tested in the context of a single host trial, limiting their ability to contribute to a body of evidence with regard to a single recruitment intervention and to researchers working in different contexts. Methods/Design The Systematic Techniques for Assisting Recruitment to Trials (START) program is funded by the United Kingdom Medical Research Council (MRC) Methodology Research Programme to support the routine adoption of embedded trials to test standardized recruitment interventions across ongoing host trials. To achieve this aim, the program involves three interrelated work packages: (1) methodology - to develop guidelines for the design, analysis and reporting of embedded recruitment studies; (2) interventions - to develop effective and useful recruitment interventions; and (3) implementation - to recruit host trials and test interventions through embedded studies. Discussion Successful completion of the START program will provide a model for a platform for the wider trials community to use to evaluate recruitment interventions or, potentially, other types of intervention linked to trial conduct. It will also increase the evidence base for two types of recruitment intervention. Trial registration The START protocol covers the methodology for embedded trials. Each embedded trial is registered separately or as a substudy of the host trial.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Peter Bower
- Medical Research Council North West Hub for Trials Methodology Research, Manchester Academic Health Science Centre, Centre for Primary Care, University of Manchester, Oxford Road, Manchester M13 9PL, UK.
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14
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Bower P, Brueton V, Gamble C, Treweek S, Smith CT, Young B, Williamson P. Interventions to improve recruitment and retention in clinical trials: a survey and workshop to assess current practice and future priorities. Trials 2014; 15:399. [PMID: 25322807 PMCID: PMC4210542 DOI: 10.1186/1745-6215-15-399] [Citation(s) in RCA: 226] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 09/30/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite significant investment in infrastructure many trials continue to face challenges in recruitment and retention. We argue that insufficient focus has been placed on the development and testing of recruitment and retention interventions. METHODS In this current paper, we summarize existing reviews about interventions to improve recruitment and retention. We report survey data from Clinical Trials Units in the United Kingdom to indicate the range of interventions used by these units to encourage recruitment and retention. We present the views of participants in a recent workshop and a priority list of recruitment interventions for evaluation (determined by voting among workshop participants). We also discuss wider issues concerning the testing of recruitment interventions. RESULTS Methods used to encourage recruitment and retention were categorized as: patient contact, patient convenience, support for recruiters, monitoring and systems, incentives, design, resources, and human factors. Interventions felt to merit investigation by respondents fell into three categories: training site staff, communication with patients, and incentives. CONCLUSIONS Significant resources continue to be invested into clinical trials and other high quality studies, but recruitment remains a significant challenge. Adoption of innovative methods to develop, test, and implement recruitment interventions are required.
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Affiliation(s)
- Peter Bower
- />National Institute for Health Research School for Primary Care Research, North West Hub for Trials Methodology Research, University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Valerie Brueton
- />MRC Clinical Trials Unit at University College London, 125 Kingsway, London, WC2B 6NH UK
| | - Carrol Gamble
- />North West Hub for Trials Methodology Research, University of Liverpool, 1st floor Duncan Building, Daulby Street, Liverpool, L69 3GA UK
| | - Shaun Treweek
- />Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD UK
| | - Catrin Tudur Smith
- />North West Hub for Trials Methodology Research and Department of Biostatistics, University of Liverpool, 1st floor Duncan Building, Daulby Street, Liverpool, L69 3GA UK
| | - Bridget Young
- />North West Hub for Trials Methodology Research and Department of Psychological Sciences, University of Liverpool, 1st floor Duncan Building, Daulby Street, Liverpool, L69 3GA UK
| | - Paula Williamson
- />North West Hub for Trials Methodology Research and Department of Biostatistics, University of Liverpool, 1st floor Duncan Building, Daulby Street, Liverpool, L69 3GA UK
