Do doctors know best? Comments on a failed trial

Hunt, Caroline J; Andrews, Gavin; Shepherd, Louise M

doi:10.5694/j.1326-5377.2001.tb143189.x

Cited by 48Mental Health Treatment and AccessEthics in Clinical ResearchTreatment of Major Depression

Do doctors know best? Comments on a failed trial

Hunt, Caroline J, Andrews, Gavin, Shepherd, Louise M·2001·Medical Journal of Australia

DOI 10.5694/j.1326-5377.2001.tb143189.x

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Abstract

A randomised controlled trial was planned to compare two different treatment strategies--structured problem solving and selective serotonin reuptake inhibitor (SSRI) medication--for patients with mild to moderate major depression. The trial was to be conducted in the primary care setting with all treatment given by general practitioners. When no patients had been recruited into the study after six months, we performed an audit of all patients with depressive symptoms attending the doctors' practices over three weeks. Exclusion criteria were changed to ease entry into the trial, but still no patients were recruited over the following six months. What went wrong?

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Recruitment to primary care trials in the United Kingdom is routinely problematic and particularly difficult in trials of mental health.
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From Development and evaluation of culturally sensitive psychosocial interventions for under-served people in primary care (2014) · cites this paper as [41]

Prevalence, comorbidity, disability and service utilisation: Overview of the Australian National Mental Health Survey
Andrews, G., Henderson, S., & Hall, W. (2001) · British Journal of Psychiatry · doi:10.1192/bjp.178.2.145 · Cited by 933 · see citing works
Self-citation
Randomised controlled trial comparing problem solving treatment with amitriptyline and placebo for major depression in primary care
Mynors‐Wallis, L., Gath, D. H., Lloyd-Thomas, A. R., & Tomlinson, D. (1995) · BMJ · doi:10.1136/bmj.310.6977.441 · Cited by 491 · see citing works
Treating Major Depression in Primary Care Practice
Schulberg, H. C. (1996) · Archives of General Psychiatry · doi:10.1001/archpsyc.1996.01830100061008 · Cited by 425 · see citing works
Non-random Reflections on Health Services Research On the 25th anniversary of Archie Cochrane's Effectiveness and Efficiency
Bury, T. (1998) · Physiotherapy · doi:10.1016/s0031-9406(05)63473-6 · Cited by 289 · see citing works
Protecting Research Subjects — What Must Be Done
Shalala, D. E. (2000) · New England Journal of Medicine · doi:10.1056/nejm200009143431112 · Cited by 190 · see citing works
A randomised controlled trial and cost analysis of problem-solving treatment for emotional disorders given by community nurses in primary care
Mynors‐Wallis, L., Davies, I., Gray, A., Barbour, F., & Gath, D. H. (1997) · The British Journal of Psychiatry · doi:10.1192/bjp.170.2.113 · Cited by 167 · see citing works
Randomised clinical trials in general practice: lessons from a failure.
Tognoni, G., Alli, C., Avanzini, F., Bettelli, G., Colombo, F., Corso, R., Marchioli, R., & Zussino, A. (1991) · BMJ · doi:10.1136/bmj.303.6808.969 · Cited by 139 · see citing works
Qualitative analysis: how to begin making sense.
Miller, W. L., & Crabtree, B. F. (1994) · PubMed · Cited by 137 · see citing works
Evaluation of a brief psychological treatment for emotional disorders in primary care
Catalan, J., Gath, D. H., Anastasiades, P., Bond, S. A. K., Day, A., & Hall, L. (1991) · Psychological Medicine · doi:10.1017/s0033291700030002 · Cited by 111 · see citing works
Factors Affecting General Practitioners' Recruitment of Patients into a Prospective Study
Peto, V., Coulter, A., & Bond, A. (1993) · Family Practice · doi:10.1093/fampra/10.2.207 · Cited by 106 · see citing works
Clinical trials in primary care
Foy, R., Parry, J. M., & McAvoy, B. (1998) · BMJ · doi:10.1136/bmj.317.7167.1168 · Cited by 50 · see citing works
Redressing the balance - The ethics of not entering an eligible patient on a randomised clinical trial
Segelov, E., Tattersall, M. H. N., & Coates, A. (1992) · Annals of Oncology · doi:10.1093/oxfordjournals.annonc.a058119 · Cited by 40 · see citing works
The treatment of emotional disorders in general practice: Psychological methods versus medication
Gath, D. H., & Catalan, J. M. (1986) · Journal of Psychosomatic Research · doi:10.1016/0022-3999(86)90017-6 · Cited by 22 · see citing works
On the promotion of non-drug treatments.
Andrews, G. (1984) · BMJ · doi:10.1136/bmj.289.6450.994 · Cited by 8 · see citing works
Self-citation
Payment of financial incentives to GPs may invalidate informed consent process
Ferguson, C. (1998) · BMJ · doi:10.1136/bmj.316.7124.75a · Cited by 5 · see citing works

