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Table 3 Summary of responses to proposals for nested recruitment studies

From: Trials within trials? Researcher, funder and ethical perspectives on the practicality and acceptability of nesting trials of recruitment methods in existing primary care trials

Type of intervention Perceived advantages Perceived disadvantages Points to consider in implementation
Financial incentives to patients and professionals Worth trying, extra resource; straightforward; it is justified to pay people for their time May create ethical dilemmas, difficult to set right payment level; managing preferences may pose problems May be more acceptable for professionals than patients; consult widely to set levels; avoiding coercion; avoiding drop-outs due to preferences?
Attachment of additional, dedicated research nurses for sessions in participating centres Dedicated extra resource; logical; gives continuity within the research; creates ownership; stimulate interest on site May impact on continuity of care; may cause logistical problems; more relationships to manage Local input to staff selection; consider continuity of care; integration in practice; contractual issues
Use of DVD of previous trial participants discussing their experiences of trial participation Worth trying; good idea; visual media are attractive; could work for lots of trials Lack of time; unwillingness to watch; content may not be believed; may over-simplify; technical challenges Mode of delivery, content, run-time; whether study specific or generic; age group biases; Information equity
Mass media approaches to change attitudes to trials among patients Very important; good idea; may work well in areas with high refusal rates; challenge notion of 'guinea pig' Expensive, difficult to focus message on local area or topic; may not produce immediate impact Cost difficulties, measuring impact; avoiding bias
Educational incentives to clinicians: e.g. seminar on trials and research methods Others report this works; may bring lasting benefit; research understanding will motivate participation Lack of time; lack of interest; burden; difficult to motivate clinicians Motivating clinicians; clinician preferences; how learning occurs; training location
Training for clinicians in seeking consent for trials Interesting idea; may lead to more positive explanations of research; reduce clinician fear Few studies use clinicians to consent patients; lack of time and motivation; burden Assess numbers of studies using clinicians to consent; motivating clinicians; training location; control arm
Option to refer patients to a dedicated research centre Feasible; interesting; participants will get more information and attention; professional Additional cost and burden of travel; data collection and co-ordination Defraying travel costs; coordinating data
Support for investigators on project management, monitoring and contingency planning Good idea, but should be in place anyway Difficult to randomize if only used by those who want help Designing to enable randomization