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Newington L, Metcalfe A. Researchers' and clinicians' perceptions of recruiting participants to clinical research: a thematic meta-synthesis. J Clin Med Res 2014; 6:162-72. [PMID: 24734142 PMCID: PMC3985558 DOI: 10.14740/jocmr1619w] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2013] [Indexed: 11/16/2022] Open
Abstract
Background Recruiting the desired number of research participants is frequently problematic with resulting financial and clinical implications. The views of individuals responsible for participant recruitment have not been previously reviewed. This systematic review and thematic meta-synthesis explores researchers’ and clinicians’ experiences and perceptions of recruiting participants to clinical research, with the aim of informing improved recruitment systems and strategies. Methods Studies published between January 1995 and May 2013 were identified from: Ovid MEDLINE, Ovid EMBASE, Ovid PSYCHINFO, ASSIA, British Nursing Index, Scopus, Web of Science, CINAHL and PubMed. Included studies were original peer reviewed research, with qualitative methodologies and an aim of exploring the views of clinicians and/or researchers on recruitment to clinical research. Studies discussing the recruitment of patients unable to give informed consent were excluded. The findings sections of the relevant studies were free coded to identify key concepts which were grouped into hierarchical themes. The quality of the identified studies was assessed and the relative contribution of each paper was checked to ensure individual studies did not dominate in any theme. Results Eighteen relevant papers were identified which examined the views of researchers and clinicians in 10 clinical specialties. Five main themes emerged: building a research community, securing resources, the nature of research, professional identities and recruitment strategies. The views of researchers and clinicians were similar, although the role of ‘researcher’ was inconsistently defined. Conclusions The general experience of recruiting participants to clinical research was one of competition and compromise. Competition arose over funding, staffing and participants, and between clinical and research responsibilities. Compromise was needed to create study designs that were acceptable to patients, clinicians and researchers. Forging relationships between clinical and research teams featured extensively, however the involvement of patients and the public within the research community was rarely discussed.
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Affiliation(s)
- Lisa Newington
- NIHR Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, Guy's Hospital, SE1 9RT, UK
| | - Alison Metcalfe
- Florence Nightingale School of Nursing and Midwifery, King's College London, James Clerk Maxwell Building, Waterloo Road, SE1 8WA, UK
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Bhatnagar S, Hoberman A, Kearney DH, Shaikh N, Moxey-Mims MM, Chesney RW, Carpenter MA, Greenfield SP, Keren R, Mattoo TK, Mathews R, Gravens-Mueller L, Ivanova A. Development and impact of an intervention to boost recruitment in a multicenter pediatric randomized clinical trial. Clin Pediatr (Phila) 2014; 53:151-7. [PMID: 24151147 PMCID: PMC4086359 DOI: 10.1177/0009922813506961] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Our primary objective was to develop and evaluate an intervention to increase recruitment in a multicenter pediatric randomized clinical trial (RCT). Our secondary objective was to assess the impact beyond 120 days. METHODS The study was conducted at 17 academic centers participating in a pediatric RCT. The intervention consisted of utilizing a recruitment assessment tool at a site visit or teleconference with key site personnel. RESULTS We found a significant increase in the number of individuals enrolled for all 17 sites at 120 days postintervention (mean = 1.12 per site; median = 1 per site; 95% confidence interval = 1-2; P = .04). No significant differences were apparent beyond the first 120 days postintervention. CONCLUSIONS Successful recruitment in RCTs is essential to the quality, generalizability, and cost-effectiveness of clinical research. Implementation of this recruitment intervention may effectively increase recruitment in RCTs. Beyond the first 120 days postintervention, repeated interventions may be required. What is new? Despite general and pediatric-specific challenges to recruitment in RCTs, a paucity of evidence exists on effective recruitment strategies or assessment tools to reliably enhance recruitment. We developed a recruitment intervention for use in RCTs that enables clinical researchers to enhance recruitment.
