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The multimorbidity collaborative medication review and decision making (MyComrade) study: a pilot cluster randomised trial in two healthcare systems. Pilot Feasibility Stud 2022; 8:225. [PMID: 36195963 PMCID: PMC9531225 DOI: 10.1186/s40814-022-01107-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 07/02/2022] [Indexed: 11/26/2022] Open
Abstract
Background While international guidelines recommend medication reviews as part of the management of multimorbidity, evidence on how to implement reviews in practice in primary care is lacking. The MyComrade (MultimorbiditY Collaborative Medication Review And Decision Making) intervention is an evidence-based, theoretically informed novel intervention which aims to support the conduct of medication reviews for patients with multimorbidity in primary care. Aim The pilot study aimed to assess the feasibility of a definitive trial of the MyComrade intervention across two healthcare systems (Republic of Ireland (ROI) and Northern Ireland (NI)). Design A pilot cluster-randomised controlled trial was conducted (clustered at general practice level), using specific progression criteria and a process evaluation framework. Setting General practices in the ROI and NI. Participants Eligible practices were those in defined geographical areas who had GP’s and Practice Based Pharmacists (PBP’s) (in NI) willing to conduct medication reviews. Eligible patients were those aged 18 years and over, with multi morbidity and on ten or more medications. Intervention The MyComrade intervention is an evidence-based, theoretically informed novel intervention which aims to support the conduct of medication reviews for patients with multimorbidity in primary care, using a planned collaborative approach guided by an agreed checklist, within a specified timeframe. Outcome measures Feasibility outcomes, using pre-determined progression criteria, assessed practice and patient recruitment and retention and intervention acceptability and fidelity. Anonymised patient-related quantitative data, from practice medical records and patient questionnaires were collected at baseline, 4 and 8 months, to inform potential outcome measures for a definitive trial. These included (i) practice outcomes—completion of medication reviews; (ii) patient outcomes—treatment burden and quality of life; (iii) prescribing outcomes—number and changes of prescribed medications and incidents of potentially inappropriate prescribing; and (iv) economic cost analysis. The framework Decision-making after Pilot and feasibility Trials (ADePT) in conjunction with a priori progression criteria and process evaluation was used to guide the collection and analysis of quantitative and qualitative data. Results The recruitment of practices (n = 15) and patients (n = 121, mean age 73 years and 51% female), representing 94% and 38% of a priori targets respectively, was more complex and took longer than anticipated; impacted by the global COVID-19 pandemic. Retention rates of 100% of practices and 85% of patients were achieved. Both practice staff and patients found the intervention acceptable and reported strong fidelity to the My Comrade intervention components. Some practice staff highlighted concerns such as poor communication of the reviews to patients, dissatisfaction regarding incentivisation and in ROI the sustainability of two GPs collaboratively conducting the medication reviews. Assessing outcomes from the collected data was found feasible and appropriate for a definitive trial. Two progression criteria met the ‘Go’ criterion (practice and patient retention), two met the ‘Amend’ criterion (practice recruitment and intervention implementation) and one indicated a ‘Stop – unless changes possible’ (patient recruitment). Conclusion The MyComrade intervention was found to be feasible to conduct within two different healthcare systems. Recruitment of participants requires significant time and effort given the nature of this population and the pairing of GP and pharmacist may be more sustainable to implement in routine practice. Trial registration Registry: ISRCTN, ISRCTN80017020; date of confirmation 4/11/2019; retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01107-y.
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Lewis SJG, Factor SA, Giladi N, Hallett M, Nieuwboer A, Nutt JG, Przedborski S, Papa SM. Addressing the Challenges of Clinical Research for Freezing of Gait in Parkinson's Disease. Mov Disord 2022; 37:264-267. [PMID: 34939228 PMCID: PMC8840955 DOI: 10.1002/mds.28837] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 02/03/2023] Open
Affiliation(s)
- Simon J. G. Lewis
- ForeFront Parkinson’s Disease Research Clinic, Brain and Mind Centre, School of Medical Sciences, University of Sydney, NSW, Australia.,Correspondence: Dr. Lewis, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Camperdown, NSW 2050, Australia; or Dr. Papa, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA;
| | - Stewart A. Factor
- Jean and Paul Amos Parkinson’s disease and Movement Disorders Program, Emory University School of Medicine, Atlanta, GA USA
| | - Nir Giladi
- Movement Disorders Unit, Department of Neurology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD, USA
| | | | - John G. Nutt
- Movement Disorder Section, Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97034. USA
| | - Serge Przedborski
- Departments of Pathology & Cell Biology, Neurology, and Neuroscience, Columbia University, New York, NY, USA
| | - Stella M. Papa
- Department of Neurology, School of Medicine, and Yerkes National Primate Research Center, Emory University, Atlanta, GA, USA.,Correspondence: Dr. Lewis, Brain and Mind Centre, School of Medical Sciences, University of Sydney, Camperdown, NSW 2050, Australia; or Dr. Papa, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA;
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Nagendrababu V, Duncan HF, Pulikkotil SJ, Dummer PMH. Glossary for randomized clinical trials. Int Endod J 2020; 54:354-365. [PMID: 33089501 DOI: 10.1111/iej.13434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/16/2020] [Indexed: 01/04/2023]
Abstract
Randomized clinical trials are positioned at the highest level of primary clinical evidence, as they are designed to be unbiased with a reduced risk of systematic error. The Consolidated Standards of Reporting Trials (CONSORT) statement was first developed in 1996 to improve the reporting quality of randomized clinical trials with updates being published subsequently. Recently, the Preferred Reporting Items for RAndomized Trials in Endodontics (PRIRATE) 2020 guidelines were developed exclusively for the field of Endodontics to address the suboptimal quality of randomized clinical trials submitted to Endodontic journals, which result in many being rejected. A principal flaw in submissions is the fact that many authors are unclear on the keys terms that should be used when developing manuscripts for publication. Clearly, authors should be aware of the most common terms used when conducting and reporting randomized clinical trials. Hence, the aim of the current paper is to present a comprehensive glossary of the terminology used in randomized clinical trials in order to assist authors when designing, executing and writing-up randomized clinical trials.
