An observational study showed that explaining randomization using gambling-related metaphors and computer-agency descriptions impeded randomized clinical trial recruitment.
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Authors
Jepson, Marcus
Conefrey, Carmel
Wade, Julia
Rooshenas, Leila
Beard, David
Blazeby, Jane M
Birtle, Alison
Halliday, Alison
Stein, Rob
Donovan, Jenny L
CSAW study group
Chemorad study group
POUT study group
ACST-2 study group
OPTIMA prelim study group
Publication Date
2018-07Journal Title
J Clin Epidemiol
ISSN
0895-4356
Publisher
Elsevier BV
Volume
99
Pages
75-83
Language
eng
Type
Article
Physical Medium
Print-Electronic
Metadata
Show full item recordCitation
Jepson, M., Elliott, D., Conefrey, C., Wade, J., Rooshenas, L., Wilson, C., Beard, D., et al. (2018). An observational study showed that explaining randomization using gambling-related metaphors and computer-agency descriptions impeded randomized clinical trial recruitment.. J Clin Epidemiol, 99 75-83. https://doi.org/10.1016/j.jclinepi.2018.02.018
Abstract
OBJECTIVES: To explore how the concept of randomization is described by clinicians and understood by patients in randomized controlled trials (RCTs) and how it contributes to patient understanding and recruitment. STUDY DESIGN AND SETTING: Qualitative analysis of 73 audio recordings of recruitment consultations from five, multicenter, UK-based RCTs with identified or anticipated recruitment difficulties. RESULTS: One in 10 appointments did not include any mention of randomization. Most included a description of the method or process of allocation. Descriptions often made reference to gambling-related metaphors or similes, or referred to allocation by a computer. Where reference was made to a computer, some patients assumed that they would receive the treatment that was "best for them". Descriptions of the rationale for randomization were rarely present and often only came about as a consequence of patients questioning the reason for a random allocation. CONCLUSIONS: The methods and processes of randomization were usually described by recruiters, but often without clarity, which could lead to patient misunderstanding. The rationale for randomization was rarely mentioned. Recruiters should avoid problematic gambling metaphors and illusions of agency in their explanations and instead focus on clearer descriptions of the rationale and method of randomization to ensure patients are better informed about randomization and RCT participation.
Keywords
CSAW study group, Chemorad study group, POUT study group, ACST-2 study group, OPTIMA prelim study group, Humans, Random Allocation, Gambling, Comprehension, Qualitative Research, Patient Selection, Metaphor, Decision Making, Computer-Assisted, Patient Education as Topic, Randomized Controlled Trials as Topic, United Kingdom
Sponsorship
NETSCC (None)
Identifiers
External DOI: https://doi.org/10.1016/j.jclinepi.2018.02.018
This record's URL: https://www.repository.cam.ac.uk/handle/1810/278987
Rights
Attribution 4.0 International (CC BY 4.0)
Licence URL: https://creativecommons.org/licenses/by/4.0/
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