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Affiliation(s)
- Sonika Bhatnagar
- University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh, Division of General Academic Pediatrics, Pittsburgh, Pennsylvania
| | - Alejandro Hoberman
- University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh, Division of General Academic Pediatrics, Pittsburgh, Pennsylvania
| | - Diana H. Kearney
- University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh, Division of General Academic Pediatrics, Pittsburgh, Pennsylvania
| | - Nader Shaikh
- University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh, Division of General Academic Pediatrics, Pittsburgh, Pennsylvania
| | - Marva M. Moxey-Mims
- NIH/National Institute of Diabetes, Digestive and Kidney Disease, Division of Kidney, Urologic and Hematologic Diseases, Bethesda, Maryland
| | - Russell W. Chesney
- Le Bonheur Children’s Medical Center, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Myra A. Carpenter
- University of North Carolina at Chapel Hill, Department of Biostatistics, Collaborative Studies Coordinating Center, Chapel Hill, North Carolina
| | - Saul P. Greenfield
- Women and Children’s Hospital of Buffalo, Division of Pediatric Urology, Buffalo, New York
| | - Ron Keren
- The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Ranjiv Mathews
- The Johns Hopkins School of Medicine, Children’s Urology Associates, Baltimore, Maryland
| | - Lisa Gravens-Mueller
- University of North Carolina at Chapel Hill, Department of Biostatistics, Collaborative Studies Coordinating Center, Chapel Hill, North Carolina
| | - Anastasia Ivanova
- University of North Carolina at Chapel Hill, Department of Biostatistics, Collaborative Studies Coordinating Center, Chapel Hill, North Carolina
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Brueton VC, Stevenson F, Vale CL, Stenning SP, Tierney JF, Harding S, Nazareth I, Meredith S, Rait G. Use of strategies to improve retention in primary care randomised trials: a qualitative study with in-depth interviews. BMJ Open 2014; 4:e003835. [PMID: 24464427 PMCID: PMC3902408 DOI: 10.1136/bmjopen-2013-003835] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 11/29/2013] [Accepted: 12/02/2013] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To explore the strategies used to improve retention in primary care randomised trials. DESIGN Qualitative in-depth interviews and thematic analysis. PARTICIPANTS 29 UK primary care chief and principal investigators, trial managers and research nurses. METHODS In-depth face-to-face interviews. RESULTS Primary care researchers use incentive and communication strategies to improve retention in trials, but were unsure of their effect. Small monetary incentives were used to increase response to postal questionnaires. Non-monetary incentives were used although there was scepticism about the impact of these on retention. Nurses routinely used telephone communication to encourage participants to return for trial follow-up. Trial managers used first class post, shorter questionnaires and improved questionnaire designs with the aim of improving questionnaire response. Interviewees thought an open trial design could lead to biased results and were negative about using behavioural strategies to improve retention. There was consensus among the interviewees that effective communication and rapport with participants, participant altruism, respect for participant's time, flexibility of trial personnel and appointment schedules and trial information improve retention. Interviewees noted particular challenges with retention in mental health trials and those involving teenagers. CONCLUSIONS The findings of this qualitative study have allowed us to reflect on research practice around retention and highlight a gap between such practice and current evidence. Interviewees describe acting from experience without evidence from the literature, which supports the use of small monetary incentives to improve the questionnaire response. No such evidence exists for non-monetary incentives or first class post, use of which may need reconsideration. An exploration of barriers and facilitators to retention in other research contexts may be justified.
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Redmond NM, Hollinghurst S, Costelloe C, Montgomery AA, Fletcher M, Peters TJ, Hay AD. An evaluation of the impact and costs of three strategies used to recruit acutely unwell young children to a randomised controlled trial in primary care. Clin Trials 2013; 10:593-603. [DOI: 10.1177/1740774513494503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Recruitment to primary care trials, particularly those involving young children, is known to be difficult. There are limited data available to inform researchers about the effectiveness of different trial recruitment strategies and their associated costs. Purpose To describe, evaluate, and investigate the costs of three strategies for recruiting febrile children to a community-based randomised trial of antipyretics. Methods The three recruitment strategies used in the trial were termed as follows: (1) ‘local’, where paediatric research nurses stationed in primary care sites invited parents of children to participate; (2) ‘remote’, where clinicians at primary care sites faxed details of potentially eligible children to the trial office; and (3) ‘community’, where parents, responding to trial publicity, directly contacted the trial office when their child was unwell. Results Recruitment rates increased in response to the sequential introduction of three recruitment strategies, which were supplemented by additional recruiting staff, flexible staff work patterns, and improved clinician reimbursement schemes. The three strategies yielded different randomisation rates. They also appeared to be interdependent and highly effective together. Strategy-specific costs varied from £297 to £857 per randomised participant and represented approximately 10% of the total trial budget. Limitations Because the recruitment strategies were implemented sequentially, it was difficult to measure their independent effects. The cost analysis was performed retrospectively. Conclusions Trial recruiter expertise and deployment of several interdependent, illness-specific strategies were key factors in achieving rapid recruitment of young children to a community-based randomised controlled trial (RCT). The ‘remote’ recruitment strategy was shown to be more cost-effective compared to ‘community’ and ‘local’ strategies in the context of this trial. Future trialists should report recruitment costs to facilitate a transparent evaluation of recruitment strategy cost-effectiveness.