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Affiliation(s)
- V Nagendrababu
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE
| | - H F Duncan
- Division of Restorative Dentistry, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
| | - S J Pulikkotil
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - P M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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Duane S, Vellinga A, Smith V, Tierney M, Beecher C, Burke M, Murphy AW, Devane D. The effectiveness of digital multimedia presentation of trial information on recruitment and retention of patients: Protocol for a study within a trial (SWAT). HRB Open Res 2020; 3:10. [PMID: 32596630 PMCID: PMC7308906 DOI: 10.12688/hrbopenres.12994.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Studies within trials (SWATs) present an opportunity to examine design factors that may impact on the successful delivery of trials. One area in need of research is trial recruitment. Recruiting patients to trials is a major challenge facing trialists. Failure to meet recruitment targets can result in delays and underpowered studies. This SWAT evaluates the effectiveness of hand-held digital multimedia presentation of trial information and standard written patient information to potential participants on recruitment and retention to a host trial. Methods: This is the protocol for SWAT 15, a two-group, embedded parallel randomised controlled trial (RCT) (ISRCTN12838042) designed within a host trial - the SATIN trial (ISRCTN88111427), a RCT designed for implementation in the Irish primary care setting. The SWAT eligibility criteria was determined by the host trial. General practices who agree to participate in the host trial will provide women (participants) who are willing to consider participating in the host trial with either a multimedia digital information resource facilitated through a handheld tablet device, plus a written participant information leaflet (Intervention) or a written participant information leaflet (comparator). Outcomes are recruitment and retention to the host SATIN trial and participant's quality of decision-making. Discussion: Although designed to be implemented in a host trial, the host trial, was suspended and therefore this SWAT was not implemented. The protocol and the lessons learnt whilst developing it offer guidance to researchers who wish to answer similar research questions in the future in a similar context or setting. Trial registration: ISRCTN Registry ISRCTN12838042 (11/10/2017).
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Affiliation(s)
- Sinead Duane
- J.E. Cairnes School of Business & Economics, National University of Ireland, Galway, Ireland.,HRB Trials Methodology Research Network, National University of Ireland, Galway, Ireland
| | - Akke Vellinga
- Discipline of Bacteriology, National University of Ireland, Galway, Ireland.,Discipline of General Practice, National University of Ireland, Galway, Ireland
| | - Valerie Smith
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Dublin, Ireland
| | - Marie Tierney
- HRB Primary Care Clinical Trial Network Ireland, National University of Ireland, Galway, Ireland
| | - Claire Beecher
- HRB Trials Methodology Research Network, National University of Ireland, Galway, Ireland
| | - Megan Burke
- HRB Trials Methodology Research Network, National University of Ireland, Galway, Ireland
| | - Andrew W Murphy
- Discipline of General Practice, National University of Ireland, Galway, Ireland.,HRB Primary Care Clinical Trial Network Ireland, National University of Ireland, Galway, Ireland
| | - Declan Devane
- HRB Trials Methodology Research Network, National University of Ireland, Galway, Ireland.,School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
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Fletcher S, Clarke J, Sanatkar S, Baldwin P, Gunn J, Zwar N, Campbell L, Wilhelm K, Harris M, Lapsley H, Hadzi-Pavlovic D, Proudfoot J. Recruiting to a Randomized Controlled Trial of a Web-Based Program for People With Type 2 Diabetes and Depression: Lessons Learned at the Intersection of e-Mental Health and Primary Care. J Med Internet Res 2019; 21:e12793. [PMID: 31127718 PMCID: PMC6555119 DOI: 10.2196/12793] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 03/18/2019] [Accepted: 03/24/2019] [Indexed: 12/25/2022] Open
Abstract
Background E-mental health (eMH) interventions are now widely available and they have the potential to revolutionize the way that health care is delivered. As most health care is currently delivered by primary care, there is enormous potential for eMH interventions to support, or in some cases substitute, services currently delivered face to face in the community setting. However, randomized trials of eMH interventions have tended to recruit participants using online recruitment methods. Consequently, it is difficult to know whether participants who are recruited online differ from those who attend primary care. Objective This paper aimed to document the experience of recruiting to an eMH trial through primary care and compare the characteristics of participants recruited through this and other recruitment methods. Methods Recruitment to the SpringboarD randomized controlled trial was initially focused on general practices in 2 states of Australia. Over 15 months, we employed a comprehensive approach to engaging practice staff and supporting them to recruit patients, including face-to-face site visits, regular contact via telephone and trial newsletters, and development of a Web-based patient registration portal. Nevertheless, it became apparent that these efforts would not yield the required sample size, and we therefore supplemented recruitment through national online advertising and promoted the study through existing networks. Baseline characteristics of participants recruited to the trial through general practice, online, or other sources were compared using the analysis of variance and chi square tests. Results Between November 2015 and October 2017, 780 people enrolled in SpringboarD, of whom 740 provided information on the recruitment source. Of these, only 24 were recruited through general practice, whereas 520 were recruited online and 196 through existing networks. Key barriers to general practice recruitment included perceived mismatch between trial design and diabetes population, prioritization of acute health issues, and disruptions posed by events at the practice and community level. Participants recruited through the 3 different approaches differed in age, gender, employment status, depressive symptoms, and diabetes distress, with online participants being distinguished from those recruited through general practice or other sources. However, most differences reached only a small effect size and are unlikely to be of clinical importance. Conclusions Time, labor, and cost-intensive efforts did not translate into successful recruitment through general practice in this instance, with barriers identified at several different levels. Online recruitment yielded more participants, who were broadly similar to those recruited via general practice.
