Obtaining support of prominent local physicians, and involving many in our advisory board, contributed to our success. The “RAND” method, which involves influential physicians recruiting community-based physicians,10 was deemed useful in this study. Similarly, a study which investigated the relationship between medical malpractice claims and physician patient communication, also utilized prominent members of the local physician community as advisory board members who made recruitment calls and endorsed the study introductory letter.27 In PCS these physicians not only participated in recruitment calls and endorsed the study introductory letter, but also allowed access to hospitals and physicians so that in-person visits and presentations could occur.
Finally, minimizing research demands, maintaining flexibility in scheduling interventions, and offering tailored interventions to meet physician’s needs all appeared to enhance recruitment rates. In particular, emphasizing that a low burden will be caused by study participation seems key, as lack of time was cited in our study as a reason for nonparticipation and has been the most common reason given for nonparticipation in other studies.10 Initial contacts with physicians focused on the individual benefits that each physician would gain from participation. An emphasis was placed on acknowledgment of physicians’ time constraints; we emphasized our intent to share resources and tools that would help physicians be more effective with the existent time constraints. Additionally, our study did not require medical office staff to be involved in recruiting patients, nor did it require access to patients’ medical records.
Several recruitment strategies used in PCS appeared to be less effective. Use of physician graduate fellows, physicians who were awarded a fellowship for postgraduate study, as a final step to contact and enroll eligible physicians did not appear to contribute to our success. Also, recruitment rates were lower among physicians who were at least 25 years out of medical school. This is consistent with Dietrich and colleagues’14 finding that nonparticipants were significantly older than participants. The reasons for this result are unclear. Perhaps more recently trained physicians are more receptive to participation in a study that targets prevention, or more receptive to participating in research. Another potential reason is that an age-based sampling bias occurred. We know that the majority of our sample were generalists, but we did not measure other variables, such as race or practice setting, that may have also influenced the formation of the sample. It was a limitation that we did not gather information on background variables that may have influenced the sample makeup, and, in using physician recruiters, there is a potential that a sampling bias will occur.
Conclusions
There is a growing need to disseminate effective strategies to assist physicians with the delivery of preventive services. We were successful in recruiting more than 80% of community-based physicians, saturating a discreet geographic area, into a dissemination trial. The enhanced involvement by a physician investigator and endorsement and efforts by local influential physicians contributed to our success. Additionally, we minimized research demands in return for participation. Studies that have required more physician involvement have not been as successful and may need more intensive recruitment strategies. The relatively low refusal rate in this study suggests that community-based, primary care physicians are interested and willing to participate in research that will help them enhance the preventive services they provide to their patients.
Acknowledgments
This study was supported by grant PO1CA50087 (James Prochaska, Principal Investigator) from the National Cancer Institute, Washington, DC. The authors wish to acknowledge David Abrams, PhD, James Prochaska, PhD, Wayne Velicer, PhD, and Joseph Rossi, PhD who contributed to the measure development process and provided support and guidance as senior scientists in the Rhode Island Cancer Prevention Consortium. We also wish to acknowledge Alexander Prokhorov, MD, PhD, Alicia Monroe, MD, William Rakowski, PhD, and Lisa Harlow, PhD, as investigators on the PCS research team. We wish to also acknowledge Allen Dietrich, MD, Judith Ockene, PhD, Jean Kristeller, PhD, and Thomas Kottke, MD, for valuable scientific consultation. We especially wish to thank and acknowledge Linda Moreau and Barbara Doll who provided essential secretarial support and Elena Morgans for her help in coding and entering data.