Table 3 Study findings/themes
Practice ‘motivators’ to join the trial as recruiters | |
• Having an existing interest in the research topic • Having the required eligible patient population registered at the practice • Being financially reimbursed • Improving lung cancer diagnosis • Developing the practice • Expanding the practice network • Personal and professional development of staff (having clinical and research learning opportunities) • Having altruistic, benevolent feelings | |
Health professional interactions with patients | |
Challenges of identifying and recruiting eligible patients • Patient eligibility criteria deemed too narrow • Staff fears that patients would have unnecessary chest X-rays • GPs feeling overworked and too busy to recruit • Having a lack of staff to participate in recruitment • Eligible patients being too busy to participate • Recruitment documentation confusing resulting in embarrassment and a reluctance to recruit • GPs too busy dealing with patients’ other needs | |
Presenting the trial to patients • Staff worries that trial would increase patient anxiety about lung cancer (resulting in staff carefully choosing words to explain trial purpose) • The popularity of advertising chest X-rays (at the time) reduced staff worries of increasing patient anxiety • Ex-smokers were deemed easier to recruit | |
Completion of patient questionnaires • Certain questions were deemed irrelevant to study • Certain questions were deemed too confidential for staff other than GPs to ask • Many patients required assistance to populate health questionnaires. • Health questionnaires taking too long to complete • Staff lacking time to help patients complete health questionnaires | |
Explaining chest X-ray referrals to patients • Staff admitted they had mistaken perceptions that patients would prefer randomisation to the chest X-ray rather than control arm of trial • Patients not having a preference for participation in particular arm of trial was attributed to them being well informed of study equipoise • A minority of patients were deemed to feel anxious waiting for chest X-ray results | |
Practice organisation to undertake trial | |
The importance of establishing key staff members responsible for the study • One staff member is required to be accountable for the study • Continuity of staff is necessary. (A reliance on GP locums does not help the trial conduct) • Part time staff struggle to manage trial commitment • Research nurses who are paid especially to undertake trials are important The need for a comprehensive recruitment system • A team effort is required to recruit patients • A clear plan is necessary to recruit patients • Recruitment database searches require timely action to avoid losing potential patient recruits Organisation of chest X-ray referral • Patient feedback to staff highlighted easy travel to hospitals whilst others complained of travel distance or no free parking • Patient feedback to staff highlighted easy and efficient access to chest X-rays • Staff contact with X-rays Departments highlighted the X-ray staff being unaware of the study | |
General impact of trial on practice staff • Staff more aware of long waiting times for a cancer diagnosis • Staff increased their knowledge of chest X-ray safety • Staff increased their knowledge of research methods and research engagement • Trial required one high recruiting practice to increase hours of practice nurse and take on a locum nurse • Staff anxiety due to concern for patients waiting for chest X-ray results • Staff fears of invoking unnecessary anxiety in patients | |
Researcher team support and involvement Impact of the research team • Staff happy with involvement and support of research team • Staff felt that newsletter from research team were beneficial and helped them focus on the trial Training day delivered by the research team • Research team helped to reassure practice staff • Training pitched at a level for non-clinicians beneficial • Staff found literature given out beneficial before start of trial • Training was too detailed with too much paperwork leaving some staff feeling overwhelmed | |
Practice staff suggestions for improvements • More administrative support • Decrease study reimbursement in exchange for assistance with recruitment • Share workload between research team and practice staff • Having practice managers and non-clinical workers consulted on trial design and delivery before start of trial • For practices to be given a mentor |