Noninvitation of eligible individuals to participate in pediatric studies - A qualitative study

Objective: To identify subjective factors that lead investigators not to invite eligible individuals to participate in pediatric studies. Design: Qualitative study with semistructured interviews. Setting: Four pediatric teaching hospitals in Paris. Participants: Pediatric investigators, (n = 24). Main Outcome Measure: Report by investigator that eligible patients were not invited by him or her to participate in a clinical research study. Results: Sixty-three percent of investigators (15 of 24) reported not inviting eligible patients. The noninvitation patterns were global (ie, investigators did not invite anyone) (37.5% [9/24]) or targeted specific patient subgroups (37.5% [9/24]). Noninvitation was often described as 'driven by ethical concerns related to the study design or patients or by anticipated patient refusal (58.3% [14/24]). None of the investigators kept records of non-invitation rates or refusal rates. Investigators estimated refusal rates of 1% to 10%, and none remembered a study that had failed because of potential subjects' refusals (including healthy participants). Conclusions: Noninvitation to participate in studies is not an absence of action but rather is an organized practice that reflects investigators' perceptions. Consequences are practical (eg, recruitment bias and study failure) and ethical (eg, unequal access to trials and failure to respect the autonomy of eligible patients). Our data suggest an urgent need for quantitative studies aimed at documenting and understanding noninvitation of eligible patients to participate in research studies in pediatrics and in other medical specialties.