Table 6 Quotations for trial team/recruiter-related factors

When it comes to including patients and send patients to the pharmacist, this was much more difficult…. mainly the physicians were concerned. And you know that’s all the problems we have: trying to establish collaboration between physicians and pharmacists - is that physicians are always afraid that pharmacists are going to steal their patients and follow their patients instead of them. T4 Principal Investigator of a discontinued trial

This was a continuous ongoing fight between the chief cardiac surgeon and myself and well… everybody else in the hospital with him. So it was not a funny thing to do, research with him, not really being involved... but well, trying to make our life as researchers difficult. (….) Well, let's put it politely: he was a very strong minded person. To put it a little less polite: he was an extremely difficult redneck. And so what he did, he prohibited… he told a senior doctor that he would no longer support that. What he did, he always said, ‘Well, this patient doesn’t qualify.’ Nobody ever qualified anymore. So the trial was… was going to be dead. T5 Principal Investigator of a discontinued trial

For rare diseases, it’s really a big challenge. And in general, I mean this non referral - you know, we talk again and again with everybody and they don’t do it (refer). Not even you know, if you think in Zurich, there is hospital A and hospital B. No way would they refer patients to each other! Yeah. I think that this is a big weakness. No large centers and no referral. R13 Representative of pharmaceutical industry

I think this academic model is outdated. I think it would be much better if we have very skilled clinicians who know how to apply clinical research and do an excellent clinical job and few researchers who first of all do not necessarily have to be MDs, they can also come from other fields, who do really good research and are well trained. And I think it’s certainly correct that we try to recruit these young talented people during different curriculums. (…..) If they are really good then you also have to develop career possibilities and funding for them and that’s also not sufficiently done because, university hospitals want to have good clinicians, good teachers, and good researchers. R8 Clinical trialist

So it’s not possible to run a trial, an academic trial for instance, with a very interesting research question just by the enthusiasm of all the people involved in all the centers. And this used to be possible about 10 years ago. And now you have so many regulations for the conduct of the trial that you need professional personnel or staff to really conduct it in the centers. There you need money and time. R20 Clinical trialist