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Affiliation(s)
- Susan Fletcher
- Department of General Practice, University of Melbourne, Carlton, Australia
| | - Janine Clarke
- Black Dog Institute, Sydney, Australia.,School of Psychiatry, University of New South Wales Sydney, Sydney, Australia
| | - Samineh Sanatkar
- Black Dog Institute, Sydney, Australia.,School of Psychiatry, University of New South Wales Sydney, Sydney, Australia
| | - Peter Baldwin
- Black Dog Institute, Sydney, Australia.,School of Psychiatry, University of New South Wales Sydney, Sydney, Australia
| | - Jane Gunn
- Department of General Practice, University of Melbourne, Carlton, Australia
| | - Nick Zwar
- School of Medicine, University of Woollongong, Woollongong, Australia
| | - Lesley Campbell
- Diabetes and Metabolism Division, Garvan Institute of Medical Research, Sydney, Australia
| | - Kay Wilhelm
- School of Psychiatry, University of New South Wales Sydney, Sydney, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales Sydney, Sydney, Australia
| | - Helen Lapsley
- School of Psychiatry, University of New South Wales Sydney, Sydney, Australia
| | | | - Judy Proudfoot
- Black Dog Institute, Sydney, Australia.,School of Psychiatry, University of New South Wales Sydney, Sydney, Australia
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Martin-Kerry J, Parker A, Bower P, Watt I, Treweek S, Torgerson D, Arundel C, Knapp P. SWATted away: the challenging experience of setting up a programme of SWATs in paediatric trials. Trials 2019; 20:141. [PMID: 30782209 PMCID: PMC6381684 DOI: 10.1186/s13063-019-3236-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/31/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Randomised controlled trials are considered the best method for determining the effectiveness and safety of health interventions. Trials involving children are essential to ensure that treatments are safe and effective. However, many trials, in both adult and paediatric populations, do not achieve recruitment targets and/or maintain retention of participants, which can lead to a reduction in the internal and external validity of the results. Identifying ways of improving trial efficiency are important in order to increase the successful completion of trials. MAIN BODY A 'Study Within A Trial' (SWAT) is a self-contained study embedded within an ongoing trial, which aims to establish evidence to improve the management and delivery of trials in healthcare. Increasing numbers of SWATs have been undertaken in recent years yet very few within paediatric trials. Herein, we describe some of the challenges with undertaking a programme of SWATs within paediatric clinical trials in the UK. The TRECA (TRials Engagement in Children and Adolescents) study involves developing multimedia websites for use within paediatric trials to provide recruitment information to children, young people and their families about the clinical trial. Challenges encountered included governance issues such as host trial approval processes and sharing of anonymised data, funding issues for host trials, internet quality and accessibility within the healthcare setting, and ethical concerns associated with SWAT methodology. We believe the ethical concerns are more pronounced in the paediatric setting, perhaps because of the fewer SWATs undertaken in these settings or that a more cautious, risk-averse approach to undertaking research with children is taken. CONCLUSION SWATs are becoming increasingly common to provide an evidence base for methods to improve trial efficiency. However, we encountered a number of unanticipated challenges to embedding TRECA that have not been previously reported within the scientific literature. We believe that, if these issues were addressed through wider promotion and explanation of undertaking SWATs involving all key stakeholders, as well as by exploration of alternative funding models for SWATs, this would enable more streamlined, appropriate and timely processes for SWATs and a stronger evidence base for what works to increase trial efficiency. TRIAL REGISTRATION The TRECA study is registered on ISRCTN, ID 73136092 . Registered on 24 August 2016.
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Affiliation(s)
| | - Adwoa Parker
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD UK
| | - Peter Bower
- MRC North West Hub for Trials Methodology Research, NIHR School for Primary Care Research, University of Manchester, Manchester, M13 9PL UK
| | - Ian Watt
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD UK
| | - David Torgerson
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD UK
| | - Catherine Arundel
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD UK
| | - Peter Knapp
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD UK
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Parker A, Knapp P, Treweek S, Madhurasinghe V, Littleford R, Gallant S, Sullivan F, Schembri S, Rick J, Graffy J, Collier DJ, Eldridge S, Kennedy A, Bower P. The effect of optimised patient information materials on recruitment in a lung cancer screening trial: an embedded randomised recruitment trial. Trials 2018; 19:503. [PMID: 30227890 PMCID: PMC6145341 DOI: 10.1186/s13063-018-2896-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 08/31/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Written participant information materials are important for ensuring that potential trial participants receive necessary information so that they can provide informed consent. However, such materials are frequently long and complex, which may negatively impact patient understanding and willingness to participate. Improving readability, ease of comprehension and presentation may assist with improved participant recruitment. The Systematic Techniques for Assisting Recruitment to Trials (MRC START) study aimed to develop and evaluate interventions to improve trial recruitment. This study aimed to assess the effectiveness of an optimised participant information brochure and cover letter developed by MRC START regarding response and participant recruitment rates. METHODS We conducted a study within a trial (SWAT) embedded in the EarlyCDT Lung Cancer Scotland (ECLS) trial that aimed to assess the effectiveness of a new test in reducing the incidence of patients with late-stage lung cancer at diagnosis compared with standard care. Potential participants approached for ECLS were randomised to receive the original participant information brochure and accompanying letter (control group) or optimised versions of these materials which had undergone user testing and a process of re-writing, re-organisation and professional graphic design (intervention group). The primary outcome was the number of patients recruited to ECLS. The secondary outcome was the proportion of patients expressing an interest in participating in ECLS. RESULTS In total, 2262 patients were randomised, 1136 of whom were sent the intervention materials and 1126 of whom were sent the control materials. The proportion of patients enrolled and randomised into ECLS was 180 of 1136 (15.8%) in the intervention group and 176 of 1126 (15.6%) in the control group (OR = 1.016, 95% CI, 0.660 to 1.564). The proportion of patients who positively responded to the invitation was 224 of 1136 (19.7%) in the intervention group and 205 of 1126 (18.2%) in the control group (OR = 1.103, 95% CI, 0.778 to 1.565). CONCLUSIONS Optimised patient information materials made little difference to the proportion of patients positively responding to a trial invitation or to the proportion subsequently randomised to the host trial. TRIAL REGISTRATION ClinicalTrials.gov, NCT01925625 . Registered on 15 August 2015. Study Within A Trial, SWAT-23. Registered on 12 April 2016.
