Tutton Elizabeth, Phelps Emma E, Baird Janis, Costa Matthew L, Achten Juul, Moscrop Amy, Gibson Phoebe, Perry Daniel C
Kadoorie, Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK.
Major Trauma Centre, Oxford University Hospital NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK.
Bone Jt Open. 2025 Sep 11;6(9):1090-1100. doi: 10.1302/2633-1462.69.BJO-2024-0258.R1.
We sought to explore staff experience of a paediatric randomized controlled trial (RCT), comparing operative fixation and nonoperative treatment for displaced medial epicondyle fractures.
A total of 20 staff (eight surgeons and 12 research delivery staff) recruiting to the RCT in 18 NHS Trusts across the UK took part in a telephone/online qualitative interview. Interviews were informed by Heideggerian Phenomenology and thematic analysis.
We identified the concept of 'leading through expertise' demonstrated through two themes: 1) choosing ways of making it work; and 2) enabling parental/child decision making. Staff drew on their clinical and organizational expertise to take a position of equipoise and invested time to make the trial work within their local context. Building trust and confidence and using creative ways to engage with children enabled parent/child decision making in the context of uncertainty. Recruitment was sustained by the energy, enthusiasm, and expertise of staff, by the local investigator and research delivery staff, the digital resources, and the support of the trial team. Recruitment was hindered by clinical pressures, a variable research culture, and lack of consistent digital access.
For this relatively rare injury in children, 'leadership through expertise' was critical for successful trial recruitment. National and local networks of surgeons were imperative to support the trial activity. The development of similar networks among research delivery staff could improve knowledge exchange and enhance trial activities. Parental/child trust and confidence to decide about trial participation could be enabled by work to deepen child engagement in research. Educational tools engaging children may help to support family decision making in an emergency context.
我们试图探讨一项儿科随机对照试验（RCT）中工作人员的经历，该试验比较了移位性肱骨内上髁骨折的手术固定和非手术治疗。
在英国18个国民保健服务信托机构参与该RCT招募工作的共20名工作人员（8名外科医生和12名研究实施人员）参加了电话/在线定性访谈。访谈以海德格尔现象学和主题分析为指导。
我们确定了“以专业知识引领”的概念，这体现在两个主题中：1）选择使其发挥作用的方式；2）促成父母/儿童的决策。工作人员利用他们的临床和组织专业知识采取平衡的立场，并投入时间使试验在当地环境中发挥作用。建立信任和信心以及采用创造性的方式与儿童互动，使得在不确定性的背景下父母/儿童能够做出决策。工作人员、当地研究者和研究实施人员的精力、热情和专业知识、数字资源以及试验团队的支持维持了招募工作。临床压力、多变的研究文化以及缺乏一致的数字接入阻碍了招募工作。
对于儿童中这种相对罕见的损伤，“以专业知识引领”对于成功的试验招募至关重要。外科医生的国家和地方网络对于支持试验活动必不可少。在研究实施人员中发展类似的网络可以改善知识交流并加强试验活动。通过加深儿童对研究的参与，可以增强父母/儿童对决定是否参与试验的信任和信心。让儿童参与的教育工具可能有助于在紧急情况下支持家庭决策。
