A Personalized, Symptom-Based Approach to Boost Research Participation in Hospitalized Older Adults

Delirium is common among hospitalized older adults on many clinical services and associated with poor outcomes. Given delirium's fluctuations, wearable devices are promising continuous monitors. While recruiting for a wearable electroencephalography (EEG) delirium study, we initially experienced low enrollment rates among older adults and patients on non-neurologic services. Our aim was to understand patient and community perspectives on inpatient, wearable research to adapt recruitment protocols and increase enrollment.

We approached patients admitted to an academic medical center to participate in an observational, wearable EEG delirium study and recorded reasons for enrolling or declining. To gain insight into recruitment protocols, we held a community panel with patients, family members, and caregivers. Recruitment protocols were refined in two phases: 1) personalizing the recruitment approach to emphasize symptoms that were personally relevant to individual patients and 2) sharing educational materials about the study in addition to delirium. We compared enrollment rates before and after these protocol adaptations.

Initially, 18.5% of approached patients enrolled (68/367). Despite antecedent concerns that wearable devices would be the primary deterrent to participation, only a small proportion of people who did not participate did so because of wearable EEG (8.8%, 26/299). Community panel members (n=7) suggested that personal relevance and understanding of the clinical conditions being studied, such as delirium, would have a greater impact on decisions to participate than study procedures. Adapting recruitment protocols to highlight personally relevant delirium-related symptoms, such as sleep disturbance, significantly increased enrollment rates (30.1%, 58/188, p<0.001), including for patients over 65 years old (p<0.001) and patients on non-neurologic services (p<0.001). The addition of educational materials focused on clinical delirium did not further impact enrollment (p=0.61).

Recruitment of older, hospitalized patients for inpatient research can be challenging, but can be significantly improved by highlighting familiar symptoms of personal relevance.