Staff and service users' views on a 'Consent for Contact' research register within psychosis services: a qualitative study

Exploring patient and staff member views on a 'consent for contact' system for sexual health research: A mixed methods study

BACKGROUND

Recruitment in sexual health research is challenging. This study explores the potential of a Consent for Contact system (C4C) - generic consent for research contact - to improve participant recruitment and engagement in sexual health research. Our objectives were to understand patient and staff understanding of research, their views on a separate C4C system, and their preferences for its acceptability in a sexual health clinic setting.

METHODS

A two-stage study was conducted at a large urban UK sexual health clinic from November 2021 to July 2022. Stage one involved a self-completed questionnaire administered to all patients and staff. In Stage 2, semi-structured interviews (SSIs) further explored patient concerns and preferences. Survey data were analysed using chi-square and Fisher's exact test and thematic analysis was applied to free-text responses and SSIs.

RESULTS

A total of 205/300 patient (68%) and 41/280 staff questionnaires (15%) were completed. Motivations for research participation included altruism and personal interest. Statistically significant differences were found between patients' and staff members' concerns on confidentiality and anticipated feeling of pressure to participate. The majority of staff (n = 38, 93%) and half of patients (n = 100, 49%) supported implementation of a sexual health C4C system. Participants recognised the potential benefits of a sexual health C4C system, including enhanced privacy and increased research opportunities. Concerns were raised about stigma, terminology, and signing-up methods.

CONCLUSION

This study found the C4C system has the potential to enhance participant recruitment and engagement in sexual health research, but implementation support is narrowly divided with concerns around privacy and sign-up processes. These insights call for a patient-centred design approach, emphasising clear communication and privacy. Future research should focus on implementing and evaluating a sexual health C4C system to further explore their effectiveness and acceptability in different contexts.

Can a 'consent to contact' community help research teams overcome barriers to recruitment? The development and impact of the 'Research for the Future' community

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.

How data science can advance mental health research

Accessibility of powerful computers and availability of so-called big data from a variety of sources means that data science approaches are becoming pervasive. However, their application in mental health research is often considered to be at an earlier stage than in other areas despite the complexity of mental health and illness making such a sophisticated approach particularly suitable. In this Perspective, we discuss current and potential applications of data science in mental health research using the UK Clinical Research Collaboration classification: underpinning research; aetiology; detection and diagnosis; treatment development; treatment evaluation; disease management; and health services research. We demonstrate that data science is already being widely applied in mental health research, but there is much more to be done now and in the future. The possibilities for data science in mental health research are substantial.

What is the impact of research champions on integrating research in mental health clinical practice? A quasiexperimental study in South London, UK

OBJECTIVES

Key challenges for mental health healthcare professionals to implement research alongside clinical activity have been highlighted, such as insufficient time to apply research skills and lack of support and resources. We examined the impact of employing dedicated staff to promote research in community mental health clinical settings.

DESIGN

Quasiexperiment before and after study.

SETTING

South London and Maudsley National Health Service Foundation Trust.

PARTICIPANTS

4455 patients receiving care from 15 community mental health teams between 1 December 2013 and 31 December 2014.

OUTCOME MEASURES

The proportion of patients approached for research participation in clinical services where research champions were present (intervention group), and where research champions were not present (comparison group).

RESULTS

Patients in the intervention group were nearly six times more likely to be approached for research participation (Adj. OR=5.98; 95% CI 4.96 to 7.22).

CONCLUSIONS

Investing in staff that promote and drive research in clinical services increases opportunities for patients to hear about and engage in clinical research studies. However, investment needs to move beyond employing short-term staff.

What proportion of patients with psychosis is willing to take part in research? A mental health electronic case register analysis

OBJECTIVE

The proportion of people with mental health disorders who participate in clinical research studies is much smaller than for those with physical health disorders. It is sometimes assumed that this reflects an unwillingness to volunteer for mental health research studies. We examined this issue in a large sample of patients with psychosis.

DESIGN

Cross-sectional study.

SETTING

Anonymised electronic mental health record data from the South London and Maudsley NHS Foundation Trust (SLaM).

PARTICIPANTS

5787 adults diagnosed with a psychotic disorder.

EXPOSURE

Whether approached prior to 1 September 2014 for consent to be approached about research participation.

MAIN OUTCOME MEASURES

Number of days spent in a psychiatric hospital, whether admitted to hospital compulsorily, and total score on the Health of the Nation Outcome Scale (HoNOS) between 1 September 2014 and 28 February 2015 with patient factors (age, gender, ethnicity, marital status and diagnosis) and treating clinical service as covariates.

