title: The practical challenges of recruitment and retention when providing psychotherapy to advanced breast cancer patients.
abstract: OBJECTIVE
  The goal of the present study was to investigate recruitment issues relevant to psychotherapy trials for metastatic cancer patients. First, we undertook a literature review of the psychotherapy intervention research for metastatic cancer patients. Second, we piloted pragmatic recruitment methods for a couples' intervention for women with metastatic breast cancer and their partners.
  
  
  METHODS
  An extensive literature search was conducted to identify psychotherapy trials involving people with metastatic cancer published in peer-reviewed journals. Study characteristics and recruitment methodologies were examined. In the pilot study, we trialled the recruitment strategies of approaching participants at outpatients' appointments, via letter, referral from the treating team and through direct advertising using two community support services.
  
  
  RESULTS
  The literature search identified 1,905 potentially relevant articles, which were narrowed to 18 studies specifically involving metastatic cancer patients involving a professionally trained facilitator and a specified theoretical orientation. Limited information was found on recruitment rates and the success of recruitment strategies. Barriers to recruitment identified in the literature included degree of patient illness, lack of interest/perceived benefit, insufficient time, socio-demographic factors and negative clinician attitudes. Our pilot study identified 72 eligible couples of which 66 were approached. Our recruitment strategies resulted in six couples consenting (9.1%) but only three couples completing the study (4.5%). The main reasons for study refusal were the intervention was not needed, lack of interest, insufficient time, patient illness and travel distance.
  
  
  CONCLUSIONS
  Recruitment for couple-based psychotherapy interventions is challenging. More work is required on developing acceptable and feasible recruitment processes for metastatic cancer patients to be able to access support.
authors.affiliation: The Department of Clinical Psychology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
authors.forename: Ann
authors.initials: A
authors.lastname: Boonzaier
authors.forename: Annabel
authors.initials: A
authors.lastname: Pollard
authors.forename: Maria
authors.initials: M
authors.lastname: Ftanou
authors.forename: Jeremy W
authors.initials: JW
authors.lastname: Couper
authors.forename: Penelope
authors.initials: P
authors.lastname: Schofield
authors.forename: Linda
authors.initials: L
authors.lastname: Mileshkin
authors.forename: Michael
authors.initials: M
authors.lastname: Henderson
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology / Q000523:psychology* / Q000628:therapy; D002986:Clinical Trials as Topic / Q000379:methods*; D019546:Couples Therapy / Q000379:methods / Q000458:organization & administration; D005260:Female; D006801:Humans; D008875:Middle Aged; D009362:Neoplasm Metastasis; D018579:Patient Selection; D010865:Pilot Projects; D014739:Victoria