Chronic rhinosinusitis: a qualitative study of patient and clinician experiences of the MACRO randomised controlled trial of surgical versus medical management
Chronic rhinosinusitis: a qualitative study of patient and clinician experiences of the MACRO randomised controlled trial of surgical versus medical management
OBJECTIVES: To explore patient and clinician experiences of participation in the MACRO randomised controlled trial (RCT)-which found endoscopic sinus surgery (ESS) to be clinically effective whereas clarithromycin was no better than placebo for chronic rhinosinusitis (CRS)-and to identify barriers and facilitators to the implementation of the trial results.
DESIGN: Qualitative study embedded within the multicentre MACRO RCT. Semistructured interviews with patients and clinicians were analysed using thematic analysis.
SETTING: 21 secondary and tertiary ear, nose and throat centres in England and Scotland participating in the MACRO RCT.
PARTICIPANTS: 20 CRS patients (16 with nasal polyps, 4 without) were interviewed approximately 6 months after trial completion, and 17 clinical staff including principal investigators (PIs), associate PIs and research nurses.
RESULTS: This study explored patients' and clinicians' experiences of the trial to identify barriers and facilitators to implementing the findings. Adopting the outcomes of the trial would involve recommending surgery to more patients with CRS. Yet patient and clinician interviews highlighted polarised views on ESS among patients, between those with positive experiences and expectations of ESS and those expressing fear of complications and hesitancy to receive surgery. During the trial, many participants randomised to surgery reported rapid improvement in symptoms, but with postoperative challenges for some patients including pain, unexpected symptoms and variations in recovery period. Priorities for implementation include providing patients with information about risks and support to make informed choices. Clinicians also reflected on the resource implications for offering ESS to more patients.
CONCLUSIONS: ESS is effective for CRS, but patient hesitancy and recovery concerns persist. Implementation requires clear communication, recognition and respect for individual preferences, tailored support for decision-making and post-surgical care to optimise acceptance and outcomes.
TRIAL REGISTRATION NUMBER: ISRCTN36962030.
Endoscopic surgery, OTOLARYNGOLOGY, Patient Preference, QUALITATIVE RESEARCH
e108999
Vennik, Jane
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Lockyer-Stevens (née McDermott), Clare
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Williams, Samantha
774c0255-e88f-4cae-a568-8bb420aedf08
Thomas, Mike
997c78e0-3849-4ce8-b1bc-86ebbdee3953
Boardman, Jim
a7d3e24b-5f0d-4401-a972-c2dc19be1d55
Philpott, Carl M
c4cb2471-a719-4ff7-806e-2c9b9bd2da9f
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Schilder, Anne
fdb4ab6d-9661-4c4e-8148-88795b7f18b8
Hopkins, Claire
8ed0a5e3-92a3-4988-9c2b-b0e51a8a044c
11 March 2026
Vennik, Jane
6ee78166-5a7a-433b-87fc-018771f20b19
Lockyer-Stevens (née McDermott), Clare
731edcc4-daf0-432d-98aa-45052beae320
Williams, Samantha
774c0255-e88f-4cae-a568-8bb420aedf08
Thomas, Mike
997c78e0-3849-4ce8-b1bc-86ebbdee3953
Boardman, Jim
a7d3e24b-5f0d-4401-a972-c2dc19be1d55
Philpott, Carl M
c4cb2471-a719-4ff7-806e-2c9b9bd2da9f
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Schilder, Anne
fdb4ab6d-9661-4c4e-8148-88795b7f18b8
Hopkins, Claire
8ed0a5e3-92a3-4988-9c2b-b0e51a8a044c
Vennik, Jane, Lockyer-Stevens (née McDermott), Clare, Williams, Samantha, Thomas, Mike, Boardman, Jim, Philpott, Carl M, Little, Paul, Schilder, Anne and Hopkins, Claire
(2026)
Chronic rhinosinusitis: a qualitative study of patient and clinician experiences of the MACRO randomised controlled trial of surgical versus medical management.
BJGP Open, 16 (3), , [e108999].
(doi:10.1136/bmjopen-2025-108999).
Abstract
OBJECTIVES: To explore patient and clinician experiences of participation in the MACRO randomised controlled trial (RCT)-which found endoscopic sinus surgery (ESS) to be clinically effective whereas clarithromycin was no better than placebo for chronic rhinosinusitis (CRS)-and to identify barriers and facilitators to the implementation of the trial results.
DESIGN: Qualitative study embedded within the multicentre MACRO RCT. Semistructured interviews with patients and clinicians were analysed using thematic analysis.
SETTING: 21 secondary and tertiary ear, nose and throat centres in England and Scotland participating in the MACRO RCT.
PARTICIPANTS: 20 CRS patients (16 with nasal polyps, 4 without) were interviewed approximately 6 months after trial completion, and 17 clinical staff including principal investigators (PIs), associate PIs and research nurses.
RESULTS: This study explored patients' and clinicians' experiences of the trial to identify barriers and facilitators to implementing the findings. Adopting the outcomes of the trial would involve recommending surgery to more patients with CRS. Yet patient and clinician interviews highlighted polarised views on ESS among patients, between those with positive experiences and expectations of ESS and those expressing fear of complications and hesitancy to receive surgery. During the trial, many participants randomised to surgery reported rapid improvement in symptoms, but with postoperative challenges for some patients including pain, unexpected symptoms and variations in recovery period. Priorities for implementation include providing patients with information about risks and support to make informed choices. Clinicians also reflected on the resource implications for offering ESS to more patients.
CONCLUSIONS: ESS is effective for CRS, but patient hesitancy and recovery concerns persist. Implementation requires clear communication, recognition and respect for individual preferences, tailored support for decision-making and post-surgical care to optimise acceptance and outcomes.
TRIAL REGISTRATION NUMBER: ISRCTN36962030.
Text
e108999.full
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Accepted/In Press date: 25 February 2026
Published date: 11 March 2026
Additional Information:
© Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY. Published by BMJ Group.
Keywords:
Endoscopic surgery, OTOLARYNGOLOGY, Patient Preference, QUALITATIVE RESEARCH
Identifiers
Local EPrints ID: 510476
URI: http://eprints.soton.ac.uk/id/eprint/510476
ISSN: 2398-3795
PURE UUID: 5d1d5d1d-1242-4368-8052-0d2d0973b470
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Date deposited: 13 Apr 2026 09:39
Last modified: 14 Apr 2026 01:55
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Contributors
Author:
Samantha Williams
Author:
Jim Boardman
Author:
Carl M Philpott
Author:
Anne Schilder
Author:
Claire Hopkins
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