Ethical issues regarding recruitment to research studies within the primary care consultation

Recruitment to primary care-based studies may occur within the consultation or in dedicated research clinics. For practical and logistic reasons, some patients are recruited to research studies by their family doctor during the consultation. However, this may preclude patients from discussing participation with others and some patients may not feel empowered to refuse participation. This may be a particular problem when patients have their own family doctor, whom they generally see, and the patient feels dependent on their practitioner's goodwill for ongoing care. Recruitment within the practice, therefore, raises ethical issues that warrant further exploration. This discussion article argues that there are reasons to suppose there may be problems associated with family doctors recruiting their own patients into research. Nevertheless, assumptions that patients feel undue pressure or obligation to participate in primary care research may not be justified. It is important that potential research participants have time to consider the implications of participation. However, the risks to patients of consenting to participate in research are, in many instances, less than the risks inherent in their routine treatment. We conclude that it is important that those responsible for the implementation of research ethics approvals and governance procedures are careful to avoid imposing inflexible rules that prevent patients from acting according to their own wishes.