Health care professional recruitment of patients and family carers to palliative care randomised controlled trials : A qualitative multiple case study

Dunleavy, Lesley and Preston, Nancy and Walshe, Catherine (2021) Health care professional recruitment of patients and family carers to palliative care randomised controlled trials : A qualitative multiple case study. PhD thesis, Lancaster University.

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Abstract

Introduction: Trial recruitment is an interactional process between health care professionals, patients and carers. There is limited understanding of how health care professionals carry out this role in palliative care trials as well as the reasons why they do or do not recruit eligible participants. The ‘6 Ps’ of the ‘Social Marketing Mix Framework’ may help guide recruitment planning, but most evidence is anecdotal. The ‘6 Ps’ are; identifying participants, product, price, place, promotion and working with partners. Aims: To explore how health care professionals undertake recruitment to palliative care randomised controlled trials and the factors that influence the strategies they use and the decisions they make during the recruitment process. Method: A narrative synthesis of palliative care trial recruitment barriers and facilitators identified in existing trial literature informed the study design. A qualitative multiple case study, using Yin’s approach, was conducted. Cases were diverse UK palliative care trials across a variety of settings. Participants included study investigators and research staff involved in the recruitment process from trial coordinating centres and clinical recruitment sites. Data collection included interviews and study documentation. Analysis was informed by developing and refining theoretical propositions, guided by the ‘6Ps’ as an initial analytical framework. Framework Analysis guided within and then cross-case analysis. Results Three cases were included in the study (n = 3, 9, 7 participants). Cross-case analysis suggests the ‘6 Ps’ are a useful framework for understanding recruitment processes but wider contextual issues also need to be incorporated. These include the ‘emotional labour’ of diagnosing dying and communicating palliative and end-of-life care to potential participants and how the recruitment process is influenced by the power relationships and hierarchies that exist among professional groups. These factors can lead to and support paternalistic practices. Discussion/conclusion Those planning trials need to ensure that trial recruiters, depending on their experience and trial characteristics, have access to training and support to address the ‘emotional labour’ of recruitment. Consideration also needs to be given to who is primarily responsible for the patient’s care when choosing a Principal Investigator.