Physicians declining patient enrollment in a critical care trial: a case study in thromboprophylaxis.

Abstract

PURPOSE:

To analyze the frequency, rationale and determinants of attending physicians requesting that their eligible patients not be approached for participation in a thromboprophylaxis trial.

METHODS:

Research personnel in 67 centers prospectively documented eligible non-randomized patients due to physicians declining to allow their patients to be approached.

RESULTS:

In 67 centers, 3,764 patients were enrolled, but 1,460 eligible patients had no consent encounter. For 218 (14.9 %) of these, attending physicians requested that their patients not be approached. The most common reasons included a high risk of bleeding (31.2 %) related to fear of heparin bioaccumulation in renal failure, the presence of an epidural catheter, peri-operative status or other factors; specific preferences for thromboprophylaxis (12.4 %); morbid obesity (9.6 %); uncertain prognosis (6.4 %); general discomfort with research (3.7 %) and unclear reasons (17.0 %). Physicians were more likely to decline when approached by less experienced research personnel; considering those with[10 years of experience as the reference category, the odds ratios (OR) for physician refusals to personnel without trial experience was 10.47 [95 % confidence interval (CI) 2.19-50.02] and those with less than 10 years experience was 1.72 (95 % CI 0.61-4.84). Physicians in open rather than closed units were more likely to decline (OR 4.26; 95 % CI 1.27-14.34). Refusals decreased each year of enrollment compared to the pilot phase.

CONCLUSIONS:

Tracking, analyzing, interpreting and reporting the rates and reasons for physicians declining to allow their patients to be approached for enrollment provides insights into clinicians' concerns and attitudes to trials. This information can encourage physician communication and education, and potentially enhance efficient recruitment.

• Authors: D Cook, Y Arabi, N Ferguson, D Heels-Ansdell, A Freitag, E McDonald, F Clarke, S Keenan, G Pagliarello, W Plaxton, M Herridge, T Karachi, S Vallance, J Cade, T Crozier, S Alves da Silva, R Costa Filho, N Brandao, I Watpool, T McArdle, G Hollinger, Y Mandourah, M Al-Hazmi, N Zytaruk, N K J Adhikari, PROTECT Research Coordinators, PROTECT Investigators, Canadian Critical Care Trials Group, Australian and New Zealand Intensive Care Society Clinical Trials Group
• Journal: Intensive care medicine (Intensive Care Med) Vol. 39 Issue 12 Pg. 2115-25 (Dec 2013) ISSN: 1432-1238 [Electronic] United States
• PMID: 24022796 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Fibrinolytic Agents
• Heparin
• Dalteparin

Topics

• Critical Care (psychology)
• Dalteparin (adverse effects, therapeutic use)
• Double-Blind Method
• Fibrinolytic Agents (adverse effects, therapeutic use)
• Heparin (administration & dosage, therapeutic use)
• Humans
• Informed Consent (psychology)
• Intensive Care Units
• Patient Participation
• Patient Selection
• Physicians (psychology)
• Practice Patterns, Physicians'
• Prospective Studies
• Refusal to Participate (psychology)
• Thrombosis (prevention & control)