Abstract
BackgroundRecruitment to randomised controlled trials (RCTs) is challenging. Pre-trial qualitative research provides insights into the feasibility and acceptability of proposed trial designs and delivery; however, this is rarely conducted. This paper reports on work undertaken in advance of the Prepare for Kidney Care trial (formerly PrepareME), which compares preparing for dialysis with preparing for conservative care for patients with chronic kidney disease. The paper describes how the findings refined plans for the forthcoming trial.MethodsSemi-structured interviews were undertaken with health-care professionals involved in delivering or recruiting to the trial. Interview findings were considered in relation to observations of a patient advisory group workshop and introductory site visits, which were set up to present the trial to professionals involved in the internal pilot phase of the RCT. The use of findings and input from multiple sources was intended to support suggested refinements to the forthcoming trial. The findings were fed back to the trial management group and other expert stakeholders.ResultsSixteen health-care professionals were interviewed, and one patient advisory group workshop and six introductory visits to sites involved in the internal pilot were observed. The professionals interviewed included renal consultants, nurses and renal social workers. Key themes identified from the interviews, supported by the observations, were concerns around the eligibility criteria, the feasibility of the trial intervention, imbalances in the presentation of the trial arms, and anticipated recruitment issues arising from patients’ and clinicians’ preferences for one arm or the other. Changes to the design were made in response, including to the content of the intervention, the presentation of the trial arms and the name of the RCT.ConclusionsThis study highlights the value of carrying out pre-trial work with health-care professionals to identify issues with delivering the proposed trial. This work can be particularly valuable in trials of new interventions, for which the barriers to their integration into routine care are unknown. This work has important implications for facilitating the identification of further obstacles in the main RCT. We suggest that pre-trial qualitative work is undertaken to address design issues early on, in addition to ongoing qualitative research to monitor the emergence of obstacles affecting recruitment.
Highlights
IntroductionPre-trial qualitative research provides insights into the feasibility and acceptability of proposed trial designs and delivery; this is rarely conducted
Recruitment to randomised controlled trials (RCTs) is challenging
Interviews involved participants from four of the six acute National Health Service (NHS) trusts participating in the internal pilot phase of PrepareME
Summary
Pre-trial qualitative research provides insights into the feasibility and acceptability of proposed trial designs and delivery; this is rarely conducted. Patient and public involvement (PPI) at the design stage has been reported as having a positive impact on RCT recruitment through, for example, suggesting ways to make the trial more attractive to potential participants [4]. O’Cathain and colleagues [5] noted, that very little of this type of pre-trial research is undertaken, despite its potential to optimise trial design and recruitment. This applies to research with health-care staff involved in delivery and recruitment to RCTs [7]
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