Table 6 Health professionals’ interactions with patients
Problems and disincentives to identifying eligible patients | Few patients were being recruited: Thirteen patients and six people come in with a chest infection [...] So just look at those figures, we look at half the people that come to our sit and wait surgery for an acute problem, about half of them are coming with a chest infection [...] well it does raise a question, why isn’t ELCID trial, why aren’t they being referred? [...] I don’t know the answer to that question. (Recruiter 4, practice manager, medium recruiter) |
“ | Eligibility criteria a problem: I didn’t end up identifying any of them I thought would fit the trial […] I don’t think we actually have as many patients who do qualify as we, we thought (Recruiter 8, general practitioner, low recruiter) |
“ | Eligibility criteria a problem: There’s a lot of patients I could have (recruited), if that (the eligibility criteria) had been a little bit more flexible, (Recruiter 1, general practitioner, low recruiter) |
“ | Unnecessary treatment causing fear: “unnecessary x-rays” (Recruiter 8, General Practitioner, Low Recruiter |
“ | Too much work: ‘it did sound very um complex and labour intensive’ (Recruiter 7, General Practitioner, High Recruiter). |
“ | Too busy: it’s ten past nine on a Monday morning, I’ve got thirty people waiting to be seen. Patient presents with an exacerbation of COPD and then you sort of... actually, I’ll do [recruit] the next one. (Recruiter 1, General Practitioner, Low Recruiter) |
“ | Study confusion may highlight lack of study knowledge: exposes my, my ignorance about what I’m supposed to be doing [...] be doing next. (Recruiter 8 General Practitioner, Low Recruiter) |
“ | Indifference to the trial: ‘you know, apathy just disinclination’ (Recruiter 8, General Practitioner, Low Recruiter). |
“ | Patients too busy: If they’re just popping in for a quick appointment and have to get off to work or got other commitments, then they’re less likely to want to participate. (Recruiter 5, Research Nurse, Low Recruiter) |
“ | Financial constraints: There’s no money in the health service at the moment and […] we’ve been told about prescribing and referring people in for unnecessary scans, x-rays whatever […] and I think there may be almost that subconscious element is oh, do I really need to refer this patient for an x-ray. (Recruiter 6, Practice Manager, Low Recruiter) |
Presenting the trial to patients | Patients with other needs or pressed for time: sometimes we’re dealing with patients who are elderly, so can’t hear very well [...] who perhaps have got an appointment in the hair dressers in twenty minutes (Recruiter 4 Practice Manager, Medium Recruiter) |
“ | Easier to recruit ex-smokers: it’s very natural then to say well as you’ve been a smoker, very glad you’ve stopped, but as you’ve been a smoker you would be eligible for this trial. (Recruiter 7, General Practitioner, High Recruiter) |
“ | Fear of worrying patients: might give them the wrong signal and they may read something in to it that’s not there. (Recruiter 6, Practice Manager, Low Recruiter) |
“ | Methods to allay patient anxiety: probably don’t say the C word until quite a way in to the explanation (Recruiter 5, Research Nurse, Low Recruiter) |
“ | Telling patients the study is to change research and practice: but it’s to help research. [I] explain why we’re doing it because um, not because I think they’ve got lung cancer but because I, I would be doing other things if I thought that [...] But we want to improve our diagnostic skills and most people are very positive. (Recruiter 7, General Practitioner, High Recruiter) |
“ | Telling patients the study is to change research and practice: normally we wouldn’t send you for an x-ray at this stage, but this study is particularly looking to see if we should change that practice. (Recruiter 9, General Practitioner, Medium Recruiter) |
“ | Chest x-rays currently popular anyway: I think some of the messages in terms of the advertising campaigns about chest x-ray patients will... increasingly we find patients are bringing that up [...] Earlier chest x-rays. So they’re happy to have a chest x-ray [...] generally. I don’t think it caused particular anxiety. (Recruiter 3, Research Nurse, High Recruiter) |
Completion of patient health questionnaires | Lengthy documentation: “onerous.” (Recruiter 1 General Practitioner, Low Recruiter) took “the best part of thirty minutes [to complete]” (Recruiter 4 Practice Manager, Medium Recruiter). |
“ | No problem helping patients to populate questionnaires: “quite straight forward” and unchallenging (Recruiter 5, Research Nurse, Low Recruiter). |
“ | Irrelevant study questions requiring assistance: ‘not relevant to the study’ ‘needed assistance completing them (Recruiter 4, Practice Manager, Medium Recruiter) |
“ | Better that the General Practitioner asks the questions: when a patient comes in and it’s the doctor, they trust that doctor. (Recruiter 4, Practice Manager, Medium Recruiter) |
“ | Unprepared and untrained to discuss confidential information: It’s awful for the patient to tell a member of staff that they know, we work in the reception area. I don’t say I’m a manager, you know I’m one of the girls [...] You know I’m telling the receptionist how depressed I’ve been feeling. It doesn’t seem professional. (Recruiter 4, Practice Manager, Medium Recruiter) |
“ | Discomfort and irrelevance of some questions: they’re happy to tell you about what their symptoms are and what medication they’ve been on and have they seen the pharmacist and the other things [...] but they look at you a bit strange [if you ask them depression screening questions] (Recruiter 2, Research Nurse, High Recruiter |
Explaining study chest X-ray referral to patients | Patients happy to have chest X-ray or not: Everybody thought that you know these patients are going to feel cheated if they don’t get a chest x-ray but in reality, I’ve actually found it the other way round […] you know they’re feeling so poorly that they don’t really feel like going up to (hospital name) for a chest X-ray so that’s been quite a surprise. (Recruiter 3, Research Nurse, High Recruiter) |
“ | Patient reassurance about having a chest X-ray if needed: ... if you’re not randomised to have a chest x-ray and your symptoms persist or become worse then you would come back to see a clinician as you would do normally and a decision would be made whether to send you for a chest x-ray at that point. So you’re not going to be deprived of a particular treatment. (Recruiter 5, Research Nurse, Low Recruiter) |
Patient feedback to health professionals following recruitment | Additional investigations following chest X-ray causing anxiety: [she was] extremely worried for the two to three week period that it took for the CT scan even though it was an urgent request. (Recruiter 5, Research Nurse, Low Recruiter) |