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Affiliation(s)
- Adwoa Parker
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD UK
| | - Peter Knapp
- Department of Health Sciences, Seebohm Rowntree Building, University of York, York, YO10 5DD UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD UK
| | - Vichithranie Madhurasinghe
- Blizard Institute, Barts and The London School of Medicine and Dentistry, 4 Newark Street, London, E1 2AT UK
| | | | - Stephanie Gallant
- Centre for Public Health Nutrition Research, University of Dundee, Dundee, UK
| | - Frank Sullivan
- School of Medicine, Medical & Biological Sciences, North Haugh, St Andrews, UK
| | - Stuart Schembri
- School of Medicine, University of Dundee, Ninewells Hospital & Medical School, Dundee, DD1 9SY Scotland, UK
| | - Jo Rick
- MRC North West Hub for Trials Methodology Research, Manchester Academic Health Science Centre, University of Manchester, Williamson Building, Manchester, M13 9PT UK
| | - Jonathan Graffy
- Department of Public Health and Primary Care, The Primary Care Unit, University of Cambridge, Cambridge, CB2 OSR UK
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, 39 Whitely Road, Bristol, BS8 2PS UK
| | - David J. Collier
- William Harvey Research Institute, Barts and the London Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ UK
| | - Sandra Eldridge
- Blizard Institute, Barts and The London School of Medicine and Dentistry, 4 Newark Street, London, E1 2AT UK
| | - Anne Kennedy
- NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Wessex, Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ UK
| | - Peter Bower
- MRC North West Hub for Trials Methodology Research, Manchester Academic Health Science Centre, University of Manchester, Williamson Building, Manchester, M13 9PT UK
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Doing trials within trials: a qualitative study of stakeholder views on barriers and facilitators to the routine adoption of methodology research in clinical trials. Trials 2018; 19:481. [PMID: 30201022 PMCID: PMC6131831 DOI: 10.1186/s13063-018-2862-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 08/17/2018] [Indexed: 01/08/2023] Open
Abstract
Background Randomised controlled trials are the cornerstone of evidence-based health care, yet many trials struggle with recruitment and retention. All too often the methodologies employed to address these problems are not evidence-based, as rigorous methodological research on these issues is rare. The current research sought to identify barriers to the routine implementation of methodology research around recruitment and retention. Methods All registered UK clinical trials unit directors were sent a short questionnaire and invited to interview. Representatives of funding bodies and other stakeholders were also approached. Interviews were recorded and the content analysed. Results Data were grouped into four themes: acceptance of the need for methodological research; trial funding and development; trial processes; and organisational factors. The need to improve the evidence base for trials methodology is well established, but numerous barriers to implementation were perceived. Conclusions The knowledge and expertise required to routinely implement methodology research exists within the current research structures, and there are clear opportunities to develop the evidence base. However, for this to be achieved there is also a need for clear strategic coordination within the sector and promotion of the necessary resources.
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Martin-Kerry J, Bower P, Young B, Graffy J, Sheridan R, Watt I, Baines P, Stones C, Preston J, Higgins S, Gamble C, Knapp P. Developing and evaluating multimedia information resources to improve engagement of children, adolescents, and their parents with trials (TRECA study): Study protocol for a series of linked randomised controlled trials. Trials 2017; 18:265. [PMID: 28595613 PMCID: PMC5465557 DOI: 10.1186/s13063-017-1962-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 05/02/2017] [Indexed: 11/17/2022] Open
Abstract
Background Randomised controlled trials are widely established as the best method for testing health interventions whilst minimising bias. However, recruitment and subsequent retention of children and adolescents in healthcare trials is challenging. Participant information sheets are often lengthy and difficult to read and understand. Presenting key information using multimedia may help to overcome these limitations and better support young people and their parents in deciding whether to participate in a clinical trial. Methods The TRECA (TRials Engagement in Children and Adolescents) study has two phases. The first phase involves a qualitative study with children and adolescents and their parents to inform the development of multimedia information resources and iterative user testing to refine the resources. The second phase will embed the use of the multimedia information resources into six host trials in the United Kingdom. Patients and parents approached to participate in the host trials will be randomly allocated to either use the multimedia information resource in conjunction with standard participant information sheets, the multimedia information resource alone, or the standard participant information sheets alone. The primary outcome will be the effect of the multimedia information resources on recruitment into trials. Other outcomes measured include the effect of multimedia information resources on retention of participants into the host trials and the impact on family members’ decision-making processes, when compared to standard participant information sheets alone. Discussion This study will inform whether multimedia information resources, when developed using participatory design principles, are able to increase recruitment and retention of children and adolescents into trials. There is also the potential for patients to make better informed decisions through the use of multimedia information resources. The multimedia information resources also have the potential to assist with providing information on other healthcare decisions outside of clinical trials. Trial registration ISRCTN registry: ISRCTN73136092 (doi:10.1186/ISRCTN73136092). Registered on 24 August 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1962-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Peter Bower
- MRC North West Hub for Trials Methodology Research, NIHR School for Primary Care Research, University of Manchester, M13 9PL, Manchester, UK
| | - Bridget Young
- MRC North West Hub for Trials Methodology Research, Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, L69 3GB, Liverpool, UK
| | - Jonathan Graffy
- Department of Public Health and Primary Care, University of Cambridge, Institute of Public Health, Forvie Site, Robinson Way, CB2 0SR, Cambridge, UK
| | - Rebecca Sheridan
- Department of Health Sciences, University of York, Heslington, YO10 5DD, York, UK
| | - Ian Watt
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, YO10 5DD, York, UK
| | - Paul Baines
- Paediatric Intensive Care Unit, Alder Hey Hospital, L12 2AP, Liverpool, UK
| | - Catherine Stones
- School of Design, Clothworkers' Central, University of Leeds, LS2 9JT, Leeds, UK
| | - Jennifer Preston
- NIHR Alder Hey Clinical Research Facility, University of Liverpool, Institute in the Park, Alder Hey Children's NHS Foundation Trust, Eaton Rd, L12 2AP, Liverpool, UK
| | - Steven Higgins
- School of Education, University of Durham, DH1 3LE, Durham, UK
| | - Carrol Gamble
- Institute of Translational Medicine, University of Liverpool, L69 3GB, Liverpool, UK
| | - Peter Knapp
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, YO10 5DD, York, UK.
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Copeland RJ, Horspool K, Humphreys L, Scott E. Recruiting to a large-scale physical activity randomised controlled trial - experiences with the gift of hindsight. Trials 2016; 17:104. [PMID: 26908117 PMCID: PMC4765210 DOI: 10.1186/s13063-016-1229-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 02/11/2016] [Indexed: 11/10/2022] Open
Abstract
Background Recruitment issues continue to impact a large number of trials. Sharing recruitment information is vital to supporting researchers to accurately predict recruitment and to manage the risk of poor recruitment during study design and implementation. The purpose of this article is to build on the knowledge available to researchers on recruiting to community-based trials. Methods A critical commentary of the recruitment challenges encountered during the Booster Study, a randomised controlled trial in which researchers investigated the effectiveness of a motivational interviewing style intervention on the maintenance of physical activity. An overview of recruitment is provided, as well as strategies employed to recruit prospective participants and possible barriers to recruitment. Results Two hundred eighty-two people, 47 % of the original target, were recruited through mail-outs, with secondary recruitment pathways yielding no additional participants. The research team encountered problems with recontacting interested participants and providing study materials in non-English languages. A lower response rate to the mail-out and a greater number of non-contactable participants in the full study than in the pilot study resulted in a smaller pool of eligible participants from the brief intervention eligible for recruitment into the randomised controlled trial. Conclusions Despite using widely accepted recruitment strategies and incorporating new recruitment tactics in response to challenges, the Booster Study investigators failed to randomise a sufficient number of participants. Recruitment in trials of community-based behavioural interventions may have different challenges than trials based on clinical or primary care pathways. Specific challenges posed by the complexity of the study design and problems with staffing and resources were exacerbated by the need to revise upwards the number of mailed invitations as a result of the pilot study. Researchers should ensure study design facilitates recruitment and consider the implications of changing recruitment on the operational aspects of the trial. Where possible, the impact of new strategies should be measured, and recruitment successes and challenges should be shared with those planning similar studies. ISRCTN56495859 (registered on 12 February 2009); NCT00836459 (registered on 3 February 2009).
