title: Linking a research register to clinical records in older adults' mental health services: a mixed-methods study.
abstract: BACKGROUND
  Patients can provide consent to have their clinical records linked to a research register, a process known as consent for contact (C4C). There is evidence about how to engage people with mental illness in C4C, but nothing specific to older adults. This is a priority area for research (for example, dementia trials), although sign-up rates to C4C are lower than for younger populations. Through this study we seek to understand these disparities.
  
  
  METHODS
  This was a two-stage cross-sectional observational study. In phase one, focus groups with service users, carers and clinicians informed a framework for clinicians to explain C4C to those on their caseload. In phase two, clinicians explained C4C to 26 service users (and carers where applicable). These conversations were recorded, and their content was analysed. Service users and carers were then interviewed to provide further feedback on their conversations with clinicians. A total of 31 service users, 24 carers and 13 clinical staff took part across the two phases.
  
  
  RESULTS
  In phase one, service users and carers sought assurance of the right to refuse participation in further studies (after joining C4C). Clinicians expressed concerns over legal and practical implications of ascertaining mental capacity and best interest. In phase two, clinicians' explanations were less thorough than similar explanations given to younger adults with psychosis. Clinicians omitted details of service users' right to stipulate contact arrangements, which was significantly associated with whether service users/carers agreed to join. Common reasons for joining C4C included altruism and the chance to speak to new people. Few participants refused to join, but reasons included avoidance of stress (potentially alleviated through the presence of a carer).
  
  
  CONCLUSIONS
  Implementing C4C in older adults' services requires clinicians to deliver concise, simple explanations to individuals and their carers where applicable. Older adults can be suspicious of unsolicited contact; thus, explanations must emphasise freedom to negotiate suitable contact arrangements. Hearing about research opportunities can be in the best interests of older adults, but communicating these opportunities requires a tailored approach.
authors.affiliation: King's College London, Institute of Psychiatry, Henry Wellcome Building, De Crespigny Park, London, SE5 8AF UK.
authors.forename: Dan
authors.initials: D
authors.lastname: Robotham
authors.affiliation: King's College London, Institute of Psychiatry, Henry Wellcome Building, De Crespigny Park, London, SE5 8AF UK.
authors.forename: Joanne
authors.initials: J
authors.lastname: Evans
authors.affiliation: UCL, Institute of Neurology, 33 Queen Square, London, WC1N 3BG UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Watson
authors.affiliation: King's College London, Institute of Psychiatry, Henry Wellcome Building, De Crespigny Park, London, SE5 8AF UK.
authors.forename: Iain
authors.initials: I
authors.lastname: Perdue
authors.affiliation: King's College London, Institute of Psychiatry, Henry Wellcome Building, De Crespigny Park, London, SE5 8AF UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Craig
authors.affiliation: King's College London, Institute of Psychiatry, Henry Wellcome Building, De Crespigny Park, London, SE5 8AF UK.
authors.forename: Diana
authors.initials: D
authors.lastname: Rose
authors.affiliation: King's College London, Institute of Psychiatry, Henry Wellcome Building, De Crespigny Park, London, SE5 8AF UK.
authors.forename: Til
authors.initials: T
authors.lastname: Wykes
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