title: Barriers and opportunities for enhancing patient recruitment and retention in clinical research: findings from an interview study in an NHS academic health science centre.
abstract: BACKGROUND
  In the UK, the recruitment of patients into clinical research is a national health research and development policy priority. There has been limited investigation of how national level factors operate as barriers or facilitators to recruitment work, particularly from the perspective of staff undertaking patient recruitment work. The aim of this study is to identify and examine staff views of the key organisational barriers and facilitators to patient recruitment work in one clinical research group located in an NHS Academic Health Science Centre.
  
  
  METHODS
  A qualitative study utilizing in-depth, one-to-one semi-structured interviews with 11 purposively selected staff with particular responsibilities to recruit and retain patients as clinical research subjects. Thematic analysis classified interview data by recurring themes, concepts, and emergent categories for the purposes of establishing explanatory accounts.
  
  
  RESULTS
  The findings highlight four key factors that staff perceived to be most significant for the successful recruitment and retention of patients in research and identify how staff located these factors within patients, studies, the research centre, the trust, and beyond the trust. Firstly, competition for research participants at an organisational and national level was perceived to undermine recruitment success. Secondly, the tension between clinical and clinical research workloads was seen to interrupt patient recruitment into studies, despite national funding arrangements to manage excess treatment costs. Thirdly, staff perceived an imbalance between personal patient burden and benefit. Ethical committee regulation, designed to protect patients, was perceived by some staff to detract from clarification and systematisation of incentivisation strategies. Finally, the structure and relationships within clinical research teams, in particular the low tacit status of recruitment skills, was seen as influential.
  
  
  CONCLUSIONS
  The results of this case-study, conducted in an exemplary NHS academic research centre, highlight current systematic challenges to patient recruitment and retention in clinical studies more generally as seen from the perspective of staff at the 'sharp end' of recruiting. Staff experience is that, beyond individual clinical research design and protocol factors, wider organisational and extra-organisational norms, structures, and processes operate as significant facilitators or hindrances in the recruitment of patients as research subjects.
authors.affiliation: King's College London, Division of Health and Social Care Research, and National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust and King's College London, Faculty of Life Sciences and Medicine, Capital House, 42 Weston Street, London, SE1 3QD, UK. mary.adams@kcl.ac.uk.
authors.forename: Mary
authors.initials: M
authors.lastname: Adams
authors.affiliation: King's College London, Division of Health and Social Care Research, and National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust and King's College London, Faculty of Life Sciences and Medicine, Capital House, 42 Weston Street, London, SE1 3QD, UK. louise.caffrey@kcl.ac.uk.
authors.forename: Louise
authors.initials: L
authors.lastname: Caffrey
authors.affiliation: King's College London, Division of Health and Social Care Research, and National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's & St Thomas' NHS Foundation Trust and King's College London, Faculty of Life Sciences and Medicine, Capital House, 42 Weston Street, London, SE1 3QD, UK. christopher.mckevitt@kcl.ac.uk.
authors.forename: Christopher
authors.initials: C
authors.lastname: McKevitt
mesh_terms: D035843:Biomedical Research / Q000191:economics; D006801:Humans; D007407:Interviews as Topic; D010352:Patient Dropouts; D018579:Patient Selection; D036301:Qualitative Research; D013222:State Medicine; D006113:United Kingdom