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Affiliation(s)
- Robert J Copeland
- Centre for Sport and Exercise Science, Sheffield Hallam University, Collegiate Campus, Sheffield, S10 2BP, UK.
| | - Kimberley Horspool
- School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Liam Humphreys
- Centre for Sport and Exercise Science, Sheffield Hallam University, Collegiate Campus, Sheffield, S10 2BP, UK.
| | - Emma Scott
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
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Gillies K, Cotton SC, Brehaut JC, Politi MC, Skea Z. Decision aids for people considering taking part in clinical trials. Cochrane Database Syst Rev 2015; 2015:CD009736. [PMID: 26613337 PMCID: PMC8725643 DOI: 10.1002/14651858.cd009736.pub2] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Several interventions have been developed to promote informed consent for participants in clinical trials. However, many of these interventions focus on the content and structure of information (e.g. enhanced information or changes to the presentation format) rather than the process of decision making. Patient decision aids support a decision making process about medical options. Decision aids support the decision process by providing information about available options and their associated outcomes, alongside information that enables patients to consider what value they place on particular outcomes, and provide structured guidance on steps of decision making. They have been shown to be effective for treatment and screening decisions but evidence on their effectiveness in the context of informed consent for clinical trials has not been synthesised. OBJECTIVES To assess the effectiveness of decision aids for clinical trial informed consent compared to no intervention, standard information (i.e. usual practice) or an alternative intervention on the decision making process. SEARCH METHODS We searched the following databases and to March 2015: Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library; MEDLINE (OvidSP) (from 1950); EMBASE (OvidSP) (from 1980); PsycINFO (OvidSP) (from 1806); ASSIA (ProQuest) (from 1987); WHO International Clinical Trials Registry Platform (ICTRP) (http://apps.who.int/trialsearch/); ClinicalTrials.gov; ISRCTN Register (http://www.controlled-trials.com/isrctn/). We also searched reference lists of included studies and relevant reviews. We contacted study authors and other experts. There were no language restrictions. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials comparing decision aids in the informed consent process for clinical trials alone, or in conjunction with standard information (such as written or verbal) or alongside alternative interventions (e.g. paper-based versus web-based decision aids). Included trials involved potential trial participants, or their guardians, being asked to consider participating in a real or hypothetical clinical trial. DATA COLLECTION AND ANALYSIS At least two authors independently assessed studies for inclusion, extracted reported data and assessed risk of bias. Findings were pooled where appropriate. We used GRADE to assess the quality of the evidence for each outcome. MAIN RESULTS We identified one study (290 randomised participants) that investigated the effectiveness of decision aids compared to standard information in the informed consent process for clinical trials. This study reported two separate decision aid randomised controlled trials (RCTs). The decision aid trials were nested within two different parent trials focusing on breast cancer in postmenopausal women. One trial focused on informed consent for treatment in women who had previously had surgery for ductal carcinoma in situ (DCIS), the other on informed consent for prevention in women at high risk for breast cancer. Two different decision aids were used in these RCTs, and were compared with standard information.The pooled findings highlight the uncertainty surrounding most reported outcomes, including knowledge, decisional conflict, anxiety, trial participation and attrition. There was very low quality evidence that decision aids lower levels of decisional regret to a small degree (MD -5.53, 95% CI -10.29 to -0.76). No data were identified on several prespecified primary outcomes, including accurate risk perception, values-based decision, or whether potential participants recognised that a decision needed to be made, were able to identify features of options that matter most to individuals, or were involved in the decision. AUTHORS' CONCLUSIONS There was insufficient evidence to determine whether decision aids to support the informed consent process for clinical trials are more effective than standard information. Additional well designed, adequately powered clinical trials in more diverse clinical and social populations are needed to strengthen the results of this review. More generally, future research on which outcomes are most relevant for assessment in this context would be helpful.
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Affiliation(s)
- Katie Gillies
- University of AberdeenHealth Services Research Unit3rd Floor, Health Sciences BuildingForesterhillAberdeenUKAB25 2ZB
| | - Seonaidh C Cotton
- University of AberdeenHealth Services Research Unit3rd Floor, Health Sciences BuildingForesterhillAberdeenUKAB25 2ZB
| | - Jamie C Brehaut
- University of OttawaDepartment of Epidemiology and Community MedicineASB 2‐004, Box 6931053 Carling AveOttawaONCanadaK1Y 4E9
| | - Mary C Politi
- Washington University School of MedicineDivision of Public Health Sciences, Department of Surgery660 S Euclid AveSt LouisMissouriUSA63110
| | - Zoe Skea
- University of AberdeenHealth Services Research Unit3rd Floor, Health Sciences BuildingForesterhillAberdeenUKAB25 2ZB
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Kenealy TW, Hao'uli S, Arroll B. A qualitative study of recruiting for investigations in primary care: Plan, pay, minimise intermediaries and keep it simple. SAGE Open Med 2015; 3:2050312115596649. [PMID: 26770794 PMCID: PMC4679335 DOI: 10.1177/2050312115596649] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 06/28/2015] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES We sought successful strategies to recruit patient and practitioner participants for studies from primary care. METHODS We interviewed people who had participated and who had not participated in a randomised controlled trial that did not reach recruitment target and successful primary care researchers. The participants and non-participants were mostly Pacific peoples. Interviews were recorded, transcribed, and analysed and reported using qualitative description. The study took place in New Zealand in 2013-2014. RESULTS A total of 31 people were interviewed. Researchers agreed that recruitment was usually the single most important phase of research but was usually under-planned and under-funded. All researchers recommended a pilot study that addressed recruitment. Successful researchers actively monitored recruitment and adapted the process as needed. Most projects were undertaken by our researchers recruited via an intermediary such as a general practice nurse. Strategies were adapted to the target population, such as specific acute or chronic conditions, age, ethnicity and gender. Intermediaries were actively recruited and retained in a manner that was often more intense than actual participant recruitment and retention. 'Layers' of intermediaries were kept to a minimum as each layer needed to be actively recruited and retained and each layer reduced participant recruitment rates. The task of intermediaries was kept simple and minimal and they were paid in some manner. Similarly, participant workload was kept to a minimum and they were paid in some manner that was intended to cover their participation costs and perhaps a little more. Even the most experienced researchers did not always achieve recruitment targets. Our interviews focused on patient participants but included recruiting general practitioners, nurses and others as research subjects. CONCLUSION Strategy details varied with the target population but had in common the need to intensively recruit and retain intermediaries, minimise layers of intermediaries, and the need to pay and minimise workload for both intermediaries and participants.
