title: Exploring recruitment barriers and facilitators in early cancer detection trials: the use of pre-trial focus groups.
abstract: BACKGROUND
  Recruiting to randomized controlled trials is fraught with challenges; with less than one third recruiting to their original target. In preparation for a trial evaluating the effectiveness of a blood test to screen for lung cancer (the ECLS trial), we conducted a qualitative study to explore the potential barriers and facilitators that would impact recruitment.
  
  
  METHODS
  Thirty two people recruited from community settings took part in four focus groups in Glasgow and Dundee (UK). Thematic analysis was used to code the data and develop themes.
  
  
  RESULTS
  Three sub-themes were developed under the larger theme of recruitment strategies. The first of these themes, recruitment options, considered that participants largely felt that the invitation to participate letter should come from GPs, with postal reminders and face-to-face reminders during primary care contacts. The second theme dealt with understanding randomization and issues related to the control group (where bloods were taken but not tested). Some participants struggled with the concept or need for randomization, or for the need for a control group. Some reported that they would not consider taking part if allocated to the control group, but others were motivated to take part even if allocated to the control group by altruism. The final theme considered perceived barriers to participation and included practical barriers (such as flexible appointments and reimbursement of travel expenses) and psychosocial barriers (such as feeling stigmatized because of their smoking status and worries about being coerced into stopping smoking).
  
  
  CONCLUSIONS
  Focus groups provided useful information which resulted in numerous changes to proposed trial documentation and processes. This was in order to address participants information needs, improve comprehension of the trial documentation, enhance facilitators and remove barriers to participation. The modifications made in light of these findings may enhance trial recruitment and future trials may wish to consider use of pretrial focus groups.
authors.affiliation: Division of Rehabilitation & Ageing, University of Nottingham, Queens Medical Centre, B98, B Floor, Nottingham NG7 2UH, UK. roshan.nair@nottingham.ac.uk.
authors.forename: Roshan
authors.initials: R
authors.lastname: das Nair
authors.forename: Kate Skellington
authors.initials: KS
authors.lastname: Orr
authors.forename: Kavita
authors.initials: K
authors.lastname: Vedhara
authors.forename: Denise
authors.initials: D
authors.lastname: Kendrick
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D032882:Comprehension; D055088:Early Detection of Cancer; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008175:Lung Neoplasms / Q000097:blood / Q000175:diagnosis*; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010353:Patient Education as Topic; D018579:Patient Selection; D010465:Perception; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D035842:Research Subjects / Q000523:psychology*; D018401:Sample Size; D012606:Scotland
chemical_list: D014408:Biomarkers, Tumor