Lessons from Clinic Recruitment: Sensitive Diagnosis

By Tiffany Lee, Clinical Research Coordinator, UCSF Department of Obstetrics, Gynecology and Reproductive Sciences

Recruiting patients can be intimidating ---and a cold approach in a clinic is even more daunting. Because most patients enter the hospital not expecting to be approached for research participation, patients may not be ready for this type of conversation—even at research-based hospitals such as UCSF. Furthermore, if the research study is related to a sensitive diagnosis, patients or recruiters may be uncomfortable.

It’s a tricky pickle! After all, specific word choices during the conversation may easily change the outcome of your recruiting effort. And who wouldn’t feel intimidated by this?  

Because other CRCs may be in the same challenging situation one day, I’d like to share a few  trial-by-fire tips I learned while recruiting for several maternal fetal medicine studies here at UCSF. These tips are specific to initial cold approaches for sensitive conditions, yet you can use them for many situations. After all, we don’t always know what a patient might consider sensitive, so refer to these tips any time you are approaching patients in a clinic setting.  Disclaimer: None of these tips are evidence-based, but merely what improved my experiences as a recruiter.

TIP #1. Give patients a sense of privacy. If possible, speak to patients in a space that is away from other patients. Seems like a no-brainer right? But you may need to do a little legwork to set this up. Talk to your PI or the clinic manager about potential options. Perhaps there’s a spare desk or room where you can meet patients briefly to speak to about the study. Or, perhaps the clinic will allow CRCs to briefly meet patients in the exam room while they are waiting to be seen. Meeting in a private setting can help patients be more receptive to the sensitive condition you are about to bring up.

In some cases, setting up a private space may not be an option. In that case, prepare your recruitment materials (e.g, brochure or flyer) and explain to them that this is a research study done in the department—if they’re interested they can contact the research team noted on your material.  This way you can deliver the information about the study without talking about sensitive details in an open setting.

TIP #2. Use simple terms to describe conditions. Technical jargon such as “chronic hypertension” or ‘nephrolithiasis” may confuse patients or seem intimidating. For the initial approach, switching to easy to understand language will come off as softer and more approachable.

For example:

Less ideal: “We’re looking for pregnant patients with chronic hypertension.”

More ideal: “We’re doing a study about high blood pressure and pregnancy. Would you be interested in participating in a study like this?”

Another example:

Less ideal: “We’re looking for women who had a preterm birth in the past.”

More ideal: “Women who delivered their baby between 30-37 weeks are eligible for this study”

What’s also great about these ‘more ideal’ examples—is the phrasing of the statement disassociates patients from their condition—not that you are singling them out.  This point is a great segue to my next tip:

TIP #3. Avoid singling out the patient.  As alluded to in the above examples, statements such as “you have [sensitive condition], so are eligible for this study” can make patients feel singled out and can be extremely off-putting. This can start your relationship with the potential participant on the wrong foot (if he or she even opts into the study at all).

Instead, I’ve found that patients are more receptive to phrases such as “a study about [insert sensitive condition] is being conducted in the hospital. Would you be interested in the study?” If the patient finds the topic relevant and interesting—he or she will engage and ask questions.

TIP #4. Reminding patients the prevalence of condition is helpful. When potential participants are reminded that a sensitive condition is a condition affecting many people, not only do you establish empathy, but you communicate that the trial can benefit a large population. When I’ve used this tip talking with patients, I’ve noticed that patients tend to appreciate this information and nod positively.  

In-person recruitment is a very powerful method of recruitment—and when done in a respectful and sensitive manner you’ll be surprised how many patients will be receptive and open for participation.