USING QUALITATIVE RESEARCH METHODS TO OPTIMISE RECRUITMENT: THE ROAM (RADIATION VERSUS OBSERVATION FOLLOWING SURGICAL RESECTION OF ATYPICAL MENINGIOMA) INFORMATION STUDY

Abstract

AIM

ROAM is a randomised controlled trial comparing radiation to observation following complete surgical resection of atypical meningioma. We embedded a qualitative sub-study within ROAM with the aim of optimising patient recruitment.

METHODS

Audio-recorded recruitment consultation (N=25), and semi-structured interviews with clinicians (N=14) and patients (N=22), including decliners and consenters. Analysis of transcribed audio-recordings was informed by content and thematic analysis.

RESULTS

Analysis identified areas where communication was problematic. Giving patients their pathology results immediately before discussing ROAM left them overwhelmed and unable to absorb trial information. Interviewed clinicians were keen to participate in ROAM but some indicated concerns regarding the eligibility of patients at either ends of the age spectrum, believing such patients may not tolerate radiotherapy well. Clinicians' presentation of the trial arms in consultations often lacked balance (emphasising the process and side effects of radiotherapy but providing limited information regarding active monitoring) and their terminology inadvertently led to misinterpretations among some patients. When interviewed, several patients struggled to see the logic of radiotherapy after hearing in previous consultations that further treatment was unnecessary. Patients who declined ROAM were concerned about the side effects of radiotherapy and viewed it as burdensome; many struggled to interpret key details of ROAM due to problematic communication.

CONCLUSIONS

Embedded qualitative studies can identify barriers to recruitment in neuro-oncology trials and suggest ways to address these. We have amended the patient information leaflet, provided workshops and a webinar for oncologists and surgeons to enhance communication about ROAM, with the aim of optimising patient recruitment. Surgeons can aid recruitment by explaining to patients before surgery that they may be eligible for ROAM, if following surgery, they are diagnosed with atypical meningioma.