Recruitment of adolescents with suicidal ideation in the emergency department: lessons from a randomized controlled pilot trial of a youth suicide prevention intervention
Abstract Background Emergency Departments (EDs) are a first point-of-contact for many youth with mental health and suicidality concerns and can serve as an effective recruitment source for randomized controlled trials (RCTs) of mental health interventions. However, recruitment in acute care settings...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-09-01
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| Series: | BMC Medical Research Methodology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12874-020-01117-5 |
| _version_ | 1818047310431518720 |
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| author | Matthew Tracey Yaron Finkelstein Reva Schachter Kristin Cleverley Suneeta Monga Melanie Barwick Peter Szatmari Myla E. Moretti Andrew Willan Joanna Henderson Daphne J. Korczak |
| author_facet | Matthew Tracey Yaron Finkelstein Reva Schachter Kristin Cleverley Suneeta Monga Melanie Barwick Peter Szatmari Myla E. Moretti Andrew Willan Joanna Henderson Daphne J. Korczak |
| author_sort | Matthew Tracey |
| collection | DOAJ |
| description | Abstract Background Emergency Departments (EDs) are a first point-of-contact for many youth with mental health and suicidality concerns and can serve as an effective recruitment source for randomized controlled trials (RCTs) of mental health interventions. However, recruitment in acute care settings is impeded by several challenges. This pilot RCT of a youth suicide prevention intervention recruited adolescents aged 12 to 17 years presenting to a pediatric hospital ED with suicide related behaviors. Methods Recruitment barriers were identified during the initial study recruitment period and included: the time of day of ED presentations, challenges inherent to study presentation, engagement and participation during an acute presentation, challenges approaching and enrolling acutely suicidal patients and families, ED environmental factors, and youth and parental concerns regarding the study. We calculated the average recruitment productivity for published trials of adolescent suicide prevention strategies which included the ED as a recruitment site in order to compare our recruitment productivity. Results In response to identified barriers, an enhanced ED-centered recruitment strategy was developed to address low recruitment rate, specifically (i) engaging a wider network of ED and outpatient psychiatry staff (ii) dissemination of study pamphlets across multiple areas of the ED and relevant outpatient clinics. Following implementation of the enhanced recruitment strategy, the pre-post recruitment productivity, a ratio of patients screened to patients randomized, was computed. A total of 120 patients were approached for participation, 89 (74.2%) were screened and 45 (37.5%) were consented for the study from March 2018 to April 2019. The screening to randomization ratio for the study period prior to the introduction of the enhanced recruitment strategies was 3:1, which decreased to 1.8:1 following the implementation of enhanced recruitment strategies. The ratio for the total recruitment period was 2.1:1. This was lower than the average ratio of 3.2:1 for published trials. Conclusions EDs are feasible sites for participant recruitment in RCTs examining new interventions for acute mental health problems, including suicidality. Engaging multi-disciplinary ED staff to support recruitment for such studies, proactively addressing anticipated concerns, and creating a robust recruitment pathway that includes approach at outpatient appointments can optimize recruitment. Trial registration ClinicalTrials.gov : NCT03488602 , retrospectively registered April 4, 2018. |
| first_indexed | 2024-12-10T10:03:45Z |
| format | Article |
| id | doaj.art-eb30caea35e04d77ad3751a5a5422d08 |
| institution | Directory Open Access Journal |
| issn | 1471-2288 |
| language | English |
| last_indexed | 2024-12-10T10:03:45Z |
| publishDate | 2020-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Research Methodology |
| spelling | doaj.art-eb30caea35e04d77ad3751a5a5422d082022-12-22T01:53:17ZengBMCBMC Medical Research Methodology1471-22882020-09-0120111010.1186/s12874-020-01117-5Recruitment of adolescents with suicidal ideation in the emergency department: lessons from a randomized controlled pilot trial of a youth suicide prevention interventionMatthew Tracey0Yaron Finkelstein1Reva Schachter2Kristin Cleverley3Suneeta Monga4Melanie Barwick5Peter Szatmari6Myla E. Moretti7Andrew Willan8Joanna Henderson9Daphne J. Korczak10Department of Psychiatry, Hospital for Sick ChildrenDivisions of Paediatric Emergency Medicine and Clinical Pharmacology and Toxicology, Hospital for Sick ChildrenDepartment of Psychiatry, Hospital for Sick ChildrenLawrence S. Bloomberg Faculty of Nursing and Department