Mariken Stegmann

potential risk. This legislation (WMO) obliges researchers to supply participants with extensive information about all procedures and their risks. Although this law does not apply to research projects with only low risk, such as those presented in this thesis, there is a tendency to impose the same rules and regulations, leading to lengthy and irrelevant information for patients that can demotivate them and act as a barrier to participation. At the same time, researchers have a responsibility to consider how they can keep the burden of the study as low as possible for patients (e.g., performing interviews at home, using online questionnaires, or involving informal caregivers). Regarding the factors related to health care professionals, I was both positively and negatively surprised. In the study of the desired content of correspondence between professionals (Chapter 7), about 40% of the health care providers we approached engaged in the panels and almost all of them answered at least 70% of the questions in both rounds. For the OPTion study, medical specialists at nine locations in six hospitals were willing to participate, but the numbers of patients approached differed substantially between departments, with some failing to meet our stated expectations. During the first months of the trial, one of our students analysed the reasons for poor performance and showed that the most important factors for non ‐ academic specialists were feeling a barrier to asking patients and forgetting to ask because of the low frequency of eligible patients. For academic specialists, competition with other studies and having concerns about the desirability or feasibility of the intervention were the main reasons for non ‐ compliance. This is in line with existing literature about this topic. 43 It might be advisable for researchers to ask explicitly about potential barriers at an early stage of the research project. During a study, researchers can improve recruitment by maintaining regular contact with specialists. In the OPTion study, for example, we were able to double the inclusion rate by intensifying this contact, even though the specialists often argued this was unnecessary. To ensure that these contacts do not place additional burdens on specialists, however, it is advisable for researchers to attend their regular meetings and stay connected by e ‐ mail. Intensifying the contact was highly effective in our study, and had a greater impact than our earlier efforts at distributing posters, pocket cards, and sweets, as suggested in the literature. 44 Providing additional training for clinicians on patient recruitment could also improve patient uptake. This could be delivered both routinely during postgraduate training and specifically for the purposes of the study. Research about medical communication Qualitative versus quantitative research Research into medical communication often involves qualitative research. Although this research has a low position in the pyramid of evidence, which may imply inferiority to other methods, it can also be the most appropriate design. The open and broad way of data analysing data in qualitative research means that new patterns can be discovered and new hypotheses formulated. This is exemplified by the findings in Chapter 5 about the change of treatment goals, and by the findings in Chapter 7 about the desired content in correspondence. Qualitative data are also much richer than quantitative data. Indeed, the open evaluation questions for GPs participating in the OPTion study (Chapter 4) provided important data about the added value of the intervention for GPs. By contrast, when solid 114 Chapter 8