title: How Accurately Do Consecutive Cohort Audits Predict Phase III Multisite Clinical Trial Recruitment in Palliative Care?
abstract: BACKGROUND
  Audits have been proposed for estimating possible recruitment rates to randomized controlled trials (RCTs), but few studies have compared audit data with subsequent recruitment rates.
  
  
  OBJECTIVE
  To compare the accuracy of estimates of potential recruitment from a retrospective consecutive cohort audit of actual participating sites and recruitment to four Phase III multisite clinical RCTs.
  
  
  METHODS
  The proportion of potentially eligible study participants estimated from an inpatient chart review of people with life-limiting illnesses referred to six Australian specialist palliative care services was compared with recruitment data extracted from study prescreening information from three sites that participated fully in four Palliative Care Clinical Studies Collaborative RCTs. The predominant reasons for ineligibility in the audit and RCTs were analyzed.
  
  
  RESULTS
  The audit overestimated the proportion of people referred to the palliative care services who could participate in the RCTs (pain 17.7% vs. 1.2%, delirium 5.8% vs. 0.6%, anorexia 5.1% vs. 0.8%, and bowel obstruction 2.8% vs. 0.5%). Approximately 2% of the referral base was potentially eligible for these effectiveness studies. Ineligibility for general criteria (language, cognition, and geographic proximity) varied between studies, whereas the reasons for exclusion were similar between the audit and pain and anorexia studies but not for delirium or bowel obstruction.
  
  
  CONCLUSIONS
  The retrospective consecutive case note audit in participating sites did not predict realistic recruitment rates, mostly underestimating the impact of study-specific inclusion criteria. These findings have implications for the applicability of the results of RCTs. Prospective pilot studies are more likely to predict actual recruitment.
authors.affiliation: Discipline, Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia. Electronic address: nicola.mccaffrey@flinders.edu.au.
authors.forename: Nikki
authors.initials: N
authors.lastname: McCaffrey
authors.affiliation: Discipline, Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Belinda
authors.initials: B
authors.lastname: Fazekas
authors.affiliation: Discipline, Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Natalie
authors.initials: N
authors.lastname: Cutri
authors.affiliation: Discipline, Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia.
authors.forename: David C
authors.initials: DC
authors.lastname: Currow
mesh_terms: D000855:Anorexia / Q000453:epidemiology / Q000628:therapy; D001315:Australia / Q000453:epidemiology; D054869:Clinical Audit / Q000379:methods* / Q000706:statistics & numerical data*; D003693:Delirium / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D007410:Intestinal Diseases / Q000453:epidemiology / Q000628:therapy; D010146:Pain / Q000453:epidemiology; D059408:Pain Management; D010166:Palliative Care / Q000379:methods* / Q000706:statistics & numerical data*; D018579:Patient Selection
keywords: Randomized controlled trial; audit; palliative care; prediction; recruitment; screening