of Psychiatry, University of TorontoDepartment of Psychiatry, Hospital for Sick ChildrenDepartment of Psychiatry, University of TorontoDepartment of Psychiatry, University of TorontoClinical Trial Unit, Ontario Child Health Support Unit, Hospital for Sick ChildrenClinical Trial Unit, Ontario Child Health Support Unit, Hospital for Sick ChildrenCentre for Addiction and Mental HealthDepartment of Psychiatry, Hospital for Sick ChildrenAbstract Background Emergency Departments (EDs) are a first point-of-contact for many youth with mental health and suicidality concerns and can serve as an effective recruitment source for randomized controlled trials (RCTs) of mental health interventions. However, recruitment in acute care settings is impeded by several challenges. This pilot RCT of a youth suicide prevention intervention recruited adolescents aged 12 to 17 years presenting to a pediatric hospital ED with suicide related behaviors. Methods Recruitment barriers were identified during the initial study recruitment period and included: the time of day of ED presentations, challenges inherent to study presentation, engagement and participation during an acute presentation, challenges approaching and enrolling acutely suicidal patients and families, ED environmental factors, and youth and parental concerns regarding the study. We calculated the average recruitment productivity for published trials of adolescent suicide prevention strategies which included the ED as a recruitment site in order to compare our recruitment productivity. Results In response to identified barriers, an enhanced ED-centered recruitment strategy was developed to address low recruitment rate, specifically (i) engaging a wider network of ED and outpatient psychiatry staff (ii) dissemination of study pamphlets across multiple areas of the ED and relevant outpatient clinics. Following implementation of the enhanced recruitment strategy, the pre-post recruitment productivity, a ratio of patients screened to patients randomized, was computed. A total of 120 patients were approached for participation, 89 (74.2%) were screened and 45 (37.5%) were consented for the study from March 2018 to April 2019. The screening to randomization ratio for the study period prior to the introduction of the enhanced recruitment strategies was 3:1, which decreased to 1.8:1 following the implementation of enhanced recruitment strategies. The ratio for the total recruitment period was 2.1:1. This was lower than the average ratio of 3.2:1 for published trials. Conclusions EDs are feasible sites for participant recruitment in RCTs examining new interventions for acute mental health problems, including suicidality. Engaging multi-disciplinary ED staff to support recruitment for such studies, proactively addressing anticipated concerns, and creating a robust recruitment pathway that includes approach at outpatient appointments can optimize recruitment. Trial registration ClinicalTrials.gov : NCT03488602 , retrospectively registered April 4, 2018.http://link.springer.com/article/10.1186/s12874-020-01117-5Clinical trialsRecruitmentMental healthSuicidePediatricsYouth |
| spellingShingle | Matthew Tracey Yaron Finkelstein Reva Schachter Kristin Cleverley Suneeta Monga Melanie Barwick Peter Szatmari Myla E. Moretti Andrew Willan Joanna Henderson Daphne J. Korczak Recruitment of adolescents with suicidal ideation in the emergency department: lessons from a randomized controlled pilot trial of a youth suicide prevention intervention BMC Medical Research Methodology Clinical trials Recruitment Mental health Suicide Pediatrics Youth |
| title | Recruitment of adolescents with suicidal ideation in the emergency department: lessons from a randomized controlled pilot trial of a youth suicide prevention intervention |
| title_full | Recruitment of adolescents with suicidal ideation in the emergency department: lessons from a randomized controlled pilot trial of a youth suicide prevention intervention |
| title_fullStr | Recruitment of adolescents with suicidal ideation in the emergency department: lessons from a randomized controlled pilot trial of a youth suicide prevention intervention |
| title_full_unstemmed | Recruitment of adolescents with suicidal ideation in the emergency department: lessons from a randomized controlled pilot trial of a youth suicide prevention intervention |
| title_short | Recruitment of adolescents with suicidal ideation in the emergency department: lessons from a randomized controlled pilot trial of a youth suicide prevention intervention |
| title_sort | recruitment of adolescents with suicidal ideation in the emergency department lessons from a randomized controlled pilot trial of a youth suicide prevention intervention |
| topic | Clinical trials Recruitment Mental health Suicide Pediatrics Youth |
| url | http://link.springer.com/article/10.1186/s12874-020-01117-5 |
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