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Affiliation(s)
- Timothy W Kenealy
- Departments of Medicine and General Practice and Primary Health Care, The University of Auckland, Auckland, New Zealand
| | - Sefita Hao'uli
- Community & Public Health Advisory Committee, Counties Manukau District Health Board, Auckland, New Zealand
| | - Bruce Arroll
- Department of General Practice and Primary Health Care, The University of Auckland, Auckland, New Zealand
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Improving recruitment to a study of telehealth management for long-term conditions in primary care: two embedded, randomised controlled trials of optimised patient information materials. Trials 2015; 16:309. [PMID: 26187378 PMCID: PMC4506607 DOI: 10.1186/s13063-015-0820-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 06/26/2015] [Indexed: 11/29/2022] Open
Abstract
Background Patient understanding of study information is fundamental to gaining informed consent to take part in a randomised controlled trial. In order to meet the requirements of research ethics committees, patient information materials can be long and need to communicate complex messages. There is concern that standard approaches to providing patient information may deter potential participants from taking part in trials. The Systematic Techniques for Assisting Recruitment to Trials (MRC-START) research programme aims to test interventions to improve trial recruitment. The aim of this study was to investigate the effect on recruitment of optimised patient information materials (with improved readability and ease of comprehension) compared with standard materials. The study was embedded within two primary care trials involving patients with long-term conditions. Methods The Healthlines Study involves two linked trials evaluating a telehealth intervention in patients with depression (Healthlines Depression) or raised cardiovascular disease risk (Healthlines CVD). We conducted two trials of a recruitment intervention, embedded within the Healthlines host trials. Patients identified as potentially eligible in each of the Healthlines trials were randomised to receive either the original patient information materials or optimised versions of these materials. Primary outcomes were the proportion of participants randomised (Healthlines Depression) and the proportion expressing interest in taking part (Healthlines CVD). Results In Healthlines Depression (n = 1364), 6.3 % of patients receiving the optimised patient information materials were randomised into the study compared to 4.0 % in those receiving standard materials (OR = 1.63, 95 % CI = 1.00 to 2.67). In Healthlines CVD (n = 671) 24.0 % of those receiving optimised patient information materials responded positively to the invitation to participate, compared to 21.9 % in those receiving standard materials (OR = 1.12, 95 % CI = 0.78 to 1.61). Conclusions Evidence from these two embedded trials suggests limited benefits of optimised patient information materials on recruitment rates, which may only be apparent in some patient populations, with no effects on other outcomes. Further embedded trials are needed to provide a more precise estimate of effect, and to explore further how effects vary by trial context, intervention, and patient population. Trial registration Current Controlled Trials: Healthlines Depression (ISRCTN27508731) on 26 June 2012; and Healthlines CVD (ISRCTN14172341) on 5 July 2012 Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0820-0) contains supplementary material, which is available to authorized users.
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Overcoming barriers to recruiting ethnic minorities to mental health research: a typology of recruitment strategies. BMC Psychiatry 2015; 15:101. [PMID: 25934297 PMCID: PMC4436137 DOI: 10.1186/s12888-015-0484-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 04/23/2015] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The ethnic minority population in developed countries is increasing over time. These groups are at higher risk of mental illness and demonstrate lower participation in research. Published evidence suggests that multiple factors like stigma, lack of trust, differences in explanatory models, logistical issues and lack of culturally aware researchers act as barriers to ethnic minority recruitment into mental health research. To reduce inequalities in participation, there is a need to devise innovative and culturally sensitive recruitment strategies. It is important that researchers share their experience of employing these strategies so that ethnic minority participation can be facilitated. METHODS We previously published a systematic review of barriers to recruiting ethnic minority participants into mental health research. The nine papers included in our prior review formed the basis for developing a typology of barriers to recruiting ethnic minorities into mental health research. This typology identified 33 barriers, described under five themes. We further extracted data on the strategies used to overcome these recruitment barriers, as described in the included studies. RESULTS The strategies employed by the authors could be matched to all but two barriers (psychopathology/substance misuse and limited resource availability). There was evidence that multiple strategies were employed, and that these depended upon the population, clinical set-up and resources available. CONCLUSIONS This typology of strategies to overcome barriers to recruiting ethnic minorities provides guidance on achieving higher rates of recruitment. It is important that researchers plan to deploy these strategies well in advance of initiating recruitment. Whilst adopting these strategies, the authors have not been able to quantify the positive impact of these strategies on recruitment. The typology should encourage researchers to employ these strategies in future research, refine them further and quantitatively evaluate their impact.
