Perspectives of clinicians who recruit to clinical trials in addictions services

First published: 10/05/2019 | Last updated: May 20th, 2019

Abstract: Background

The difficulties of recruiting to trials are widely known, yet the process of recruitment has not been thoroughly documented.  Clinicians in clinical services often mediate researcher access to patients, but few studies consider the role that these gatekeepers may have in recruiting participants.

Objective

To investigate the process of recruitment from the perspective of clinicians recruiting into a cluster trial which evaluated the effectiveness of contingency management (using supermarket voucher incentives) in promoting completion of hepatitis B vaccination amongst opiate drug users – HBV ConMan Trial (Weaver et al 2014). To describe the factors that contributed to successful recruitment of 210 trial subjects.

Design

Qualitative focus group study. The study formed part of a process evaluation that investigated the influence of trial context on study implementation and outcome generation

Setting

11 NHS community drug treatment services in England that participated in the HBV ConMan Trial

Participants

Clinician-gatekeepers who were tasked with screening and consenting participants into the HBV ConMan trial

Main outcome measures

Focus groups were coded using NVIVO 10 and subjected to thematic analysis. The primary objective of the analysis was to identify factors that staff felt positively and negatively influenced the recruitment of participants.

Results

Clinicians suggested that increases in their workload, job insecurities, and external pressure caused by service-level structuring affected their prioritization of recruiting participants into the HBV Trial. Despite the barriers that existed, they identified numerous techniques to mitigate these barriers. Clinicians felt more willing and able to work with patients to overcome trial ambivalence when they were equipped with adequate understanding of trial procedures and had regular support from a team of visible on-site researchers.

Conclusions

Contextual factors surrounding trials influence the willingness and ability of staff to successfully recruit participants. The relationship clinicians have with their service and with the research team is a key influence upon the recruitment of subjects. These factors should be considered when planning a recruitment strategy for the trial and implementing trial recruitment protocols.

Co-Authors

Dilkushi Poovendran – Research Assistant (Imperial College) Nicola Metrebian- Senior Research Fellow (King’s College London) Vikki Charles- Senior Research Worker(King’s College London) Nicholas Little- Research Assistant (University College London) Tim Weaver – Senior Lecturer (Imperial College)

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Ms Dilkushi Poovendran