Obstacles to recruitment in paediatric studies focusing on mental health in a physical health context: the experiences of.., 2019, Loades et al

[Andy]

Crawley's team churn another paper out.

Obstacles to recruitment in paediatric studies focusing on mental health in a physical health context: the experiences of clinical gatekeepers in an observational cohort study

Background

Studies in both paediatric and psychiatric settings often experience problems in recruitment. This can compromise the ability of the study to recruit to target, meaning studies are potentially underpowered. It can also result in a biased sample if a non-representative group are selectively recruited. Recruitment to studies in health contexts often depends on healthcare professionals, who act as gatekeepers by screening patients for eligibility and obtaining consent for the research team to contact them. The experience of health professionals as gatekeepers in paediatric studies is poorly understood and may affect whether recruitment is successful or not.

Methods
Six out of seven eligible healthcare professionals from a specialist paediatric chronic fatigue syndrome (CFS) team were interviewed. All participants were undertaking initial clinical assessments within which they were asked to identify eligible patients for an observational study of co-morbid mental health problems in adolescents with confirmed CFS/ME. This study had experienced particular recruitment problems, more so than other studies in the same service. Interview questions were designed to explore perceptions of research, and barriers and facilitators of recruitment. Interviews were audio recorded and transcribed verbatim. Thematic analysis was used.

Results
Participants espoused their commitment to the value of research. However, they perceived there to be a number of barriers to recruitment. Barriers within the clinical context included time pressures and the emotional nature of initial clinical assessments. Barriers posed by the wider research context included recruiting to multiple studies at the same time. Factors specific to the observational study of mental health in CFS/ME included aspects of the study design, such as the name and nature of the study, as well as the focus of the study itself. Participants made a number of recommendations about how recruitment barriers could be overcome.

Conclusions
The current study highlights the need to carefully consider, at design stage, how to overcome potential barriers to recruitment. Gatekeepers should be actively involved at this stage to ensure that the study is set up in such a way to best enable recruitment activities within the clinical setting.

Open access at https://bmcmedresmethodol.biomedcentral.com/articles/10.1186/s12874-019-0730-z

 

[Wonko]

Hmmm...just from reading the above;

Aren't 'gatekeepers' supposed to keep people who shouldn't be there out? They surely shouldn't be metaphorically dragging people in off the street to get the numbers up. There's another name for people who do that that escapes me ATM, but it's not 'gatekeeper'. 'Tout' maybe?

Thematic analysis? I didn't know what it was so I googled it. The information gained is quite alarming if used as part of 'science'. Totally subjective and subject to both bias and fatigue/boredom/'it's hot and I want to go to the pub' effects. Extremely so. To such an extent I can't see it not happening if the person doing it is alive and there is any significant amount of data, beyond an hour or 2, no matter if they are acting with integrity or not. People have limitations, and thematic analysis seems designed to provoke them and produce bias.

I can see it's use in market research, but in science?

Just my concerns from a quick read of the above.

It is not surprising that EC's team is involved in this 'research'.

 

[Trish]

So now they are studying their own studies. Or rather the difficulties of recruiting to their endless stream of studies. Good to see one of the findings from interviewing the clinicians in their clinic about their role in recruiting patients to their studies is that they are doing too many studies!

The focus seems to be particularly on a study of the prevalence mental health problems, and specifically depression in newly diagnosed CFS patients at the clinic, to be carried out by a structured interview which included intrusive questions about sex and drugs.

No wonder the clinicians were reluctant to recruit children to this ill conceived trial. As some of them said, if a child is already distressed, you're not going to add this burden to them, and if they are coping well, they and their parents will not see the point, and the doctor will feel it's inappropriate to ask them to take part in a mental health study when the have a physical illness.
So with biases in recruitment, it's a non starter as an epidemiological study anyway.

This is another of the Crawley/Loades studies dreamed up - during a coffee break, no doubt.

 

[rvallee]

Is this an elaborate Dunning-Kruger experiment? Their entire body of work is built on doing selective filtering of participants who do not have the disease they incompetently allege expertise in yet cannot properly define.

This is the kettle criticizing the pot for not being as shiny as it is.

That's what happens when people are made to fall backwards. Even when they cheat their way through they convince themselves of their own merit despite leaving nothing but failure behind them. They have no idea what they're doing.

 

[Jonathan Edwards]

Seems like if colleagues don't like your studies they won't recruit to them. And quite right too.

 

[NelliePledge]

not read it but hoping this means their reputation is going before them

wondering if clinicians are now aware they didnt get proper ethics for the school study

I mean thinking about it from my work if someone somewhere was publicly criticising one of our colleagues it would definitely be known about on the grapevine

 

[Hoopoe]

This was a study about depression in pediatric CFS. Sounds like the recruiters were tired of the constant recruitment into studies and don't see much value or need for the study in question.

“there is a danger of getting research overload so I think it suffered a bit because it came on the back of all the other trials we’d done and we’d just finished recruiting and people heaved a sigh of relief and said can we have a little window off recruiting please”

“…there were around four or five research projects, seem to be, seemingly on the go at any one time…and that is confusing.”

“…because it’s got depression in the title and um I think um you it just seems a little bit more explanation um by inviting them to take part I’m not suggesting that they are depressed…”

“…sometimes you won’t even think of it if you’ve got a patient who clearly isn’t depressed at all is coping extremely well it doesn’t even cross your mind to enter them into something called the depression study so I think the name of the study is wrong it should be called you know mood in chronic fatigue or something to help people think it’s for everyone, we’re just as interested in people who don’t have depression as people who do. So the name was wrong”

“…it doesn’t lead to additional help or additional resource or anything, it is simply, um a snapshot of the people coming through which is very valuable …but look what’s – what’s the benefit for the client?”

Indeed, that is a good question. What has Crawley's work done for patients?

 

[Sean]

Factors specific to the observational study of mental health in CFS/ME included aspects of the study design, such as the name and nature of the study, as well as the focus of the study itself.

Two words: Methodological rigour.

The current study highlights the need to carefully consider, at design stage, how to overcome potential barriers to recruitment. Gatekeepers should be actively involved at this stage to ensure that the study is set up in such a way to best enable recruitment activities within the clinical setting.

See above response.

 

[Amw66]

Perhaps cognitive dissonance is a protective measure. Bottom line is that too few people actually want to participate.

Whilst i have no direct experience, from parents forums there was often a perception that it was a Hobson' s choice situation for some, and others had been pestered so much to take part that they gave in.

I would imagine newly diagnosed are more likely to participate.