title: Health care professionals' views of the factors influencing the decision to refer patients to a stroke rehabilitation trial.
abstract: BACKGROUND
  Effective recruitment is an essential element of successful research but notoriously difficult to achieve. This article examines health care professionals' views on the factors influencing decision-making regarding referral to a stroke rehabilitation trial.
  
  
  METHODS
  Semi-structured interviews and a card-sorting task were undertaken with stroke service staff in acute and community hospital trusts. Data analysis used a thematic framework approach.
  
  
  RESULTS
  Twenty-seven qualified health care professionals from 12 (6 acute and 6 community) hospital trusts and one charity participated. Four main factors emerged: patient-related, professional views, the organisation and research logistics, which all contributed to staff's decision about whether to refer patients to a trial. Clinicians identified patient-related factors as the most frequent influence and considered themselves the patients' advocate. They used their knowledge of the patient to anticipate the patients' reaction to possible participation and tended to only refer those whom they perceived would respond positively. Participants also identified experience of research, a sense of ownership of the project and a positive view of the intervention being evaluated as factors influencing referral. The need to prioritise clinical matters, meet managerial demands and cope with constant change were organisational factors impacting negatively on referral. Staff often simply forgot about recruitment in the face of other higher priorities. Quick, simple, flexible research processes that were closely aligned with existing ways of working were felt to facilitate recruitment.
  
  
  CONCLUSIONS
  Patient- and professional-related factors were the most frequent influence on clinicians' recruitment decisions, which often had a 'gate-keeping' effect. Managerial and clinical responsibility to juggle multiple (often higher) priorities was also an important factor. To facilitate recruitment, researchers need to develop strategies to approach potential participants as directly as possible to enable them to make their own decisions about participation; ensure that research processes are as quick and simple as possible; align with existing clinical pathways and systems; and give regular reminders and ongoing support to promote recruitment.
  
  
  BACKGROUND
  ISRCTN, 98287938 . Registered 6 May 2015.
authors.affiliation: Salford Royal NHS Foundation Trust, Salford, UK. Nessa.thomas@nhs.net.
authors.forename: Nessa
authors.initials: N
authors.lastname: Thomas
authors.affiliation: School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK. sarah.plant@manchester.ac.uk.
authors.forename: Sarah
authors.initials: S
authors.lastname: Plant
authors.affiliation: School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK. kate.woodward-nutt@manchester.ac.uk.
authors.forename: Kate
authors.initials: K
authors.lastname: Woodward-Nutt
authors.affiliation: Centre for Health Sciences Research, University of Salford, Salford, UK. Y.Prior@salford.ac.uk.|Mid Cheshire Hospitals NHS Foundation Trust, Cheshire, UK. Y.Prior@salford.ac.uk.
authors.forename: Yeliz
authors.initials: Y
authors.lastname: Prior
authors.affiliation: School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK. sarah.tyson@manchester.ac.uk.|Stroke Research Centre, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK. sarah.tyson@manchester.ac.uk.
authors.forename: Sarah
authors.initials: S
authors.lastname: Tyson
mesh_terms: D001291:Attitude of Health Personnel; D002755:Choice Behavior; D004739:England; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006764:Hospitals, Community; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D024802:Nurse's Role; D009741:Nursing Staff, Hospital / Q000523:psychology; D010344:Patient Advocacy; D010353:Patient Education as Topic; D010358:Patient Participation; D018579:Patient Selection; D059825:Physical Therapists / Q000523:psychology; D010819:Physician's Role; D010820:Physicians / Q000523:psychology; D036301:Qualitative Research; D012017:Referral and Consultation; D012108:Research Personnel / Q000523:psychology*; D035842:Research Subjects / Q000523:psychology; D015983:Selection Bias; D013222:State Medicine; D020521:Stroke / Q000175:diagnosis / Q000503:physiopathology; D000071939:Stroke Rehabilitation