RESULTS

1187 patients (20.5% of the total sample) had been approached about research participation. Of those who were approached, 773 (65.1%) agreed to be contacted in future by researchers. Patients who had been approached had 2.3 fewer inpatient days (95% CI -4.4 to -0.3, p=0.03), were less likely to have had a compulsory admission (OR 0.65, 95% CI 0.50 to 0.84, p=0.001) and had a better HoNOS score (β coefficient -0.9, 95% CI -1.5 to -0.4, p=0.001) than those who had not. Among patients who were approached, there was no significant difference in clinical outcomes between those agreed to research contact and those who did not.

CONCLUSIONS

About two-thirds of patients with psychotic disorders were willing to be contacted about participation in research. The patients who were approached had better clinical outcomes than those who were not, suggesting that clinicians were more likely to approach patients who were less unwell.

Attitudes toward Potential Participant Registries

Difficult participant recruitment is a consistent barrier to successful medical research. Potential participant registries represent an increasingly common intervention to overcome this barrier. A variety of models for registries exist, but few data are available to instruct their design and implementation. To provide such data, we surveyed 110 cognitively normal research participants enrolled in a longitudinal study of aging and dementia. Seventy-four (67%) individuals participated in the study. Most (78%, CI: 0.67, 0.87) participants were likely to enroll in a registry. Willingness to participate was reduced for registries that required enrollment through the Internet using a password (26%, CI: 0.16, 0.36) or through email (38%, CI: 0.27, 0.49). Respondents acknowledged their expectations that researchers share information about their health and risk for disease and their concerns that their data could be shared with for-profit companies. We found no difference in respondent preferences for registries that shared contact information with researchers, compared to honest broker models that take extra precautions to protect registrant confidentiality (28% versus 30%; p = 0.46). Compared to those preferring a shared information model, respondents who preferred the honest broker model or who lacked model preference voiced increased concerns about sharing registrant data, especially with for-profit organizations. These results suggest that the design of potential participant registries may impact the population enrolled, and hence the population that will eventually be enrolled in clinical studies. Investigators operating registries may need to offer particular assurances about data security to maximize registry enrollment but also must carefully manage participant expectations.

Data science for mental health: a UK perspective on a global challenge

Data science uses computer science and statistics to extract new knowledge from high-dimensional datasets (ie, those with many different variables and data types). Mental health research, diagnosis, and treatment could benefit from data science that uses cohort studies, genomics, and routine health-care and administrative data. The UK is well placed to trial these approaches through robust NHS-linked data science projects, such as the UK Biobank, Generation Scotland, and the Clinical Record Interactive Search (CRIS) programme. Data science has great potential as a low-cost, high-return catalyst for improved mental health recognition, understanding, support, and outcomes. Lessons learnt from such studies could have global implications.

Facilitating mental health research for patients, clinicians and researchers: a mixed-method study

OBJECTIVES

Research registers using Consent for Contact (C4C) can facilitate recruitment into mental health research studies, allowing investigators to contact patients based on clinical records information. We investigated whether such a register was useful for mental health research, seeking the perspectives of patients and research investigators.

SETTING AND DESIGN

In 2012, a C4C register was developed in a large secondary mental health provider within the UK; almost 9000 patients have joined. This mixed-method study audited the effectiveness of the register.

PARTICIPANTS

A 'mystery shopper' exercise was conducted, and patients (n=21) were recruited to ask clinicians about the availability of research opportunities. Structured interviews were conducted with patients (n=52) about their experiences of being on the register. Similar interviews were conducted with 18 investigators from 19 studies, who had attempted to use the register to recruit participants.

OUTCOME MEASURES

The impact of C4C on study recruitment, and whether it helped patients learn about research.

RESULTS

So far, the register has provided 928 individuals with 1085 research opportunities (in 60% of cases, the individual agreed to participate in the study). Clinicians were willing to link patients to research opportunities, but often lacked information about studies. For patients, the register provided opportunities which they may not otherwise have; 27 of 52 had participated in studies since joining the register (18 participating for the first time). Most investigators used the register to supplement recruitment to their studies, but described problems in prescreening potential participants from a clinical record for complex studies.

CONCLUSIONS

Although the register helped investigators recruit for studies, and provided patients with research opportunities, clinicians' input is still useful for identifying suitable participants. C4C registers should be adapted to provide clinicians with automatically updated information on local studies allowing them to match patients on their caseload with active studies.

Consenting for contact? Linking electronic health records to a research register within psychosis services, a mixed method study

Background

Research registers of potential participants linked to Electronic Health Records (EHRs) provide a basis for screening and identifying people suitable for studies. Such a system relies upon people joining the register and giving permission for their record to be used in this way. This study describes the process of training clinicians to explain EHR-linked research registers to service users, and to recruit them onto the register.

