[Study of the factors motivating refusal of women to participate to a randomized clinical trial in gynecological surgery. Retrospective observational bicentric study].
BACKGROUND
Randomized controlled trials (RCT) in surgery are often subject to difficulties inherent in the study design and recruitment of patients. Women's participation rate to RCTs in surgery is relatively low and varies from 30 to 70%. These recruitment problems might induce a weak scientific value and even stop the study. Thus, optimizing recruitment is a challenge for surgical research. In contemporary literature, we lack data on motivations and profile of women who refuse to participate in a RCT in surgery.


OBJECTIVE
To explore the potentially influential factors affecting women's decision to decline participation in PROSPERE trial, comparing laparoscopic sacrocolpopexy (LSCP) to vaginal mesh for cystocele repair.


METHODS
Retrospective, observational, qualitative, bicentric study conducted in the department of gynecology of Poissy and Lille hospitals. Patients included were those who refused to participate to PROSPERE trial in both centers. Factors of non-participation in the trial were recorded at the time of the first visit. A control group consisted of women who agreed to participate in the trial was also analyzed.


RESULTS
In both centers, 139 were eligible to participate in the trial but 35 of them (25%) refused. Thirty-two women agreed to declare their refusal motivations. Vaginal mesh was finally performed in 18 (56,2%) patients and LSCP in 14 patients (43,8%). The control group consisted of 20 women, including 9 operated by vaginal mesh and 11 by LSCP. Patient's characteristics were similar in the both groups. Most influencing factor in refusal for participation was "previous choice of technique" in 50% cases (16/32), followed by "geographical remoteness and difficulties for additional visits" in 40.6% cases (13/32), and finally by "do not accept the concept of randomization" in 21.8% cases (7/32). The most influencing factor in women's acceptance was interest in helping others by "supporting medical research" in 100% cases (20/20), followed by "potential personal benefits and close follow-up" in 60% (12/20).


CONCLUSIONS
Our study identified the most influential factors relevant to women decision-making whether or not to participate in RCT in surgery. A number of factors leading to refusal of participation are potentially correctable leading to better recruitment rates in future RCTs. Optimization of information on the principle of randomization, limiting the number of additional visits could help researchers improve participation rates.
Département de gynécologie-obstétrique, CHI Poissy/Saint-Germain-en-Laye, 10, rue du Champ-Gaillard, 78300 Poissy, France. Electronic address: ht_nguyenx@hotmail.fr.
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HT
Nguyen-Xuan
Département de gynécologie-obstétrique, CHI Poissy/Saint-Germain-en-Laye, 10, rue du Champ-Gaillard, 78300 Poissy, France.
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Thiollier
Département de gynécologie-obstétrique, CHRU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France.
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O
Ruault
Département de gynécologie-obstétrique, CHI Poissy/Saint-Germain-en-Laye, 10, rue du Champ-Gaillard, 78300 Poissy, France.
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Fauconnier
Département de gynécologie-obstétrique, CHRU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France.
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JP
Lucot
Département de gynécologie-obstétrique, CHI Poissy/Saint-Germain-en-Laye, 10, rue du Champ-Gaillard, 78300 Poissy, France.
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G
Bader
D000368:Aged; D002755:Choice Behavior; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000523:psychology*; D006801:Humans; D008875:Middle Aged; D009042:Motivation; D018579:Patient Selection; D036301:Qualitative Research; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies
Chirurgie; Clinical trial; Essai clinique; Motivations de refus; Recruitment; Recrutement; Refusal motivations; Surgery