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Wilson C, Rooshenas L, Paramasivan S, Elliott D, Jepson M, Strong S, Birtle A, Beard DJ, Halliday A, Hamdy FC, Lewis R, Metcalfe C, Rogers CA, Stein RC, Blazeby JM, Donovan JL. Development of a framework to improve the process of recruitment to randomised controlled trials (RCTs): the SEAR (Screened, Eligible, Approached, Randomised) framework. Trials 2018; 19:50. [PMID: 29351790 PMCID: PMC5775609 DOI: 10.1186/s13063-017-2413-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 12/14/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Research has shown that recruitment to trials is a process that stretches from identifying potentially eligible patients, through eligibility assessment, to obtaining informed consent. The length and complexity of this pathway means that many patients do not have the opportunity to consider participation. This article presents the development of a simple framework to document, understand and improve the process of trial recruitment. METHODS Eight RCTs integrated a QuinteT Recruitment Intervention (QRI) into the main trial, feasibility or pilot study. Part of the QRI required mapping the patient recruitment pathway using trial-specific screening and recruitment logs. A content analysis compared the logs to identify aspects of the recruitment pathway and process that were useful in monitoring and improving recruitment. Findings were synthesised to develop an optimised simple framework that can be used in a wide range of RCTs. RESULTS The eight trials recorded basic information about patients screened for trial participation and randomisation outcome. Three trials systematically recorded reasons why an individual was not enrolled in the trial, and further details why they were not eligible or approached, or declined randomisation. A framework to facilitate clearer recording of the recruitment process and reasons for non-participation was developed: SEAR - Screening, to identify potentially eligible trial participants; Eligibility, assessed against the trial protocol inclusion/exclusion criteria; Approach, the provision of oral and written information and invitation to participate in the trial, and Randomised or not, with the outcome of randomisation or treatment received. CONCLUSIONS The SEAR framework encourages the collection of information to identify recruitment obstacles and facilitate improvements to the recruitment process. SEAR can be adapted to monitor recruitment to most RCTs, but is likely to add most value in trials where recruitment problems are anticipated or evident. Further work to test it more widely is recommended.
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Affiliation(s)
- Caroline Wilson
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Leila Rooshenas
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Sangeetha Paramasivan
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Daisy Elliott
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Marcus Jepson
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Sean Strong
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Alison Birtle
- Rosemere Cancer Centre, Royal Preston Hospital, Sharoe Green Land North, Fulwood, Preston, Lancashire PR2 9HT UK
| | - David J. Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD UK
| | - Alison Halliday
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, OX3 9DU UK
| | - Freddie C. Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, OX3 9DU UK
| | - Rebecca Lewis
- Institute of Cancer Research Clinical Trials and Statistics Unit (ICR-CTSU), Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG UK
| | - Chris Metcalfe
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS UK
- Bristol Randomised Trials Collaboration University of Bristol, School of Social and Community Medicine, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Chris A. Rogers
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Level 7 Queens Building, Bristol Royal Infirmary, Bristol, BS2 8HW UK
| | - Robert C. Stein
- NIHR University College London Hospitals Biomedical Research Centre, 149 Tottenham Court Road, London, W1T 7DN UK
| | - Jane M. Blazeby
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Jenny L. Donovan
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS UK
- Collaboration for Leadership in Applied Health Research and Care West, University Hospitals Bristol, 9th Floor, Whitefriars Lewins, Bristol, BS1 2NT UK
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