Date: 29 January 2019
Clinical Research Practitioner (CRP) Servious Dube shares his experience of providing clinical research support for three months at a south London hospital to improve recruitment to Division 1 studies.
I was told to go and help the Division 1 (Cancer) team at a south London hospital from for three months in prostate cancer studies, which included the studies PROMPTS, UKGPS and Add-Aspirin.
When I started working there, I found only one staff member working on all studies. She was employed as a study administrator and at the time I started my secondment there, she was also serving notice to leave her employment within the next few weeks. Before she eventually left, we were joined by a new band six research practitioner.
What I also found out was that before the commencement of my secondment, the recruitment of participants into the studies had stopped. This was because there was no clinical staff available to help recruit research participants. My immediate tasks were to read all protocols I was required to work on.
I was constantly in contact with trial offices to go through practical steps that were not clear in the protocols or follow-up research schedules. Basically, I orientated myself into the studies and also actively engaged in distance learning by reading all Standard Operating Procedures (SOPs) then seeking clarification where needed from the trial office coordinators. For me to be able to start on my job, I organised some clinic rooms I was to work in for consenting and conducting research activities with potential participants. Furthermore, I found my way into the multidisciplinary team (MDT) meetings, where I introduced myself to the members. I was attending the MDT meetings every Tuesday between 08:00 and 09:30 and the MDT also became a platform for screening prostate patients for eligibility to participate in the studies. After all these practical arrangements were complete, I started recruiting study participants into the prostate cancer studies.
It took me almost a month to get things sorted because I did not find help from a research nurse working on these studies. The trial offices had no time to conduct quick protocol training for me so I couldn’t immediately delve into performing research tasks. Also, the preparatory work took a while to complete and I had to read and orientate myself into the environment and the studies; if I had problems I could pick up a telephone and talk to the trial offices.
For me, the most important learning I got from this work was being able to identify steps required to settle myself into the job. I realised that relationships play a critical part in settling into a job. I assimilated myself into the oncology unit through communication with everyone including the cleaners, receptionists, patient appointment clerks, MDT coordinators, nurses and consultants. I recognised the importance of teamwork during the initial days of my secondment, and while the mundane tasks involved in reaching a point where I could recruit were draining, they were very important in providing a smooth transition to my clinical work.
It was surprising how I immediately gained the confidence to approach and work with everyone in the Outpatient Oncology unit with ease. The interpersonal skills I gained are transferable across-site. My initial stages were difficult because I felt as though people resented me; perhaps this was because I was a stranger. People are naturally more closed off to strangers who could be ‘rocking their boats’.
At that time, I was denied clinic rooms for conducting research tasks including consenting. If I was lucky enough to get one it would be a small office space not even suitable for face-to-face interviews, let alone the collection of human tissue samples. This is how bad my initial circumstances were. I remember clearly a disturbing event one day in my research work there when I was working in a quiet room that was near the clinic room. In the middle of my work with a patient, a nurse came to me to say I had to move, because one of the oncology registrars wanted to see a patient newly diagnosed with prostate cancer for counselling purposes right away in the room I was using. It was an instruction to move, but there was nowhere I could go to complete my assessments with the patient. I excused myself to the patient and quickly roamed around to look for an empty space. The empty room I found was but a temperature controlled room that stores research drugs. Fortunately, the patient agreed to continue with the assessment when I asked him after the short break. Looking back, if the consenting process has not been completed, I would have considered abandoning the recruitment process, because I felt embarrassed and I was also not prepared to subject patients to such poor circumstances.
The episode meant I was continuously apologising for the inconvenience caused to the study participant. He was such a pleasant gentleman and so understanding as well that he felt more pity for me than for himself, and said: “poor you… you’re enduring all this… like a homeless person.” We both laughed over this; however, I later complained about the incident to the Outpatient Manager. I escalated the incident so that the situation should not happen again to anybody who is providing care to patients because it amounts to bad clinical practice and is also viewed as a violation of patient’s rights, respect and dignity. Additionally, this could result in poor patient care and an unpleasant patient experience.
Working across sites and across CRN divisions has both advantages and disadvantages. Some of the advantages I got from this secondment were learning new roles, learning to work effectively with a diverse population across different NHS staff levels. I also learnt new IT systems and different ways of working from how I was used to working in my CRN research division. I have realised that most of the cancer studies have complex protocols and study tasks, which certainly require attention to detail. However, the downside of working across sites or divisions is that you remain a stranger and regular staff initially tend to isolate you no matter how extroverted you might be in wanting to socialise with them. Regular staff members have the advantage of knowledge of the workplace that, at times, they are not keen to share with you outright until you become part of the team. This process determines how you become accepted. Sometimes such chaos can feel like it’s breaking you into pieces, but afterwards you emerge heroic and ready to start working across teams smoothly and effectively.
Although I was frustrated initially trying to find my way around the outpatient unit, I eventually got myself into a stronger position that embedded me into the team. This became a driving factor that enabled me to do my job efficiently and with all the support I required from the outpatient clinic team. The support I got from the CRN lead nurse was fabulous, but she could not save my skin when my world was crumbling around me during my initiation time. I can honestly and assertively acknowledge my experience at the hospital as a revealing personal journey full of mixed positive and painful feelings, which I am still reflecting on now. As I look back, I can see myself initially having failed to penetrate into the culture of the outpatient team at the beginning of my secondment. The common issues appearing again and again, were the unavailability of clinic space for research tasks. These issues were never resolved completely up until the end of my secondment.
The new employees who started during my secondment experienced similar problems as well. Possibly, this could be explained by NHS Trusts pushing research activities to the back of the queue. I feel these are some of the issues that need to be looked into by the CRN senior management in partnership with new research sites.
Unavailability of research clinic rooms is exacerbated by the fact that some PIs are less motivated to be actively involved in research roles, and would distance themselves from their research teams, hence the research team members remain alone, and feel parched of the steam of required resources and information. For me, I view such a scenario as part of the barrier to recruiting study participants to time and target; it was even harder to resolve some of the problems if the PI was disengaged from the research team. I believe these are some of the issues that need to be taken seriously by senior management and local NHS partners before posting flexible research staff to new places. Otherwise, such an experience can affect the staff morale negatively.
Personally, I enjoy challenges emerging from my work, because they enrich my experience and also develop me professionally, unless they are affecting my health or wellbeing; although, I’m not sure this assertion can be generalised to apply to most flexible research staff. But I now know that support we get from our line managers and colleagues matter in keeping us motivated and engaged. I am sure that such loyalty and commitment of personal values of employees to the work are closely aligned to putting the patient first in all of what we do. Most importantly, such value-based behaviours are critical factors for enhancing quality patient care and service improvement. I personally believe in these leadership concepts that are there to be confirmed in the workplace.
What I carried to the next situation from my experience was to work across teams effectively. The importance of leadership roles, for me, remains an area that I would like to develop further, not just for my current job but my future professional development. The concept of working across multidisciplinary teams is critical to helping me meet the objective of recruiting participants to time and target efficiently. I mentioned that it's very important to work as a team and that includes the PI, therefore my next aims in this regard are to make sure that the PIs I'm working with are also actively engaged and motivated to play their leading roles in clinical research trials. I have high hopes that if these suggestions are put into place there is a good chance of improving research delivery and achieving higher performance levels, but also that there would be more adherence to protocol and improvement to data collection with fewer queries and a more pleasant research participant experience. I hope I have captivated you in following me along my personal journey across-sites. The narrative was told for you to read and to form your own opinions.
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