***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background A commonly reported problem with the conduct of multicentre r and omised controlled trials ( RCTs ) is that recruitment is often slower or more difficult than expected , with many trials failing to reach their planned sample size within the timescale and funding originally envisaged . The aim of this study was to explore factors that may have been associated with good and poor recruitment in a cohort of multicentre trials funded by two public bodies : the UK Medical Research Council ( MRC ) and the Health Technology Assessment ( HTA ) Programme . Methods The cohort of trials was identified from the administrative data bases held by the two funding bodies . 114 trials that recruited participants between 1994 and 2002 met the inclusion criteria . The full scientific applications and subsequent trial reports su bmi tted by the trial teams to the funders provided the principal data sources . Associations between trial characteristics and recruitment success were tested using the Chi-squared test , or Fisher 's exact test where appropriate . Results Less than a third ( 31 % ) of the trials achieved their original recruitment target and half ( 53 % ) were awarded an extension . The proportion achieving targets did not appear to improve over time . The overall start to recruitment was delayed in 47 ( 41 % ) trials and early recruitment problems were identified in 77 ( 63 % ) trials . The inter-relationship between trial features and recruitment success was complex . A variety of strategies were employed to try to increase recruitment , but their success could not be assessed . Conclusion Recruitment problems are complex and challenging . Many of the trials in the cohort experienced recruitment difficulties . Trials often required extended recruitment periods ( sometimes supported by additional funds ) . While this is of continuing concern , success in addressing the trial question may be more important than recruitment alone We investigated whether a short course in communication skills for physicians would improve the quality of informed consent in a r and omized clinical adjuvant trial on breast cancer . In this prospect i ve , case-controlled intervention study , physicians and research nurses who introduced the cancer treatment trial to patients at three of the participating hospitals first attended a one-day communication skills course . The quality of informed consent was then evaluated by addressing a st and ardized question naire , QuIC , to trial patients at the three intervention hospitals and at control hospitals . Response rate was 90.0 % ( n = 288 ) . Of the patients treated by the intervention group , 73 % were very satisfied with the information received compared with 56 % of those of the control group ( p = 0.003 ) . The patients of the intervention group considered the time given for making their decision sufficient more often than those of the controls ( 98 % vs. 90 % , p=0.004 ) . The patients of the intervention group recalled more often than those of the controls that the physician had also offered other therapeutic options than the trial treatment ( 91 % vs. 97 % , p=0.032 ) . They also understood the main aim of the study better than the patients of the controls ( 89 % vs. 78 % , p=0.030 ) . In conclusion , a short communication skills course for the trial physicians and nurses improved the quality of informed consent and patient satisfaction in the trial BACKGROUND Previous research has shown that communication between members of multidisciplinary teams ( MDTs ) is often suboptimal and communication about trials between MDTs and their patients is difficult . Educational interventions can help dyadic exchanges with different aspects of trial recruitment but less work has focussed on team interventions . METHODS 22 multidisciplinary cancer teams in the UK participated in an RCT of a novel Teams Talking Trials ( TTT ) Workshop aim ed at improving the following : awareness , involvement , communication and recruitment to cancer trials . MDTs were r and omised following either 6 or 12 months of audits , which were repeated after the intervention . Audits included numbers approached about trials , team members ' attitudes , involvement and awareness of their teams ' trial portfolios . RESULTS There was no significant difference in the rate of approaching patients about trials post workshop ( estimated improvement 22 % higher regression coefficient of 0.2 , exp . (0.2)=1.22 ) . There was improvement in team members ' involvement in trials in 4 areas ( p≤0.04 ) : the pressure to enter patients into RCTs , the likelihood of a start-up meeting to discuss a newly accepted trial , the informational role played by individuals and recognition of this HCP 's role by other team members . Also , confidence in communication about RCTS increased and awareness of different aspects of trial management improved on all 14 aspects ( p=0.001 ) . CONCLUSION Attendance by teams at focussed workshops design ed to enhance communication and trial recruitment improved several aspects of team functioning , but a significant impact on the number of patients approached could not be demonstrated Background Poor recruitment to r and omised controlled trials ( RCTs ) is a widespread problem . Provision of interventions aim ed at supporting or incentivising clinicians may improve recruitment to RCTs . Objectives To