Population Health Sciences, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, Bristol, United Kingdom.
NIHR Collaboration for Leadership in Applied Health Research and Care at University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.
J Clin Epidemiol. 2019 Feb;106:108-120. doi: 10.1016/j.jclinepi.2018.10.004. Epub 2018 Oct 16.
To evaluate the impact of the QuinteT Recruitment Intervention (QRI) on recruitment in challenging randomized controlled trials (RCTs) that have applied the intervention. The QRI aims to understand recruitment difficulties and then implements "QRI actions" to address these as recruitment proceeds.
A mixed-methods study, comprising (1) before-and-after comparisons of recruitment rates and the numbers of patients approached and (2) qualitative case studies, including documentary analysis and interviews with RCT investigators.
Five UK-based publicly funded RCTs were included in the evaluation. All recruited to target. Randomized controlled trial 2 and RCT 5 both received up-front prerecruitment training before the intervention was applied. Randomized controlled trial 2 did not encounter recruitment issues and recruited above target from its outset. Recruitment difficulties, particularly communication issues, were identified and addressed through QRI actions in RCTs 1, 3, 4, and 5. Randomization rates significantly improved after QRI action in RCTs 1, 3, and 4. Quintet Recruitment Intervention actions addressed issues with approaching eligible patients in RCTs 3 and 5, which both saw significant increases in the number of patients approached. Trial investigators reported that the QRI had unearthed issues they had been unaware of and reportedly changed their practices after QRI action.
There is promising evidence to suggest that the QRI can support recruitment to difficult RCTs. This needs to be substantiated with future controlled evaluations.
评估 QuinteT 招募干预措施(QRI)对已应用该干预措施的挑战性随机对照试验(RCT)招募的影响。QRI 的目的是了解招募困难,然后在招募过程中实施“QRI 措施”来解决这些问题。
一项混合方法研究,包括(1)在实施干预措施之前和之后对招募率和接触患者数量进行比较,以及(2)包括文献分析和对 RCT 研究者进行访谈的定性案例研究。
共有 5 项英国公共资助的 RCT 纳入评估。所有研究均按目标招募。RCT 2 和 RCT 5 均在应用干预措施之前接受了预先招募培训。RCT 2 没有遇到招募问题,从一开始就超过了目标招募人数。RCT 1、3、4 和 5 通过 QRI 措施发现并解决了招募困难,特别是沟通问题。在 RCT 1、3 和 4 中,随机化率在 QRI 措施实施后显著提高。RCT 3 和 5 中的 QRI 措施解决了接触合格患者的问题,这两个研究的接触患者数量都显著增加。试验研究者报告称,QRI 揭示了他们以前没有意识到的问题,并在 QRI 措施实施后改变了他们的做法。
有有希望的证据表明,QRI 可以支持困难 RCT 的招募。这需要通过未来的对照评估来证实。