Downloaded from http://emj.bmj.com/ on November 19, 2015 - Published by group.bmj.com
EMJ Online First, published on March 31, 2015 as 10.1136/emermed-2014-204401 Original article
Why is it so difficult to recruit patients to research in emergency care? Lessons from the AHEAD study Rowena Johnson,1 Maxine Kuczawski,2 Suzanne Mason2 1
Medical School, The University of Sheffield, Sheffield, UK 2 School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK Correspondence to Rowena Johnson, The Medical School, The University of Sheffield, Beech Hill Road, Sheffield, S10 2RX rmjohnson1@sheffield.ac.uk Received 8 October 2014 Revised 19 February 2015 Accepted 7 March 2015
ABSTRACT Introduction In February 2014, all 23 National Institute for Health Research medical research specialities were failing to meet recruitment targets, with ‘Injuries and Emergencies’ research performing particularly poorly. In this paper, the multicentre AHEAD study was used to explore issues surrounding recruitment in UK emergency departments. Method The AHEAD study investigated management and outcomes in over 3000 anticoagulated patients who suffered a head injury. Data from the study were used to compare patient recruitment at 33 Type-1 emergency departments. A questionnaire was sent to a research nurse at each of these sites and 30 replied (91% response rate). The survey investigated the difficulties encountered during patient recruitment and whether these were related to recruitment methods. More detailed interviews were conducted with three research nurses, to gain further insight into the barriers and facilitators involved. Results Overall recruitment varied widely between sites with an eightfold variation in recruitment rates. Population demographics and other uncontrollable factors will partly contribute to this variation. However, research nurses reported many problems, including site resources, lack of staff engagement and flaws in recruitment strategies, which could be improved. Conclusions Many of the barriers to recruiting patients for research studies encountered by research nurses have previously been reported in the literature, but there remain consistent problems. Until solutions are found, researchers will continue to miss recruitment targets and this will have implications for the efficiency and quality of emergency medicine research in the UK.
INTRODUCTION
To cite: Johnson R, Kuczawski M, Mason S. Emerg Med J Published Online First: [ please include Day Month Year] doi:10.1136/emermed-2014204401
Despite numerous attempts to improve the situation, medical research studies are failing to meet their patient recruitment targets. When planning a medical research study, a target sample size is calculated. Enough patients must be recruited to produce meaningful, reliable and statistically significant results. But for many years, researchers have struggled to recruit sufficient patients to reach their targets. Indeed ‘slower than expected recruitment’ is one of the most common problems encountered during research trials.1 A 2006 study found that only 31% of the 114 UK trials assessed successfully met the recruitment target and only 55% achieved >80% of the recruitment target.2 In total, 31% of the trials reduced their recruitment target, while 54% asked to extend their time for recruitment. The problem is not limited to the UK and has been occurring for many years.
Key messages What is already known on this subject? All medical specialties are missing National Institute for Health Research patient recruitment targets and emergency medicine research performs particularly poorly. The 2011 Government Plan to Growth implemented changes to address these issues but following these changes little improvement in recruitment has been seen. What might this study add? Recruitment data from the recent multicentre AHEAD study, along with surveys and interviews of research nurses, have been used to identify the current issues affecting patient recruitment in emergency care research.
A 1984 study reported that 34% of trials conducted in the USA recruited
EMJ Online First, published on March 31, 2015 as 10.1136/emermed-2014-204401 Original article
Why is it so difficult to recruit patients to research in emergency care? Lessons from the AHEAD study Rowena Johnson,1 Maxine Kuczawski,2 Suzanne Mason2 1
Medical School, The University of Sheffield, Sheffield, UK 2 School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK Correspondence to Rowena Johnson, The Medical School, The University of Sheffield, Beech Hill Road, Sheffield, S10 2RX rmjohnson1@sheffield.ac.uk Received 8 October 2014 Revised 19 February 2015 Accepted 7 March 2015
ABSTRACT Introduction In February 2014, all 23 National Institute for Health Research medical research specialities were failing to meet recruitment targets, with ‘Injuries and Emergencies’ research performing particularly poorly. In this paper, the multicentre AHEAD study was used to explore issues surrounding recruitment in UK emergency departments. Method The AHEAD study investigated management and outcomes in over 3000 anticoagulated patients who suffered a head injury. Data from the study were used to compare patient recruitment at 33 Type-1 emergency departments. A questionnaire was sent to a research nurse at each of these sites and 30 replied (91% response rate). The survey investigated the difficulties encountered during patient recruitment and whether these were related to recruitment methods. More detailed interviews were conducted with three research nurses, to gain further insight into the barriers and facilitators involved. Results Overall recruitment varied widely between sites with an eightfold variation in recruitment rates. Population demographics and other uncontrollable factors will partly contribute to this variation. However, research nurses reported many problems, including site resources, lack of staff engagement and flaws in recruitment strategies, which could be improved. Conclusions Many of the barriers to recruiting patients for research studies encountered by research nurses have previously been reported in the literature, but there remain consistent problems. Until solutions are found, researchers will continue to miss recruitment targets and this will have implications for the efficiency and quality of emergency medicine research in the UK.
INTRODUCTION
To cite: Johnson R, Kuczawski M, Mason S. Emerg Med J Published Online First: [ please include Day Month Year] doi:10.1136/emermed-2014204401
Despite numerous attempts to improve the situation, medical research studies are failing to meet their patient recruitment targets. When planning a medical research study, a target sample size is calculated. Enough patients must be recruited to produce meaningful, reliable and statistically significant results. But for many years, researchers have struggled to recruit sufficient patients to reach their targets. Indeed ‘slower than expected recruitment’ is one of the most common problems encountered during research trials.1 A 2006 study found that only 31% of the 114 UK trials assessed successfully met the recruitment target and only 55% achieved >80% of the recruitment target.2 In total, 31% of the trials reduced their recruitment target, while 54% asked to extend their time for recruitment. The problem is not limited to the UK and has been occurring for many years.
Key messages What is already known on this subject? All medical specialties are missing National Institute for Health Research patient recruitment targets and emergency medicine research performs particularly poorly. The 2011 Government Plan to Growth implemented changes to address these issues but following these changes little improvement in recruitment has been seen. What might this study add? Recruitment data from the recent multicentre AHEAD study, along with surveys and interviews of research nurses, have been used to identify the current issues affecting patient recruitment in emergency care research.
A 1984 study reported that 34% of trials conducted in the USA recruited
