Optimising ambulance service contribution to clinical trials: a phenomenological exploration using focus groups

Area of Science:

• Emergency medicine
• Clinical trial methodology
• Pre-hospital care research

Background:

• Out-of-hospital cardiac arrest (OHCA) trials present recruitment challenges.
• The PARAMEDIC2 trial investigated adrenaline's efficacy in OHCA.
• Sharing recruitment experiences from successful OHCA trials is essential.

Purpose of the Study:

• To describe the experiences of operational ambulance staff during the PARAMEDIC2 trial.
• To identify facilitators and barriers to recruitment in a pre-hospital OHCA trial.
• To inform future large-scale pre-hospital research.

Main Methods:

• Four focus groups were conducted with trial paramedics and emergency care staff.
• Participants were from a single UK ambulance service involved in the PARAMEDIC2 study.
• Thematic analysis, supported by NVivo 12, was used to identify key themes.

Main Results:

• Forty-four participants contributed, highlighting four themes: research context, ethical concerns, patient-side issues, and trial support.
• Paramedics recognized the importance of research but faced ethical dilemmas, particularly with deferred consent and vulnerable patients.
• Simplicity of trial processes, reinforcement, and personalized feedback were vital for recruitment, alongside addressing concerns about patient care and family communication.

Conclusions:

• Paramedic experiences in the PARAMEDIC2 trial offer valuable insights for pre-hospital research.
• Investment in face-to-face training and individualized feedback enhances paramedic engagement and trial performance.
• Addressing ethical concerns and cognitive load is critical for successful recruitment in OHCA trials.