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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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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: 235] [Impact Index Per Article: 23.5] [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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Sawhney V, Graham A, Campbell N, Schilling R. Does modification to the approach to contacting potential participants improve recruitment to clinical trials? J Clin Med Res 2014; 6:384-7. [PMID: 25110544 PMCID: PMC4125335 DOI: 10.14740/jocmr1879w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2014] [Indexed: 11/13/2022] Open
Abstract
Background It is critical that clinical trial researchers ensure efficient and successful patient recruitment. Recruitment is often slower than expected and required sample sizes not obtained within initial funding deadlines. There is little rigorous evidence supporting ways to improve recruitment. We hypothesized making telephone contact with subjects prior to hospital attendance would improve recruitment rates into clinical trials. Methods Retrospective post hoc analysis of recruitment rates in an on-going clinical trial was undertaken. Two hundred twelve consecutive patients were recruited over 6 months. During the first 3 months, patients received a telephone call from the research team and also received an information sheet by post prior to clinic attendance (group 1). The study was discussed on telephone and any issues were re-addressed at the patient’s clinic appointment when they were formally invited to participate in the study. After 3 months, the investigators stopped telephoning the patients (group 2); patients were invited to participate in the study by post and were first spoken to directly by an investigator in clinic. The study protocol and investigators did not change between groups. Results There was no significant difference in baseline demographics between the two groups. There was a significant improvement in recruitment rate in group 1 compared to group 2 (77.7% vs. 45.0%, P < 0.0001). An improvement in clinic attendance rate in group 1 was observed, although this was not significant (did not attend rate: 2.9% vs. 7.8%, P = 0.14). Conclusion Telephone contact between researchers and potential participants prior to clinic attendance can greatly improve study recruitment rates. This information may benefit the design of all clinical studies.
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Affiliation(s)
- Vinit Sawhney
- Department of Cardiology, St Bartholomew's Hospital, Queen Mary University of London, UK
| | - Adam Graham
- Department of Cardiology, St Bartholomew's Hospital, Queen Mary University of London, UK
| | - Niall Campbell
- Department of Cardiology, St Bartholomew's Hospital, Queen Mary University of London, UK
| | - Richard Schilling
- Department of Cardiology, St Bartholomew's Hospital, Queen Mary University of London, UK
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Hapca A, Jennings CG, Wei L, Wilson A, MacDonald TM, Mackenzie IS. Effectiveness of newspaper advertising for patient recruitment into a clinical trial. Br J Clin Pharmacol 2014; 77:1064-72. [PMID: 24283948 PMCID: PMC4093931 DOI: 10.1111/bcp.12262] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 09/22/2013] [Indexed: 11/28/2022] Open
Abstract
AIMS To measure the impact of newspaper advertising across Scotland on patient interest, and subsequent recruitment into the Standard Care vs. Celecoxib Outcome Trial (SCOT), a clinical trial investigating the cardiovascular safety of non-steroidal anti-inflammatory drugs in patients with osteoarthritis or rheumatoid arthritis. METHODS Newspaper advertisements about the SCOT trial were placed sequentially in regional and national Scottish newspapers. The number of phone calls as a result of exposure to the advertisements and ongoing study recruitment rates were recorded before, during and after the advertising campaign. To enroll in SCOT individuals had to be registered with a participating GP practice. RESULTS The total cost for the advertising campaign was £46 250 and 320 phone calls were received as a result of individuals responding to the newspaper advertisements. One hundred and seventy-two individuals were identified as possibly suitable to be included in the study. However only 36 were registered at participating GP practices, 17 completed a screening visit and 15 finally were randomized into the study. The average cost per respondent individual was £144 and the average cost per randomized patient was £3083. Analysis of recruitment rate trends showed that there was no impact of the newspaper advertising campaign on increasing recruitment into SCOT. CONCLUSIONS Advertisements placed in local and national newspapers were not an effective recruitment strategy for the SCOT trial. The advertisements attracted relatively small numbers of respondents, many of whom did not meet study inclusion criteria or were not registered at a participating GP practice.
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Affiliation(s)
- Adrian Hapca
- Medicines Monitoring Unit, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK
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Bozzolan M, Simoni G, Balboni M, Fiorini F, Bombardi S, Bertin N, Da Roit M. Undergraduate physiotherapy students' competencies, attitudes and perceptions after integrated educational pathways in evidence-based practice: a mixed methods study. Physiother Theory Pract 2014; 30:557-71. [DOI: 10.3109/09593985.2014.910285] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Treweek S, Lockhart P, Pitkethly M, Cook JA, Kjeldstrøm M, Johansen M, Taskila TK, Sullivan FM, Wilson S, Jackson C, Jones R, Mitchell ED. Methods to improve recruitment to randomised controlled trials: Cochrane systematic review and meta-analysis. BMJ Open 2013; 3:bmjopen-2012-002360. [PMID: 23396504 PMCID: PMC3586125 DOI: 10.1136/bmjopen-2012-002360] [Citation(s) in RCA: 371] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED This review is an abridged version of a Cochrane Review previously published in the Cochrane Database of Systematic Reviews 2010, Issue 4, Art. No.: MR000013 DOI: 10.1002/14651858.MR000013.pub5 (see www.thecochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and Cochrane Database of Systematic Reviews should be consulted for the most recent version of the review. OBJECTIVE To identify interventions designed to improve recruitment to randomised controlled trials, and to quantify their effect on trial participation. DESIGN Systematic review. DATA SOURCES The Cochrane Methodology Review Group Specialised Register in the Cochrane Library, MEDLINE, EMBASE, ERIC, Science Citation Index, Social Sciences Citation Index, C2-SPECTR, the National Research Register and PubMed. Most searches were undertaken up to 2010; no language restrictions were applied. STUDY SELECTION Randomised and quasi-randomised controlled trials, including those recruiting to hypothetical studies. Studies on retention strategies, examining ways to increase questionnaire response or evaluating the use of incentives for clinicians were excluded. The study population included any potential trial participant (eg, patient, clinician and member of the public), or individual or group of individuals responsible for trial recruitment (eg, clinicians, researchers and recruitment sites). Two authors independently screened identified studies for eligibility. RESULTS 45 trials with over 43 000 participants were included. Some interventions were effective in increasing recruitment: telephone reminders to non-respondents (risk ratio (RR) 1.66, 95% CI 1.03 to 2.46; two studies, 1058 participants), use of opt-out rather than opt-in procedures for contacting potential participants (RR 1.39, 95% CI 1.06 to 1.84; one study, 152 participants) and open designs where participants know which treatment they are receiving in the trial (RR 1.22, 95% CI 1.09 to 1.36; two studies, 4833 participants). However, the effect of many other strategies is less clear, including the use of video to provide trial information and interventions aimed at recruiters. CONCLUSIONS There are promising strategies for increasing recruitment to trials, but some methods, such as open-trial designs and opt-out strategies, must be considered carefully as their use may also present methodological or ethical challenges. Questions remain as to the applicability of results originating from hypothetical trials, including those relating to the use of monetary incentives, and there is a clear knowledge gap with regard to effective strategies aimed at recruiters.
