Background To test the benefit of an early patient-driven Advance Care Planning (ACP) intervention using the “SENS”-structure we are conducting a multi-centre mixed methods trial in patients with cancer. Because difficulties recruiting patients for studies in early PC are documented the process needs distinct attention because of their often vulnerable situation.

Aim Due to a low inclusion rate of patient we needed to identify potential barriers for successful recruitment patients for ACP research.

Methods Analysis of reasons for non-inclusion of eligible patients and critical reflection of recruitment strategies. Used recruitment strategies: screening of tumour board lists, direct referral by oncologists, flexible timing of appointments with potential participants.

Results During the first 3 months the screening of 76 patients resulted in 6 eligibilities (7.9%) of which 1 patient gave consent. After appointing a senior physician to systematically screen patient and implementing innovative recruitment strategies the number of eligible participants raised to 18.5% with an actual participation of momentarily 27 patients and 3 dropouts. Identified barriers included difficulties locating eligible patients, severity of illness, putative provider protection due to differences in understanding of the term “early Palliative Care (PC)” and conflicting concepts of ACP.

Discussion/conclusion Conducting research in early PC implies careful planning of the recruitment process. A clear understanding of the clinical context, e.g. readiness of oncologists to talk about ACP and recognition of ACP as integral part of care, can improve recruitment. Detailed analysis of factors responsible for non-recruitment in ACP trials must be an integral part of the design in this type of studies.