Enrollment of intensive care unit patients into clinical studies: a trinational survey of researchers' experiences, beliefs, and practices.
BACKGROUND
As critical care practice increases in scope, size, and complexity, enrollment of critically ill patients into clinical studies is increasing.


OBJECTIVE
To understand the experiences, beliefs, and practices of the Canadian Critical Care Trials Group and Australian and New Zealand Intensive Care Society Clinical Trials Group regarding enrollment of critically ill children and adults into clinical studies.


METHODS
Survey items generated by the research team were formatted in four domains: experiences, beliefs, practices, and demographics. Five research coordinators and five physicians pretested the survey, providing feedback on clarity and completeness. Intrarater reliability (16 participants, 2 wks apart) was very good.


RESULTS
The response rate was 284 of 322 (88.2%). Respondents worked in intensive care units with a mean of 20.5 (SD 10) beds, caring for adults (72.2%), pediatric (18.8%), and both groups (9%) of critically ill patients. Clinical research was considered key to the future of improved clinical care. To enhance recruitment efficiency, respondents widely endorsed the effectiveness of increasing participating centers, after-hours, and weekend enrollment (all 3 scores 7 [6-7[sqb], reflecting median [interquartile range] on 1-7 scale). Overall, the effectiveness (6 [4-7]), feasibility (5 [4-6]) and ethics (5 [4-7]) of coenrollment into more than one randomized trial was endorsed. Half of respondents have adopted coenrollment with scientific and psychosocial provisos. Alternative designs, such as factorial and cluster randomized trials, were considered when suitable. Modifications to consent approaches (deferred consent (7 [6-7]), waived consent (7 [6-7]), or consent from two physicians in the absence of a substitute decision maker (6 [5-7])) were considered effective, but beliefs about the feasibility and ethics of some of these approaches varied.


CONCLUSIONS
Clinical research is highly valued by these intensive care unit communities. Strategies to increase capacity involve enhancing recruitment efficiencies, considering alternative study designs and expanding consent procedures. Thoughtfully implementing these strategies may advance the care of critically ill adults and children.
Department of Medicine, McMaster University, Hamilton, ON, Canada. debcook@mcmaster.ca
Deborah J
DJ
Cook
David
D
Blythe
Amanda
A
Rischbieth
Paul C
PC
Hebert
Nicole
N
Zytaruk
Kusum
K
Menon
Simon
S
Erikson
Robert
R
Fowler
Diane
D
Heels-Ansdell
Maureen O
MO
Meade
D000328:Adult; D001291:Attitude of Health Personnel; D001315:Australia; D002170:Canada; D002648:Child; D003422:Critical Care; D006801:Humans; D007362:Intensive Care Units; D008511:Medicine; D009520:New Zealand; D018579:Patient Selection / Q000941:ethics; D010560:Personnel Selection / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D013038:Specialization