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Affiliation(s)
- Shaun Treweek
- Division of Population Health Sciences, University of Dundee, Dundee, UK
| | - Pauline Lockhart
- Division of Population Health Sciences, University of Dundee, Dundee, UK
| | - Marie Pitkethly
- Scottish School of Primary Care, University of Dundee, Dundee, UK
| | - Jonathan A Cook
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Marit Johansen
- Norwegian Knowledge Centre for the Health Services, Oslo, Norway
| | - Taina K Taskila
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Frank M Sullivan
- Division of Population Health Sciences, University of Dundee, Dundee, UK
| | - Sue Wilson
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham, UK
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Fletcher B, Gheorghe A, Moore D, Wilson S, Damery S. Improving the recruitment activity of clinicians in randomised controlled trials: a systematic review. BMJ Open 2012; 2:e000496. [PMID: 22228729 PMCID: PMC3253423 DOI: 10.1136/bmjopen-2011-000496] [Citation(s) in RCA: 227] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 12/01/2011] [Indexed: 11/06/2022] Open
Abstract
Background Poor recruitment to randomised controlled trials (RCTs) is a widespread problem. Provision of interventions aimed at supporting or incentivising clinicians may improve recruitment to RCTs. Objectives To quantify the effects of strategies aimed at improving the recruitment activity of clinicians in RCTs, complemented with a synthesis of qualitative evidence related to clinicians' attitudes towards recruiting to RCTs. Data sources A systematic review of English and non-English articles identified from: The Cochrane Library, Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, Ebsco CINAHL, Index to Theses and Open SIGLE from 2001 to March 2011. Additional reports were identified through citation searches of included articles. Study eligibility criteria Quantitative studies were included if they evaluated interventions aimed at improving the recruitment activity of clinicians or compared recruitment by different groups of clinicians. Information about host trial, study design, participants, interventions, outcomes and host RCT was extracted by one researcher and checked by another. Studies that met the inclusion criteria were assessed for quality using a standardised tool, the Effective Public Health Practice Project tool. Qualitative studies were included if they investigated clinicians' attitudes to recruiting patients to RCTs. All results/findings were extracted, and content analysis was carried out. Overarching themes were abstracted, followed by a metasummary analysis. Studies that met the inclusion criteria were assessed for quality using the Critical Appraisal Skills Programme qualitative checklist. Data extraction Data extraction was carried out by one researcher using predefined data fields, including study quality indicators, and verified by another. Results Eight quantitative studies were included describing four interventions and a comparison of recruiting clinicians. One study was rated as strong, one as moderate and the remaining six as weak when assessed for quality using the Effective Public Health Practice Project tool. Effective interventions included the use of qualitative research to identify and overcome barriers to recruitment, reduction of the clinical workload associated with participation in RCTs and the provision of extra training and protected research time. Eleven qualitative studies were identified, and eight themes were abstracted from the data: understanding of research, communication, perceived patient barriers, patient-clinician relationship, effect on patients, effect on clinical practice, individual benefits for clinicians and methods associated with successful recruitment. Metasummary analysis identified the most frequently reported subthemes to be: difficulty communicating trial methods, poor understanding of research and priority given to patient well-being. Overall, the qualitative studies were found to be of good quality when assessed using the Critical Appraisal Skills Programme checklist. Conclusions There were few high-quality trials that tested interventions to improve clinicians' recruitment activity in RCTs. The most promising intervention was the use of qualitative methods to identify and overcome barriers to clinician recruitment activity. More good quality studies of interventions are needed to add to the evidence base. The metasummary of qualitative findings identified understanding and communicating RCT methods as a key target for future interventions to improve recruitment. Reinforcement of the potential benefits, both for clinicians and for their patients, could also be a successful factor in improving recruitment. A bias was found towards investigating barriers to recruitment, so future work should also encompass a focus on successfully recruiting trials.
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Affiliation(s)
- Ben Fletcher
- School of Health and Population Sciences, The University of Birmingham, Edgbaston, Birmingham, UK
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Page MJ, French SD, McKenzie JE, O'Connor DA, Green SE. Recruitment difficulties in a primary care cluster randomised trial: investigating factors contributing to general practitioners' recruitment of patients. BMC Med Res Methodol 2011; 11:35. [PMID: 21453543 PMCID: PMC3076278 DOI: 10.1186/1471-2288-11-35] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 03/31/2011] [Indexed: 11/15/2022] Open
Abstract
Background Recruitment of patients by health professionals is reported as one of the most challenging steps when undertaking studies in primary care settings. Numerous investigations of the barriers to patient recruitment in trials which recruit patients to receive an intervention have been published. However, we are not aware of any studies that have reported on the recruitment barriers as perceived by health professionals to recruiting patients into cluster randomised trials where patients do not directly receive an intervention. This particular subtype of cluster trial is commonly termed a professional-cluster trial. The aim of this study was to investigate factors that contributed to general practitioners recruitment of patients in a professional-cluster trial which evaluated the effectiveness of an intervention to increase general practitioners adherence to a clinical practice guideline for acute low-back pain. Method General practitioners enrolled in the study were posted a questionnaire, consisting of quantitative items and an open-ended question, to assess possible reasons for poor patient recruitment. Descriptive statistics were used to summarise quantitative items and responses to the open-ended question were coded into categories. Results Seventy-nine general practitioners completed at least one item (79/94 = 84%), representing 68 practices (85% practice response rate), and 44 provided a response to the open-ended question. General practitioners recalled inviting a median of two patients with acute low-back pain to participate in the trial over a seven-month period; they reported that they intended to recruit patients, but forgot to approach patients to participate; and they did not perceive that patients had a strong interest or disinterest in participating. Additional open-ended comments were generally consistent with the quantitative data. Conclusion A number of barriers to the recruitment of patients with acute low-back pain by general practitioners in a professional-cluster trial were identified. These barriers were similar to those that have been identified in the literature surrounding the recruitment of patients in individual patient randomised trials. To advance the evidence base for patient recruitment strategies in primary care settings, trialists undertaking professional-cluster trials need to develop and evaluate patient recruitment strategies that minimise the efforts required by practice staff to recruit patients, while also meeting privacy and ethical responsibilities and minimising the risk of selection bias. Trial registration Australian New Zealand Clinical Trials Registry ACTRN012606000098538 (date registered 14/03/2006).
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Affiliation(s)
- Matthew J Page
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
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