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Affiliation(s)
- Niamh M Redmond
- Centre for Academic Primary Care, NIHR School for Primary Care Research, School of Social and Community Medicine, University of Bristol, UK
| | - Sandra Hollinghurst
- Centre for Academic Primary Care, NIHR School for Primary Care Research, School of Social and Community Medicine, University of Bristol, UK
| | - Céire Costelloe
- Centre for Academic Primary Care, NIHR School for Primary Care Research, School of Social and Community Medicine, University of Bristol, UK
| | - Alan A Montgomery
- Centre for Academic Primary Care, NIHR School for Primary Care Research, School of Social and Community Medicine, University of Bristol, UK
- Nottingham Clinical Trials Unit, Nottingham Health Science Partners, Queen’s Medical Centre, University of Nottingham, Nottingham, UK
| | - Margaret Fletcher
- Faculty of Health and Social Care, University of the West of England Bristol, Bristol, UK
| | - Tim J Peters
- Centre for Academic Primary Care, NIHR School for Primary Care Research, School of Social and Community Medicine, University of Bristol, UK
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, NIHR School for Primary Care Research, School of Social and Community Medicine, University of Bristol, UK
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Research priorities for syndromic surveillance systems response: consensus development using nominal group technique. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2013; 16:529-34. [PMID: 20885183 DOI: 10.1097/phh.0b013e3181c7c9bd] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify a set of fundable and practically feasible research priorities in the field of syndromic surveillance response on the basis of expert consensus. METHODS The nominal group technique was used to structure an expert panel meeting in February 2009. Eleven national experts participated in the meeting, representing health departments at the city, county, state, and federal levels as well as academia and the military. RESULTS The expert panel identified 3 research topics as consensus research priorities. These included the following: (1) How should different types of evidence and complementary data systems be integrated (merging data, visualizations)? (2) How can syndromic surveillance best be used in an electronic medical record environment? and (3) What criteria should be used to prioritize alerts? All identified research priorities were considered to be moderately highly fundable and feasible by an external group of experts with a record of obtaining grant funding in the field of biosurveillance. CONCLUSIONS Prioritized research needs clustered around the common theme of how best to integrate diverse types and sources of information to inform action; thus, the major challenge that health departments are facing appears to be how to process abundant alert data from dissimilar sources. The nominal group technique in this study provided a method for systems' monitors to communicate their needs to the research community and can influence the commissioning of research by funding institutions.
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Fletcher K, Mant J, Roalfe A, Hobbs FDR. Impact of study design on recruitment of patients to a primary care trial: an observational time series analysis of the Birmingham Atrial Fibrillation Treatment of the Aged (BAFTA) study. Fam Pract 2010; 27:691-7. [PMID: 20610490 DOI: 10.1093/fampra/cmq050] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND recruitment targets to randomized controlled trials (RCTs) are often not met. Many interventions are used to improve recruitment but there is little empirical evidence on whether these approaches work. OBJECTIVE to examine whether changes to the design and conduct of a primary care-based RCT were associated with changes in patient recruitment. METHODS an observational time series analysis of recruitment to a primary care-based multi-centre RCT of aspirin versus warfarin for stroke prevention, which involved 330 practices. Several changes to the trial protocol and procedures were made over the 4 years of patient recruitment. For each quarter throughout the recruitment period, the recruitment rate per 1000 total population in active practices was calculated. RESULTS the recruitment target of 930 patients was exceeded. Fluctuations in recruitment rate occurred during the recruitment period. Following protocol changes aimed to reduce clinical workload, there was a significant increase in recruitment during the final 6 months of the study, during a period when there was not a similarly large increase in the total population available. CONCLUSIONS these findings suggest that the conduct of a trial is an important consideration if studies are to recruit successfully. Expanding the number of centres may not be the most effective way to improve recruitment.
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Affiliation(s)
- K Fletcher
- Department of Primary Care and General Practice, Clinical Sciences Building, University of Birmingham, Birmingham B15 2TT, UK.
