What is this thing called "randomise"?

Capturing users' experiences of participating in cancer trials

Randomized controlled trials are accepted to be the research design of choice to evaluate the effectiveness of health care interventions and are commonly used to evaluate cancer treatments. There are concerns, however, that levels of recruitment to trials are often much lower than anticipated, particularly in cancer trials. Several research methods have been used to collect aspects of users' experiences of participating in cancer trials. Perhaps the most common method has been through measures of outcome and the impact of treatments on quality of life (QoL), using standardized schedules to capture physical, social and psychological health. In some areas of cancer, individual patient testimonies illuminate particular issues or narratives. Another body of research has grown around issues of user involvement in trials, including surveys of recruitment and participation, as well as investigations of patient preferences and experiences of participation. We searched MEDLINE and the Cochrane Trials Library from 1995 to 2001 for relevant publications. In this article, we review the literature in these areas and examine whether users' experiences of participating in cancer trials can be used to assist in the design or conduct of trials.

Experience with t-PA treatment in a large south American City

BACKGROUND AND PURPOSE

Early thrombolysis with intravenous recombinant tissue plasminogen activator (t-PA) reduces disability following ischemic stroke. However, only a small fraction of the potential candidates receive therapy. We studied the proportion of eligible patients who did not receive t-PA and the reasons therapy was withheld from patients admitted to a Brazilian university hospital.

METHODS

From July 1996 to June 1997, each suspected case of hyperacute ischemic stroke led to the immediate evaluation by a research physician. Patients first seen in primary care centers near the research hospital were to be rapidly transferred. Reasons for patient exclusion were detailed.

RESULTS

Fifty-six patients were evaluated; only 5 received t-PA therapy. The main reason for not receiving t-PA (34 cases) was late hospital arrival. This was caused by lack of recognition of the early stroke signs (n=13); delayed personal or family response (n=7); wrong medical orientation (n=4); and late patient transportation (n=10). A computed tomographic (CT) scand could not be done fast enough to allow therapy in 8 patients. Nine of 14 patients in whom neurological evaluation and CT scan were done within the 3-hour period were also excluded. The main reason was refusal of informed consent (n=5). Only a few patients were excluded because of medical contraindications (n=3) or the presence of early mass effect (n=1).

CONCLUSIONS

The main factor limiting access of patients with ischemic stroke to t-PA therapy in Rio de Janeiro is a low public awareness of early stroke symptoms and of the need for urgent hospital evaluation. Public education, an efficient transport system for suspected stroke patients, and optimization of the use of available CT scanners could have a significant impact on the number of treated patients.