Method

Training materials were developed for clinicians to help them describe the register to service users. These materials were based upon findings from focus groups reported elsewhere, they were then tested with 31 clinicians in early intervention psychosis services and each clinician discussed the register with service users on their caseload (n = 100 service users). Consultations were recorded and analysed in relation to their coverage of the training criteria. Service users also provided data on the acceptability of the process from their perspective. The content of clinicians’ explanations to service users was described, and then compared against the likelihood of service users joining the register. Interpretive statistics (t-test and Chi-Squared) were used to explore differences between consultations in which service users agreed to join the register, and consultations where they did not agree to join.

Results

Service users appeared more likely to join the register if they felt control over what they signed up to, this necessitated understanding that they could decide when, how often, and by whom they were contacted, that joining the register did not automatically enlist them to future studies, and that they could change their mind in future. Clinicians’ explanations did not always include that researchers would be able to see the service users’ EHR. Service users often confused the idea of signing up to the register and signing up to studies themselves. Confidentiality was not well explained, but service users were not always concerned by confidentiality.

Conclusion

EHR-linked research registers provide recruitment opportunities, and help service users to find out about research. Implementing these registers within mental health settings requires a trained clinical workforce and an informed service user population.

Linking a research register to clinical records in older adults' mental health services: a mixed-methods study

Introduction

Patients can provide consent to have their clinical records linked to a research register, a process known as consent for contact (C4C). There is evidence about how to engage people with mental illness in C4C, but nothing specific to older adults. This is a priority area for research (for example, dementia trials), although sign-up rates to C4C are lower than for younger populations. Through this study we seek to understand these disparities.

Methods

This was a two-stage cross-sectional observational study. In phase one, focus groups with service users, carers and clinicians informed a framework for clinicians to explain C4C to those on their caseload. In phase two, clinicians explained C4C to 26 service users (and carers where applicable). These conversations were recorded, and their content was analysed. Service users and carers were then interviewed to provide further feedback on their conversations with clinicians. A total of 31 service users, 24 carers and 13 clinical staff took part across the two phases.

Results

In phase one, service users and carers sought assurance of the right to refuse participation in further studies (after joining C4C). Clinicians expressed concerns over legal and practical implications of ascertaining mental capacity and best interest. In phase two, clinicians’ explanations were less thorough than similar explanations given to younger adults with psychosis. Clinicians omitted details of service users’ right to stipulate contact arrangements, which was significantly associated with whether service users/carers agreed to join. Common reasons for joining C4C included altruism and the chance to speak to new people. Few participants refused to join, but reasons included avoidance of stress (potentially alleviated through the presence of a carer).

Conclusions

Implementing C4C in older adults’ services requires clinicians to deliver concise, simple explanations to individuals and their carers where applicable. Older adults can be suspicious of unsolicited contact; thus, explanations must emphasise freedom to negotiate suitable contact arrangements. Hearing about research opportunities can be in the best interests of older adults, but communicating these opportunities requires a tailored approach.

Developing a new model for patient recruitment in mental health services: a cohort study using Electronic Health Records

OBJECTIVES

To develop a new model for patient recruitment that harnessed the full potential of Electronic Health Records (EHRs). Gaining access to potential participants' health records to assess their eligibility for studies and allow an approach about participation ('consent for contact') is ethically, legally and technically challenging, given that medical data are usually restricted to the patient's clinical team. The research objective was to design a model for identification and recruitment to overcome some of these challenges as well as reduce the burdensome (and/or time consuming) gatekeeper role of clinicians in determining who is appropriate or not to participate in clinical research.

SETTING

Large secondary mental health services context, UK.

PARTICIPANTS

2106 patients approached for 'consent for contact'. All patients in different services within the mental health trust are gradually and systematically being approached by a member of the clinical care team using the 'consent for contact' model. There are no exclusion criteria.

PRIMARY AND SECONDARY OUTCOME MEASURES

Provision of 'consent for contact'.

RESULTS

A new model (the South London and Maudsley NHS Trust Consent for Contact model (SLaM C4C)) for gaining patients' consent to contact them about research possibilities, which is built around a de-identified EHR database. The model allows researchers to contact potential participants directly. Of 2106 patients approached by 25 October 2013, nearly 3 of every 4 gave consent for contact (1560 patients; 74.1%).

CONCLUSIONS

The SLaM C4C model offers an effective way of expediting recruitment into health research through using EHRs. It reduces the gatekeeper function of clinicians; gives patients greater autonomy in decisions to participate in research; and accelerates the development of a culture of active research participation. More research is needed to assess how many of those giving consent for contact subsequently consent to participate in particular research studies.