title: A systematic review of strategies used to increase recruitment of people with cancer or organ failure into clinical trials: implications for palliative care research.
abstract: BACKGROUND
  The challenges of palliative care clinical trial recruitment are well documented.
  
  
  OBJECTIVE
  The aim of the study was to review tested strategies to improve recruitment to trials of people with a range of conditions who may access palliative care services but are not explicitly stated to be "palliative."
  
  
  METHODS
  This was a systematic review with narrative description. The Cochrane, Embase, PubMed, PsycINFO, and CINAHL electronic databases were searched (English; January 2002 to February 2014) for quasi-experimental and randomized controlled trials (RCTs) testing the effect of recruitment strategies on accrual to clinical trials of people with organ failure and cancer. Titles, abstracts, and retrieved articles were screened by two researchers and categorized by recruitment challenge: 1) patients with reduced cognition, 2) those requiring emergency treatment, and 3) willingness of patients and clinical staff to contribute to trials.
  
  
  RESULTS
  Of 549 articles identified, 15 were included. Thirteen reported RCTs and two papers reported three quasi-experimental studies. Five were cluster RCTs of recruiting sites/institutions. One was a randomized cluster, crossover, feasibility study. Seven studies recruited patients with cancer. Others included patients with dementia, stroke, cardiovascular disease, diabetes, frail elderly, and bereaved carers. Some interventions improved recruitment: memory aid, contact before arrival, cluster consent, "opt out" consent. Others either reduced recruitment (formal mental capacity assessment) or made no difference (advance research directive; a variety of educational, supportive, and advertising interventions).
  
  
  CONCLUSIONS
  Successful strategies from other disciplines could be considered by palliative care researchers. Tailored, efficient, evidence-based strategies must be developed, acknowledging that strategies with face validity are not necessarily the most effective.
authors.affiliation: Hull York Medical School, University of Hull, Hull, United Kingdom.
authors.forename: Jason
authors.initials: J
authors.lastname: Boland
authors.affiliation: Discipline, Palliative and Supportive Services, Flinders University, Daw Park, South Australia, Australia.
authors.forename: David C
authors.initials: DC
authors.lastname: Currow
authors.affiliation: University of Nottingham, Nottingham, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wilcock
authors.affiliation: Discipline, Palliative and Supportive Services, Flinders University, Daw Park, South Australia, Australia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Tieman
authors.affiliation: Hull York Medical School, University of Hull, Hull, United Kingdom.
authors.forename: Jamilla Akhter
authors.initials: JA
authors.lastname: Hussain
authors.affiliation: Hull York Medical School, University of Hull, Hull, United Kingdom.
authors.forename: Constantine
authors.initials: C
authors.lastname: Pitsillides
authors.affiliation: Discipline, Palliative and Supportive Services, Flinders University, Daw Park, South Australia, Australia; Division of Medical Oncology, Department of Medicine, Duke University Medical Centre, Durham, North Carolina, USA.
authors.forename: Amy P
authors.initials: AP
authors.lastname: Abernethy
authors.affiliation: Hull York Medical School, University of Hull, Hull, United Kingdom. Electronic address: miriam.johnson@hyms.ac.uk.
authors.forename: Miriam J
authors.initials: MJ
authors.lastname: Johnson
mesh_terms: D006801:Humans; D009369:Neoplasms / Q000628:therapy*; D010166:Palliative Care / Q000379:methods*; D018579:Patient Selection; D016032:Randomized Controlled Trials as Topic
keywords: Patient selection; clinical trials; disease progression; palliative care; research subject recruitment