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Campbell, M., Snowdon, C., Francis, D., Elbourne, D., McDonald, A., Knight, R., Entwistle, V, Garcia, J., Roberts, I., Grant, A., et al. (2007) · Health Technology Assessment · doi:10.3310/hta11480 · Cited by 433 · see citing works
How evidence based are recruitment strategies to randomized controlled trials in primary care? Experience from seven studies
Foy, R. (2003) · Family Practice · doi:10.1093/fampra/20.1.83 · Cited by 160 · see citing works
Improving recruitment to health research in primary care
Bower, P., Wallace, P., Ward, E. S., Graffy, J., Miller, J. M., Delaney, B. C., & Kinmonth, A. L. (2009) · Family Practice · doi:10.1093/fampra/cmp037 · Cited by 155 · see citing works
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GPs' experiences of primary care mental health research: a qualitative study of the barriers to recruitment
Mason, V. L., Shaw, A. R. G., Wiles, N., Mulligan, J., Peters, T., Sharp, D., & Lewis, G. (2007) · Family Practice · doi:10.1093/fampra/cmm047 · Cited by 112 · see citing works
Effective recruitment strategies in primary care research: a systematic review.
Ngune, I., Jiwa, M., Dadich, A., Lotriet, J., & Sriram, D. (2012) · PubMed · Cited by 92 · see citing works
Counselling for mental health and psychosocial problems in primary care
Bower, P., Knowles, S. E., Coventry, P. A., & Rowland, N. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001025.pub3 · Cited by 77 · see citing works
Developing a survey of barriers and facilitators to recruitment in randomized controlled trials
Kaur, G., Smyth, R. L., & Williamson, P. R. (2012) · Trials · doi:10.1186/1745-6215-13-218 · Cited by 74 · see citing works
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Pilkington, K., Kirkwood, G., Rampes, H., Fisher, P., & Richardson, J. (2006) · Homeopathy · doi:10.1016/j.homp.2006.05.005 · Cited by 69 · see citing works
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Involving patients with depression in research: survey of patients' attitudes to participation
Tallon, D., Mulligan, J., Wiles, N., Thomas, L., Peters, T. J., Elgie, R., Sharp, D., & Lewis, G. (2011) · British Journal of General Practice · doi:10.3399/bjgp11x567036 · Cited by 40 · see citing works
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Untitled work
(2013) · doi:10.1093/fampra/cmt028 · Cited by 11 · see citing works
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Library, N. J. (2012) · Cited by 5 · see citing works
Randomised controlled trial of cognitive‐behavioural therapy and routine GP care for major depression
Bolton, P. G. M., Fergusson, K. J., Parker, S. M., & Orman, J. D. (2001) · The Medical Journal of Australia · doi:10.5694/j.1326-5377.2001.tb143545.x · Cited by 5 · see citing works
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Brief Cognitive Behavioural Therapy Compared to Optimised General Practitioners’ Care for Depression: A Randomised Trial
Schene, A. H. (2014) · Journal of Depression & Anxiety · doi:10.4172/2167-1044.s2-001 · Cited by 2 · see citing works
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Ekers, D. (2011) · White Rose eTheses Online (University of Leeds, The University of Sheffield, University of York) · Cited by 2 · see citing works
Recruitment of individuals into a type 2 diabetes prevention program: the relative effectiveness and cost of different recruitment strategies used for the randomised controlled trial testing an Australian Lifestyle Change Program (AUS2PREVENT)
Kaim, A. L., Benton, F., Afzali, H. H. A., Ullah, S., Pham, C. T., Ward, P., & Luscombe‐Marsh, N. D. (2026) · Pilot and Feasibility Studies · doi:10.1186/s40814-025-01759-6 · Cited by 1 · see citing works
Recruitment challenges associated with a randomised controlled trial within a general telephone counselling service
Burgess, N. M., Christensen, H. M., Griffiths, K. M., & Farrer, L. M. (2010) · Journal of Telemedicine and Telecare · doi:10.1258/jtt.2010.090814 · Cited by 1 · see citing works
Improving long-term outcome of major depression in primary care: the role of recurrence prevention
Smit, A. (2007) · International Journal of Integrated Care · doi:10.5334/ijic.222 · Cited by 1 · see citing works
Depression is complex and heterogeneous
Ellard, J. H. T. (2001) · The Medical Journal of Australia · doi:10.5694/j.1326-5377.2001.tb143418.x · Cited by 1 · see citing works
The ethics of recruitment
Pearn, J. H. (2001) · The Medical Journal of Australia · doi:10.5694/j.1326-5377.2001.tb143415.x · Cited by 1 · see citing works
Evaluatie van patiëntenwerving via fysiotherapeuten in gerandomiseerd onderzoek met patiënten met lage rugpijn.
Ouwerkerk, J. W., Morren, M., & van Dulmen, S. (2008) · Data Archiving and Networked Services (DANS)
Doctors could know better
Bolton, P. G. M., Parker, S. M., Fergusson, K. J., & Orman, J. D. (2001) · The Medical Journal of Australia · doi:10.5694/j.1326-5377.2001.tb143417.x
Provider Interventions to Increase Uptake of Evidence-Based Treatment for Depression: A Systematic Review
Pedersen, E. R., Kandrack, R., Danz, M., Motala, A., Booth, M. J., Larkin, J., & Hempel, S. (2018) · Rand health quarterly · doi:10.7249/rhq-09-01-06
Medications are more heavily promoted than psychotherapies
Wilson, I. G. (2001) · The Medical Journal of Australia · doi:10.5694/j.1326-5377.2001.tb143416.x
Hindsight reveals room for improvement
Hunt, C. J., & Andrews, G. (2001) · The Medical Journal of Australia · doi:10.5694/j.1326-5377.2001.tb143419.x
Self-citation
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Nelson, M. R. (2001) · The Medical Journal of Australia · doi:10.5694/j.1326-5377.2001.tb143414.x
An investigation of practice and practitioner factors that influence the recruitment of patients to primary care based randomised controlled trials: case study of the Birmingham Atrial Fibrillation Treatment of the Aged (BAFTA) study
Fletcher, K. (2012) · University of Birmingham Institutional Research Archive (University of Birmingham)

