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Table 3 Clinicians factors which influence recruitment

From: A thematic analysis of factors influencing recruitment to maternal and perinatal trials

Themes and specific findings

Clinicians' attitudes to research and trials

â–ª Clinicians who are more research oriented are more likely to be involved in trials and to recruit participants [8, 26, 39]

▪ Although nurses and midwives typically report moderate to strong research orientation this does not generally translate into research activity or involvement mainly due to lack of sufficient research training and insufficient time for research [41–47]

â–ª Doctors who believe trial participation affects patient-doctor relationship are less likely to recruit patients into trials [48]

â–ª Doctors choosing not to participate in trials may believe that trial participation restricts ability to individualise care [26]

â–ª Doctors with a strong preference for one or other therapy are less likely to enrol patients in trials [39, 49]

â–ª Evidence unclear whether discussing uncertainty is a barrier to recruitment for clinicians [9, 26, 39, 48]

Issues related to the trial protocol and methodology

â–ª Aspects of trial protocol can affect clinicians' participation in trials and recruitment activity [26, 27, 39, 50, 51]

   - treatments more aggressive than standard

   - use of placebo

   - complex protocols

   - strict eligibility criteria

â–ª Relevance of trial, especially local relevance [27, 39, 52]

Clinician beliefs about potential participants

â–ª Younger patients with better prognosis are more likely to be asked to enrol [39, 48]

â–ª Women and babies from minority groups are less likely to be recruited [53, 54]

â–ª Women and babies thought to be unable to participate or to consent are less likely to be recruited [10, 39, 50, 52]

Organisational/institutional issues

▪ Lack of time is a significant barrier to trial involvement for doctors and nurses [9, 25–27, 39, 41–43, 45, 46, 52, 54]

▪ A positive organisational culture and material support for trial activity increases clinician participation [9, 26, 27, 39, 41–47]

â–ª A range of practical barriers to setting up and running a trial have been identified [9, 10, 14, 39, 50, 52, 55, 56]

   - identifying and contacting eligible patients

   - ethics approvals

   - setting up trial treatment procedures