quantify the effects of strategies aim ed at improving the recruitment activity of clinicians in RCTs , complemented with a synthesis of qualitative evidence related to clinicians ' attitudes towards recruiting to RCTs . Data sources A systematic review of English and non-English articles identified from : The Cochrane Library , Ovid MEDLINE , Ovid EMBASE , Ovid PsycINFO , Ebsco CINAHL , Index to Theses and Open SIGLE from 2001 to March 2011 . Additional reports were identified through citation search es of included articles . Study eligibility criteria Quantitative studies were included if they evaluated interventions aim ed at improving the recruitment activity of clinicians or compared recruitment by different groups of clinicians . Information about host trial , study design , participants , interventions , outcomes and host RCT was extracted by one research er and checked by another . Studies that met the inclusion criteria were assessed for quality using a st and ardised tool , the Effective Public Health Practice Project tool . Qualitative studies were included if they investigated clinicians ' attitudes to recruiting patients to RCTs . All results / findings were extracted , and content analysis was carried out . Overarching themes were abstract ed , followed by a meta summary analysis . Studies that met the inclusion criteria were assessed for quality using the Critical Appraisal Skills Programme qualitative checklist . Data extraction Data extraction was carried out by one research er using predefined data fields , including study quality indicators , and verified by another . Results Eight quantitative studies were included describing four interventions and a comparison of recruiting clinicians . One study was rated as strong , one as moderate and the remaining six as weak when assessed for quality using the Effective Public Health Practice Project tool . Effective interventions included the use of qualitative research to identify and overcome barriers to recruitment , reduction of the clinical workload associated with participation in RCTs and the provision of extra training and protected research time . Eleven qualitative studies were identified , and eight themes were abstract ed from the data : underst and ing of research , communication , perceived patient barriers , patient – clinician relationship , effect on patients , effect on clinical practice , individual benefits for clinicians and methods associated with successful recruitment . Meta summary analysis identified the most frequently reported subthemes to be : difficulty communicating trial methods , poor underst and ing of research and priority given to patient well-being . Overall , the qualitative studies were found to be of good quality when assessed using the Critical Appraisal Skills Programme checklist . Conclusions There were few high- quality trials that tested interventions to improve  clinicians ' recruitment activity in RCTs . The most promising intervention was the use of qualitative methods to identify and overcome barriers to  clinician recruitment activity . More good quality studies of interventions are needed to add to the evidence base . The meta summary of qualitative findings identified underst and ing and communicating RCT methods as a key target for future interventions to improve recruitment . Reinforcement of the potential benefits , both for clinicians and for their patients , could also be a successful factor in improving recruitment . A bias was found towards investigating barriers to recruitment , so future work should also encompass a focus on successfully recruiting trials Abstract Objective To evaluate a training intervention aim ed at improving healthcare professionals ' communication with cancer patients about r and omised clinical trials . Design Before and after evaluation of training programme . Setting Members of the National Cancer Research Network , Scottish Trials Network , and the Welsh Cancer Trials Network Participants 101 healthcare professionals ( 33 clinicians and 68 research nurses ) . Intervention Four modules delivered by a trained facilitator using videotapes and interactive exercises to cover general issues about discussing r and omised clinical trials with patients , problems specific to adjuvant trials , trials with palliation as the goal , and trials where patients had a strong preference for one treatment arm . Main outcome measures Before and after the intervention , participants were videotaped discussing a trial with an actor portraying a patient . These consultations were assessed for presence of information required by good clinical practice guidelines . The actor patients gave an assessment after each interview . Participants reported their self confidence about key aspects of trial discussion . Results Analysis of the videotaped consultations showed that , after intervention , significantly more participants displayed key communication behaviours such as explaining r and omisation ( 69 v 81 , odds ratio 2.33 , P = 0.033 ) , checking patients ' underst and ing ( 11 v 31 , odds ratio 3.22 , P = 0.002 ) , and discussing st and ard treatment ( 73 v 88 , odds ratio 4.75 , P = 0.005 ) and side effects ( 69 v 85 , odds ratio 3.29 , P = 0.006 ) . Participants ' self confidence increased significantly ( P < 0.001 ) across all areas . Actor patients ' ratings of participants ' communication showed significant improvements for 12/15 key items . Conclusion This intensive 8 hour intervention significantly improved participants ' confidence and competence when communicating about r and omised clinical trials Objective The aim of the study was to investigate how doctors considered and experienced the concept of equipoise while recruiting patients to r and omized controlled trials ( RCTs ) .  