Health care professionals’ views of the factors influencing the decision to refer patients to a stroke rehabilitation trial

Abstract

Background: Effective recruitment is an essential element of successful research but notoriously difficult to achieve.

This article examines health care professionals’ views on the factors influencing decision-making regarding referral

to a stroke rehabilitation trial.

Methods: Semi-structured interviews and a card-sorting task were undertaken with stroke service staff in acute and

community hospital trusts. Data analysis used a thematic framework approach.

Results: Twenty-seven qualified health care professionals from 12 (6 acute and 6 community) hospital trusts and

one charity participated. Four main factors emerged: patient-related, professional views, the organisation and

research logistics, which all contributed to staff’s decision about whether to refer patients to a trial.

Clinicians identified patient-related factors as the most frequent influence and considered themselves the patients’

advocate. They used their knowledge of the patient to anticipate the patients’ reaction to possible participation and

tended to only refer those whom they perceived would respond positively.

Participants also identified experience of research, a sense of ownership of the project and a positive view of the

intervention being evaluated as factors influencing referral. The need to prioritise clinical matters, meet managerial

demands and cope with constant change were organisational factors impacting negatively on referral. Staff often

simply forgot about recruitment in the face of other higher priorities. Quick, simple, flexible research processes that

were closely aligned with existing ways of working were felt to facilitate recruitment.

Conclusions: Patient- and professional-related factors were the most frequent influence on clinicians’ recruitment

decisions, which often had a ‘gate-keeping’ effect. Managerial and clinical responsibility to juggle multiple (often

higher) priorities was also an important factor.

To facilitate recruitment, researchers need to develop strategies to approach potential participants as directly as

possible to enable them to make their own decisions about participation; ensure that research processes are as

quick and simple as possible; align with existing clinical pathways and systems; and give regular reminders and

ongoing support to promote recruitment.

Trial registration: ISRCTN, 98287938. Registered 6 May 2015