Facilitators and Barriers to Recruiting Ambulatory Oncology Practices Into a Large Multisite Study: Mixed Methods Study.

Milisa Manojlovich,Kari Mendelsohn-Victor,Christopher R Friese,Louise Bedard,Jennifer J Griggs,Michaella Mcbratnie

doi:10.2196/14476

Abstract

BackgroundPractice-based research is essential to generate the data necessary to understand outcomes in ambulatory oncology care. Although there is an increased interest in studying ambulatory oncology care, given the rising patient volumes and complexity in those settings, little guidance is available on how best to recruit ambulatory oncology practices for research.ObjectiveThis paper aimed to describe the facilitators and barriers to recruiting ambulatory oncology practices into a large multisite study.MethodsUsing a mixed methods design, we sought to recruit 52 ambulatory oncology practices that have participated in a state-wide quality improvement collaborative for the quantitative phase. We used 4 domains of the Consolidated Framework for Implementation Research (CFIR) to describe facilitators and barriers to recruitment.ResultsWe successfully recruited 28 of the 52 collaborative-affiliated practices, collecting survey data from 2223 patients and 297 clinicians. Intervention attributes included multimodal outreach and training activities to assure high fidelity to the data collection protocol. The implementation process was enhanced through interactive training and practice-assigned champions responsible for data collection. External context attributes that facilitated practice recruitment included partnership with a quality improvement collaborative and the inclusion of a staff member from the collaborative in our team. Key opinion leaders within each practice who could identify challenges to participation and propose flexible solutions represented internal context attributes. We also reported lessons learned during the recruitment process, which included navigating diverse approaches to human subjects protection policies and understanding that recruitment could be a negotiated process that took longer than anticipated, among others.ConclusionsOur experience provides other researchers with challenges to anticipate and possible solutions for common issues. Using the CFIR as a guide, we identified numerous recruitment barriers and facilitators and devised strategies to enhance recruitment efforts. In conclusion, researchers and clinicians can partner effectively to design and implement research protocols that ultimately benefit patients who are increasingly seeking care in ambulatory practices.

Highlights

BackgroundA growing proportion of health care is delivered in ambulatory practice settings, yet little information about ambulatory care quality and safety is available [1]
We began with a quantitative phase, by distributing questionnaires to all prescribers and registered nurses who work in a sample of ambulatory oncology practices
Michigan Oncology Quality Consortium (MOQC) is an alliance of ambulatory oncology practices formed with the purpose of sharing and benchmarking their data to improve the quality of oncology care

Summary

Introduction

BackgroundA growing proportion of health care is delivered in ambulatory practice settings, yet little information about ambulatory care quality and safety is available [1]. Substantial amounts of complex care are delivered in ambulatory practice settings, where research has an important role in improving the quality and safety of patient care [2]. Given the rising patient volumes and complexity, researchers have an increased interest in studying ambulatory practice settings for descriptive, interventional, and implementational research. Researchers have identified barriers and facilitators to the successful recruitment of community health centers [3] and primary care practices [4] for example, but specialty practices such as ambulatory practice settings that provide care to oncology patients may have other recruitment challenges, and we know little about those. There is an increased interest in studying ambulatory oncology care, given the rising patient volumes and complexity in those settings, little guidance is available on how best to recruit ambulatory oncology practices for research. Researchers and clinicians can partner effectively to design and implement research protocols that benefit patients who are increasingly seeking care in ambulatory practices

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