In-person and remote recruitment of people with dementia into a primary care-based cluster randomised controlled trial: lessons from the Dementia PersonAlised Care Team (D-PACT) feasibility study

Abstract

Abstract Background Recruiting individuals with dementia for clinical trials within primary care is complex, involving socio-cultural, psychological, geographical, and service-related factors. Phase 1 of the Dementia PersonAlised Care Team (D-PACT) study assessed the feasibility of evaluating a personalized dementia support intervention based in primary care in a cluster randomized controlled trial. COVID-19 necessitated a shift to remote working, providing the opportunity to compare in-person and remote capacity judgment and recruitment. Methods Using an inclusive multi-stage approach, in-person recruitment commenced September 2019 but was temporarily halted in March 2020 due to COVID-19. The study resumed recruitment remotely from September 2020 to March 2021. We analysed quantitative data comparing both periods, examining proportion of recruited GP practices and participants, participant recruitment rate per month and number of meetings/time required for consent and baseline. Qualitative interviews explored participants’ experiences of remote recruitment using thematic analysis. Results Pre-COVID-19, 61.5% (n = 8) of approached GP practices (n = 13) were recruited vs. 20% (n = 4) during COVID-19. In-person participant recruitment yielded 9.9% (22 recruited/228 approached), while remote recruitment achieved 17.2% (n = 34). 15 of the 34 had been approached prior to COVID-19, put on hold but re-approached/recruited remotely post-study pause. Even accounting for this, remote recruitment remained comparable at 9.6% (19/198). Monthly recruitment rate increased from 3.6 dyads in-person to 5.6 remotely. However mean time on recruitment was higher (9 hours per participant in-person vs.15 remotely), and time on specific activities differed: no travel time during COVID-19, offset by increased preparation/administration. Our multi-stage approach added to overall recruitment time but proved productive, achieving recruitment percentages of 40%, 39%, and 23% respectively from interested patients. Qualitative interviews (n = 13) indicated general acceptability of remote recruitment, with preferences tied to individual needs. Conclusions Our findings contribute to recruitment strategies for primary care trials by showing remotely judging capacity and recruiting people with dementia without specialist support using person-centred approaches is possible. While time-intensive, recruitment rates were not compromised. Researchers should consider flexible, hybrid approaches to increase participation. Understanding the time commitment essential for inclusive dementia recruitment will guide realistic target setting and study design. Funders should consider time and financial requirements in their decisions. Trial registration: ISRCTN80204146. Registration date 23/09/2019