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Randomised controlled trial of problem solving treatment, antidepressant medication, and combined treatment for major depression in primary care
Mynors‐Wallis, L. (2000) · BMJ · doi:10.1136/bmj.320.7226.26 · Cited by 451 · see citing works
Treatment of Depression in General Practice
Johnson, D. A. W. (1973) · BMJ · doi:10.1136/bmj.2.5857.18 · Cited by 133 · see citing works
The MIR Trial: lessons learned from conducting a Clinical Trial of an Investigational Medicinal Product (CTIMP) in general practices
Carter, M., Jenkinson, C. E., Campbell, J., Dickens, C. M., Tallon, D., & Kessler, D. (2016) · Bristol Research (University of Bristol)
Improving treatment of depression in primary health care: a case study of obstacles to perform a clinical trial designed to implement practice guidelines
Sundberg, L. R., Nyström, M. E., Krakau, I., & Sandahl, C. (2014) · Primary Health Care Research & Development · doi:10.1017/s1463423614000243 · Cited by 10 · see citing works

Authors: Hunt, C. J., Andrews, G., & Shepherd, L. M.
Affiliations: UNSW Sydney (AU)
St Vincent's Hospital Sydney (AU)
Corresponding author: Hunt, Caroline J
ORCID: Hunt, Caroline J
Andrews, Gavin
Venue: Medical Journal of Australia
Publisher: AMPCo
Published: 2001-02
Volume: 174
Issue: 3
Pages: 144-146
ISSN: 0025-729X (ISSN-L)
1326-5377
DOI: 10.5694/j.1326-5377.2001.tb143189.x
OpenAlex: W2398688178
Cited by: 48
References: 15
Citations by year: 2026: 1 · 2018: 2 · 2015: 2 · 2014: 3 · 2013: 3 · 2012: 5
FWCI: 4.93
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
doi.wiley.com/10.1002/tdm_license_1.1 (tdm)
Locations: The Medical Journal of Australia (publishedVersion)
PubMed (publishedVersion)
DigitalGeorgetown (Georgetown University Library) (submittedVersion)
Topics: Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics in Clinical Research
Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Keywords: randomized controlled trials, major depressive disorder, structured problem solving, selective serotonin reuptake inhibitors, primary care, general practitioners, exclusion criteria
MeSH terms: Australia, Depressive Disorder, Family Practice, Humans, Medical Audit, Practice Patterns, Physicians', Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Selective Serotonin Reuptake Inhibitors, Patient Selection

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Do doctors know best? Comments on a failed trial

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