title: Recruitment barriers in a randomized controlled trial from the physicians' perspective: a postal survey.
abstract: BACKGROUND
  The feasibility of randomized trials often depends on successful patient recruitment. Although numerous recruitment barriers have been identified it is unclear which of them complicate recruitment most. Also, most surveys have focused on the patients' perspective of recruitment barriers whereas the perspective of recruiting physicians has received less attention. Therefore, our aim was to conduct a postal survey among recruiting physicians of a multi-center trial to weigh barriers according to their impact on recruitment.
  
  
  METHODS
  We identified any potential recruitment barriers from the literature and from our own experience with a multi-center trial of respiratory rehabilitation in patients with chronic obstructive pulmonary disease. We developed and pilot-tested a self-administered questionnaire where recruiting physicians were asked to express their agreement with statements about recruitment barriers on a Likert-type scale from 1 (full agreement with statement = very substantial recruitment barrier) to 7 (no agreement with statement = no recruitment barrier).
  
  
  RESULTS
  38 of 55 recruiting physicians returned questionnaires (69% response rate), of which 35 could be analyzed (64% useable response rate). Recruiting physicians reported that "time constraints" (median agreement of 3, interquartile range 2-5) had the most negative impact on recruitment followed by "difficulties including identified eligible patients" (median agreement of 5, IQR 3-6). Other barriers such as "trial design barriers", "lack of access to treatment", "individual barriers of recruiting physicians" or "insufficient training of recruiting physicians" were perceived to have little or no impact on patient recruitment.
  
  
  CONCLUSIONS
  Physicians perceived time constraints as the most relevant recruitment barrier in a randomized trial. To overcome recruitment barriers interventions, that are affordable for both industry- and investigator-driven trials, need to be developed and tested in randomized trials.
  
  
  BACKGROUND
  ISRCTN84612310.
authors.affiliation: Horten Centre for Patient-Oriented Research and Knowledge Transfer, University of Zurich, Switzerland. anne.spaar@usz.ch
authors.forename: Anne
authors.initials: A
authors.lastname: Spaar
authors.forename: Martin
authors.initials: M
authors.lastname: Frey
authors.forename: Alexander
authors.initials: A
authors.lastname: Turk
authors.forename: Werner
authors.initials: W
authors.lastname: Karrer
authors.forename: Milo A
authors.initials: MA
authors.lastname: Puhan
mesh_terms: D003625:Data Collection; D006801:Humans; D018579:Patient Selection / Q000941:ethics*; D010820:Physicians; D016032:Randomized Controlled Trials as Topic; D011795:Surveys and Questionnaires