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Primary care physicians' views about gate-keeping in clinical research recruitment: a qualitative study
journal contribution
posted on 2017-03-16, 00:00 authored by Dominique MartinDominique Martin, M Guillemin, R McDougall, A Brookes, N Hallowell, L GillamBackground: Clinical research is increasingly being undertaken in primary care settings. This development
offers both benefits and challenges. The ethical challenges of occupying the roles of both clinician and
researcher may be accentuated in primary care settings, where relationships are longer lasting and
medical conditions are less acute. This article examines primary care physicians’ experiences of
undertaking research, particularly their decision making about recruiting patients in the context of their
own dual roles. Methods: This project comprised in-depth interviews with eight Australian primary care
physicians working in general or specialist practices that were involved in clinical research. Data were
analyzed using inductive thematic analysis. Results: Physicians involved in recruiting their patients into
clinical trials acted as gatekeepers; they were selective about which patients to recruit and did not
necessarily approach all patients who met the research eligibility criteria. Physicians’ accounts suggested
they prioritized their clinician role over their researcher role. In addition to the rigor and merit of the
research, physicians considered the possible benefit of trial participation for individual patients. Physicians
described making recruitment decisions based on their perceived knowledge of patients’ personal,
behavioral, and attitudinal characteristics—often derived from their long-standing relationships with their
patients. Conclusion: Our data show evidence of gatekeeping by primary care physicians when deciding
to participate in, and recruit their patients to, clinical studies. We argue that such gatekeeping is a way of
addressing the dual and sometimes conflicting roles of clinician and researcher. It need not be ethically
problematic, but primary care physicians should be reflexive about their recruitment practices and biases.
In addition, this form of gatekeeping should be explicitly recognized in protocol design and the analysis of
trial findings.
offers both benefits and challenges. The ethical challenges of occupying the roles of both clinician and
researcher may be accentuated in primary care settings, where relationships are longer lasting and
medical conditions are less acute. This article examines primary care physicians’ experiences of
undertaking research, particularly their decision making about recruiting patients in the context of their
own dual roles. Methods: This project comprised in-depth interviews with eight Australian primary care
physicians working in general or specialist practices that were involved in clinical research. Data were
analyzed using inductive thematic analysis. Results: Physicians involved in recruiting their patients into
clinical trials acted as gatekeepers; they were selective about which patients to recruit and did not
necessarily approach all patients who met the research eligibility criteria. Physicians’ accounts suggested
they prioritized their clinician role over their researcher role. In addition to the rigor and merit of the
research, physicians considered the possible benefit of trial participation for individual patients. Physicians
described making recruitment decisions based on their perceived knowledge of patients’ personal,
behavioral, and attitudinal characteristics—often derived from their long-standing relationships with their
patients. Conclusion: Our data show evidence of gatekeeping by primary care physicians when deciding
to participate in, and recruit their patients to, clinical studies. We argue that such gatekeeping is a way of
addressing the dual and sometimes conflicting roles of clinician and researcher. It need not be ethically
problematic, but primary care physicians should be reflexive about their recruitment practices and biases.
In addition, this form of gatekeeping should be explicitly recognized in protocol design and the analysis of
trial findings.
