43COMPREHENSIVE GERIATRIC ASSESSMENT IN HOSPITAL OR AT HOME? THE ROLE OF CLINICIAN UNCERTAINTY IN RECRUITMENT TO A RANDOMISED CONTROLLED TRIAL
Bibliographic record
Abstract
Introduction: Ethical recruitment of patients to a clinical trial assumes uncertainty about advantages and disadvantages of the treatment modalities, or ‘equipoise’. This study considers the concept of uncertainty in a multicentre randomised controlled trial (RCT) of a complex intervention: Comprehensive Geriatric Assessment (CGA) in a hospital or hospital at home (HAH) setting. We aimed to identify factors influencing recruitment, which may ultimately affect trial success. Methods: We used mixed methods in an explanatory sequential design: (1) quantitative data collection from screening logs, for cross-site comparison of enrolment outcomes and documented reasons for exclusion of eligible patients, and (2) qualitative discussions with a purposive sample of research coordinators, clinicians and principle investigators across sites, to explore perspectives and issues arising during screening and recruitment. Results: Data were collated for a total of 2325 patients documented as potentially eligible across seven RCT sites over a period of 20 months, of whom 883 patients were recruited to the trial (37.98% of those documented to be potentially eligible). Recorded reasons for non-recruitment varied across the sites, however higher rates of non-recruitment of potentially eligible patients appeared to be associated with higher proportions of clinician-led reasons for exclusion. Through preliminary content analysis of qualitative data, we have identified: (1) caution expressed by clinicians regarding research engagement; (2) clinicians’ preferences vary according to the service in which recruitment decisions are made; and (3) personal experience of HAH services influences perceptions of the RCT and clinicians’ engagement with recruitment. Conclusions: Our preliminary findings indicate that perceptions of local services shape individual clinicians’ preferences and diminish the uncertainty in decision-making that supports RCT recruitment. Further analysis will explore additional factors affecting clinician engagement with this research, and effects of patients’ expressed preferences when invited to participate.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.760 | 0.828 |
| Meta-epidemiology (narrow) | 0.001 | 0.002 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.003 | 0.005 |
| Science and technology studies | 0.004 | 0.017 |
| Scholarly communication | 0.013 | 0.011 |
| Open science | 0.004 | 0.007 |
| Research integrity | 0.007 | 0.005 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; the direct Gemma label and the distilled Codex classifier agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".