Optimised clinical study recruitment in palliative care: success strategies and lessons learned

Abstract

Recruitment challenges to clinical research studies in palliative care settings, particularly in hospices, are well documented. However, a recent study (Hospice Inpatient Deep vein thrombosis Detection (HIDDen) study) performed across five hospices in the UK recruited above target and on time. We describe strategies that aided successful recruitment in this study, and the lessons learnt for improving future studies. A recent review suggested that the ‘Social Marketing Mix Framework’ (SMMF) could help researchers with recruitment strategies in palliative care. We describe the recruiting strategies employed through the Social Marketing Mix lens and consider if it would be a useful framework for future researchers to use at the planning stage. Successful recruitment strategies employed in HIDDen study included: (i) addressing particular study-related factors, (ii) ensuring all patients were screened and offered participation if eligible, (iii) reducing impact on the clinical team through dedicated research nurses at sites, (iv) addressing research team issues with cross-cover between sites, where geographically possible, and (v) regular video conferencing meetings for support and collaborative solving of challenges. Limited pre-existing research infrastructure at most of the recruiting hospices created particular challenges. The SMMF provides a potential structure to help researchers to plan recruitment. However, to fully streamline trial set up and in order for hospice involvement in research to be realised systematically, a centralised approach to governance, organisational culture change whereby hospices embrace research as a legitimate purpose and consistent access to research staff are identified as key strategic elements promoting recruitment to studies in hospices.

Gaps in Hospice and Palliative Care Research: A Scoping Review of the North American Literature

“…This may mean that not all the experiences of those in HPC are considered, and therefore, care models that stem from research may not be appropriate for all types of patients. One way this gap can be remedied is perhaps by establishing/fostering a palliative research network [ 28 , 39 ]. A research network dedicated specifically to palliative care can also help to refine and establish a clearer agenda of research needs [ 34 ].…”

Recruitment, Retention and Intervention Delivery Experiences With Hospice Family Caregivers

“…Using the 6 P’s of SMM framework provides one potential structure to address these issues. 2 Our findings indicate that the current dosage of one intervention session per week is not sufficient to allow individuals to watch all videos before the caregiving burden becomes too great or the patient dies. Thus, an earlier study enrollment through universal screening is advised for advancing the timing of NOVELA.…”

“…In addition to patient/family-related factors, 1 particular obstacles in the hospice setting include lack of research infrastructure, few trained clinical researches, prioritization of clinical responsibilities, lack of protected research time and funding difficulties. 2 As a result, there are few adequately powered hospice clinical trials, especially, studies involving hospice family caregivers (HFCGs). 3 HFCGs, which include spouses, relatives or friends of a patient receiving hospice, are tasked with managing pain and other symptoms at home.…”

“…Is important that given the vulnerability of HFCGs, researchers must take care to place as little burden as possible on participants 1 while recruiting and delivering interventions in the hospice setting. The Social Marketing Mix (SMM) framework was proposed by White et al 2 as a guide for researchers when planning and implementing recruitment strategies in palliative care. This framework consists of the 6 P’s: participants, product, price, place, promotion and partners.…”

HIDDEN2: Study protocol for the hospital deep vein thrombosis detection study in patients with cancer receiving palliative care

“…The HIDDen study demonstrated the feasibility of recruiting and performing lower limb imaging in hospice/SPCU-based palliative care cancer patients; it recruited ahead of schedule and gained significant ‘buy-in’ from patients and their respective families. 15 …”