Clear obstacles and hidden challenges: Lessons for recruitment from the Trombone Feasbility Trial for oligometastatic prostate cancer


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Caroline Wilson1,Richard Bryant2,Christopher Eden3,Neelam Hassanali2,John Kelly4,Alastair Lamb5,Surjeet Singh2,Freddie Hamdy2,Prasanna Sooriakumaran4
1University of Bristol,2Oxford University,3Nhs,4Ucl,5Oxford university

Abstract

Background

Recruitment to randomised controlled trials (RCTs) is difficult and particularly challenging in cancer trials involving more or less treatment arms. This presentation reports findings from the Quintet Recruitment Intervention (QRI) in the Trombone trial, testing radical prostatectomy in men with oligometastatic prostate cancer versus standard care. 

Method

Phase 1 of the QRI included analysis of interviews with key trial staff, screening log data, audio-recordings of recruitment consultations with patients, and interviews with patients declining the trial. In phase 2, findings were fed back to the chief investigator and a plan of action agreed, to optimise recruitment and train recruiters. 

Results

Clear obstacles to  recruitment included fewer than expected eligible patients,  problems identifying men with newly diagnosed oligometastatic prostate cancer, and difficulties approaching men at the optimal time to consider trial participation. Logistical issues were addressed through changes to local pathways and clinical practices. Hidden challenges included recruiter equipoise, difficulties presenting balanced information and exploration of patient preferences. Individual and group training was provided to recruiters to communicate key trial concepts and support informed patient decision making. 

Conclusion

The QRI is on going to monitor patient eligibility and improve informed decision-making and recruitment, to support recruiters, and assess trial feasibility and progression to a main trial.