Recruiting to the FReSH START project – Experiences on the Ground
Recruiting participants to any research study is always a challenge, something the research team here at the University fully understand. However, because most of that recruitment work takes place on site, in the hospitals we are working with, we do not always have a very detailed insight into what the challenges are, and what we could do to help.
Last year, Faye, FReSH START research assistant, was able to view the recruitment process from ‘the other side’ as she joined one of the local teams as a site researcher. Here Faye tells us a little bit about her experiences ‘on the ground’, the challenges and surprises, and the lessons she has learnt.
I was a little nervous going into this role. I was new to the team, to the local researcher role and to all the processes and systems involved. I was also very aware of the immense clinical pressures currently faced by the NHS and the liaison teams. Discussing screening and recruitment for the trial with a team that was already stretched and overloaded, felt like a difficult task and I wasn’t sure where to begin.
However, the team were lovely and welcoming. Sitting in the office together, sharing cakes and biscuits, meant I got to know some of the practitioners well. I developed a much better understanding of how the team worked, as well as the challenges they were facing. Challenges such as working short staffed on a shift were common due to staff sickness and multiple job vacancies. I had great support from the admin team, who really helped to keep me in the loop, as I was only able to be in the liaison office once or twice a week.
Being able to access referral data was really useful in terms of understanding the types of referrals the team were seeing, and how this translated, or did not translate, into patients being introduced to the trial. Something that surprised me was the number of younger people that were being seen in A&E, who were under 18 and therefore not eligible for the trial. Another benefit of seeing the referral data was that I could estimate the number of potentially missed participants and flag this to the team. This led to some interesting discussions around reasons why practitioners may not have introduced the study such as confidence, particularly for staff new to the team who were still gaining confidence in their role.
Knowing the challenges the teams were facing I tried to be respectful when approaching staff to discuss the trial. I tried to take note of what their day-to-day workflow was like, to try catch individuals at a good time, when they had capacity to discuss the trial and recruitment. Alongside that, finding time to chat to the team manager about the recruitment and screening process was always beneficial. It gave a wider understanding of the team’s capacity and the measures in place to promote the study from a management perspective. The main lesson I have learnt while working on the trial site is that the wider context of the team is crucial. Whatever is going on, both directly for the team as well as more widely in the trust, will have a knock on effect for everything the team is trying to do, including the trial. As well as issues such as staffing levels, things such as organisational difficulties and other training needs in the team also seemed to have an important effect. Enthusiasm and support for the trial was never in question, but capacity within the team was always a challenge.
On a personal level, I learnt just how difficult the role of site researcher can be. The role involves a lot of chasing of members of the liaison team, a team I know are stretched and doing their best, and feeling like you are nagging can be a difficult feeling to manage. Similarly, it can be frustrating not being able to get hold of people deemed eligible for the trial and deciding at what point you have tried enough times. I have found myself at times feeling demoralised, when you are doing your very best, working hard to engage the liaison team, putting in a lot of effort, and the recruitment numbers are still low. Even when you understand the reasons the numbers are low, whether that be staffing challenges, or that the referrals being seen are not eligible for the trial, it can be difficult not to feel like you are failing a little – the only outcome others see from your work is recruitment numbers after all!
Overall, taking on the role of a local researcher within the FReSHSTART study, whilst challenging, has really given me a different perspective on recruitment. It has enabled me to feedback difficulties, as well as suggestions to the wider FReSHSTART team, and understand more about the day-to-day running of the trial. As discussed above, some days can seem like quite a challenge but I know everyone is doing an amazing job, working hard to ensure the study is a success.