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Graffy J, Bower P, Ward E, Wallace P, Delaney B, Kinmonth AL, Collier D, Miller J. Trials within trials? Researcher, funder and ethical perspectives on the practicality and acceptability of nesting trials of recruitment methods in existing primary care trials. BMC Med Res Methodol 2010; 10:38. [PMID: 20433728 PMCID: PMC2873514 DOI: 10.1186/1471-2288-10-38] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 04/30/2010] [Indexed: 11/13/2022] Open
Abstract
Background Trials frequently encounter difficulties in recruitment, but evidence on effective recruitment methods in primary care is sparse. A robust test of recruitment methods involves comparing alternative methods using a randomized trial, 'nested' in an ongoing 'host' trial. There are potential scientific, logistical and ethical obstacles to such studies. Methods Telephone interviews were undertaken with four groups of stakeholders (funders, principal investigators, trial managers and ethics committee chairs) to explore their views on the practicality and acceptability of undertaking nested trials of recruitment methods. These semi-structured interviews were transcribed and analysed thematically. Results Twenty people were interviewed. Respondents were familiar with recruitment difficulties in primary care and recognised the case for 'nested' studies to build an evidence base on effective recruitment strategies. However, enthusiasm for this global aim was tempered by the challenges of implementation. Challenges for host studies included increasing complexity and management burden; compatibility between the host and nested study; and the impact of the nested study on trial design and relationships with collaborators. For nested recruitment studies, there were concerns that host study investigators might have strong preferences, limiting the nested study investigators' control over their research, and also concerns about sample size which might limit statistical power. Nested studies needed to be compatible with the main trial and should be planned from the outset. Good communication and adequate resources were seen as important. Conclusions Although research on recruitment was welcomed in principle, the issue of which study had control of key decisions emerged as critical. To address this concern, it appeared important to align the interests of both host and nested studies and to reduce the burden of hosting a recruitment trial. These findings should prove useful in devising a programme of research involving nested studies of recruitment interventions.
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Affiliation(s)
- Jonathan Graffy
- NIHR School for Primary Care Research, University of Cambridge, Cambridge, UK.
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Abstract
BACKGROUND Increasing challenges to health care systems and the prominence of patient-centered care and evidence-based practice have fostered the application of qualitative approaches in health care settings, prompting discussions of associated ethical issues in a range of disciplines. OBJECTIVES The purposes of this work were to identify and describe the application and value of qualitative health research for physical therapy and to identify ethical considerations in a qualitative research study. DESIGN This was a qualitative interview study with telephone follow-ups. METHODS Forty-six participants were interviewed about their early experiences with rheumatoid arthritis. They also were asked what motivated them to volunteer for the study. To inform the discussion of ethics in qualitative health research, this study drew on the in-depth interviews, took a descriptive approach to the data, and applied the traditional ethical principles of autonomy, justice, and beneficence to the study process. RESULTS Ethical issues emerged in this qualitative health research study that were both similar to and different from those that exist in a positivist paradigm (eg, clinical research). With flexibility and latitude, the traditional principle approach can be applied usefully to qualitative health research. CONCLUSIONS These findings build on previous research and discussion in physical therapy and other disciplines that urge a flexible approach to qualitative research ethics and recognize that ethics are embedded in an unfolding research process involving the role of the subjective researcher and an active participant. We suggest reflexivity as a way to recognize ethical moments throughout qualitative research and to help build methodological and ethical rigor in research relevant to physical therapist practice.
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Bower P, Wallace P, Ward E, Graffy J, Miller J, Delaney B, Kinmonth AL. Improving recruitment to health research in primary care. Fam Pract 2009; 26:391-7. [PMID: 19549623 DOI: 10.1093/fampra/cmp037] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Recruitment to health research is known to be problematic. However, evidence concerning ways of improving recruitment is sparse. OBJECTIVE To outline the process of recruitment, factors impacting on recruitment success and key areas for further research and development. METHODS Narrative literature review. RESULTS This paper argues that three ways of improving recruitment should form the focus of future work: developing a repository of evidence-based techniques and methods which can be introduced by research teams; developing the infrastructure to support recruitment, especially new technologies around the electronic patient record; and increasing public engagement with research, to improve participation by both clinicians and patients. CONCLUSION Recruitment to health research in primary care remains a major hurdle, and key research and development priorities must be addressed.
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Affiliation(s)
- Peter Bower
- National Institute for Health Research School for Primary Care Research, University of Manchester, UK.
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What is the role of local enhanced services in building clinical research facilities in primary care? Prim Health Care Res Dev 2009. [DOI: 10.1017/s1463423609990077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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