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

Joanna Henderson¹  Andrew Willan²  Myla E. Moretti²  Matthew Tracey³  Reva Schachter³  Suneeta Monga⁴  Daphne J. Korczak⁵  Peter Szatmari⁶  Melanie Barwick⁷  Yaron Finkelstein⁸  Kristin Cleverley⁹ 

[1] Centre for Addiction and Mental Health, 5226-88 Workman Way, M5J 1H4, Toronto, ON, Canada;Clinical Trial Unit, Ontario Child Health Support Unit, Hospital for Sick Children, 555 University Avenue, M5G 1X8, Toronto, ON, Canada;Department of Psychiatry, Hospital for Sick Children, 555 University Avenue, M5G 1X8, Toronto, ON, Canada;Department of Psychiatry, Hospital for Sick Children, 555 University Avenue, M5G 1X8, Toronto, ON, Canada;Department of Psychiatry, University of Toronto, 250 College St, M5T 1R8, Toronto, ON, Canada;Department of Psychiatry, Hospital for Sick Children, 555 University Avenue, M5G 1X8, Toronto, ON, Canada;Research Institute, Hospital for Sick Children, 686 Bay Street, M5G 0A4, Toronto, ON, Canada;Department of Psychiatry, University of Toronto, 250 College St, M5T 1R8, Toronto, ON, Canada;Department of Psychiatry, University of Toronto, 250 College St, M5T 1R8, Toronto, ON, Canada;Research Institute, Hospital for Sick Children, 686 Bay Street, M5G 0A4, Toronto, ON, Canada;Divisions of Paediatric Emergency Medicine and Clinical Pharmacology and Toxicology, Hospital for Sick Children, 525 University Avenue, M5G 2L3, Toronto, ON, Canada;Lawrence S. Bloomberg Faculty of Nursing and Department of Psychiatry, University of Toronto, 130-155 College Street, M5P 1T8, Toronto, ON, Canada;

关键词: Clinical trials;    Recruitment;    Mental health;    Suicide;    Pediatrics;    Youth;    Adolescents;    Emergency departments;    Interventions;   

DOI  :  10.1186/s12874-020-01117-5

来源: Springer

【 摘 要 】

BackgroundEmergency 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.MethodsRecruitment 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.ResultsIn 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.ConclusionsEDs 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 registrationClinicalTrials.gov: NCT03488602, retrospectively registered April 4, 2018.

【 授权许可】

CC BY