Study Design and Setting In-depth interviews with 32 doctors in six publicly funded pragmatic RCTs  explored their perceptions of equipoise as they undertook RCT recruitment . The RCTs varied in size , duration , type of complex intervention , and clinical specialties . Interview data were analyzed using qualitative content and thematic analytical methods derived from grounded theory and synthesized across six RCTs . Results All six RCTs suffered from poor recruitment . Doctors wanted to gather robust evidence but experienced considerable discomfort and emotion in relation to their clinical instincts and concerns about patient eligibility and safety . Although they relied on a sense of community equipoise to justify participation , most acknowledged having “ hunches ” about particular treatments and patients , some of which undermined recruitment . Surgeons experienced these issues most intensely . Training and support promoted greater confidence in equipoise and improved engagement and recruitment . Conclusion Recruitment to RCTs is a fragile process and difficult for doctors intellectually and emotionally . Training and support can enable most doctors to become comfortable with key RCT concepts including equipoise , uncertainty , patient eligibility , and r and omization , promoting a more resilient recruitment process in partnership with patients Background : The optimal treatment for localised oesophageal squamous cell carcinoma ( SCC ) is uncertain . We assessed the feasibility of an RCT comparing neoadjuvant treatment and surgery with definitive chemoradiotherapy . Methods : A feasibility RCT in three centres examined incident patients and reasons for in eligibility using multi-disciplinary team meeting records . Eligible patients were offered participation in the RCT with integrated qualitative research involving audio-recorded recruitment appointments and interviews with patients to inform recruitment training for staff . Results : Of 375 patients with oesophageal SCC , 42 ( 11.2 % ) were eligible .  Reasons for eligibility varied between centres , with significantly differing proportions of patients excluded because of total tumour length ( P=0.002 ) . Analyses of audio-recordings and patient interviews showed that recruiters had challenges articulating the trial design in simple terms , balancing treatment arms and explaining the need for r and omisation . Before analyses of the qualitative data and recruiter training no patients were r and omised . Following training in one centre 5 of 16 eligible patients were r and omised . Conclusions : An RCT of surgical vs non-surgical treatment for SCC of the oesophagus is not feasible in the UK alone because of the low number of incident eligible patients . A trial comparing diverse treatment approaches may be possible with investment to support the recruitment process Purpose Few studies have compared the instructiveness of real patient contacts with simulated patient ( SP ) contacts . Although most of these studies found no difference , students often comment that the instructiveness of both encounters is dissimilar . The aims of this study were to evaluate which contact ( real patient or SP ) is perceived as most instructive by students and which variables contribute to this . Method The authors performed an experiment involving 163 first-year medical students , r and omized to having a real patient contact ( n = 61 ) or SP contact ( n = 102 ) .  Quantitative ( question naires ) and qualitative ( focus groups ) methods were used to evaluate the perceived instructiveness of the contact . Results The general instructiveness of both real patient contacts and SP contacts was marked high . Several differences between the evaluations of real patient contacts and SP contacts were found . For example , students considered real patient contacts less helpful in practicing communication skills and considered the real patients ' feedback less relevant . The focus group interviews yielded explanations for many of the differences found . Students regarded real patients as more authentic . However , SPs were better informed about the purpose of the consultation and provided the student with more specific feedback . Conclusions Students consider authenticity an important advantage of real patients . Their difficult recruitment is an important disadvantage , however , SPs have important advantages compared with real patients —for example , their feedback . The choice of real patient contacts or SP contacts for medical education depends on factors like the phase of the curriculum and the aim of the 
    Output:
    
Recruiter training programmes were well received and some increased recruiters ’ self-confidence in communicating key RCT concepts to patients .
There was , however , little evidence that this training increased actual recruitment rates or patient underst and ing , satisfaction , or levels of informed consent .
Conclusions There is a need to develop recruiter training programmes that can lead to improved recruitment and informed consent in r and omised trials