Role of clinical research coordinators in promoting clinical trials of drugs for surgical patients

Navigating the challenges of clinical trial professionals in the healthcare sector

Clinical trials (CTs) are essential for medical advancements but face significant challenges, particularly in professional training and role clarity. Principal investigators, clinical research coordinators (CRCs), nurses, clinical trial pharmacists, and monitors are key players. Each faces unique challenges, such as maintaining protocol compliance, managing investigational products, and ensuring data integrity. Clinical trials' complexity and evolving nature demand specialized and ongoing training for these professionals. Addressing these challenges requires clear role delineation, continuous professional development, and supportive workplace environments to improve retention and trial outcomes. Enhanced training programs and a collaborative approach are essential for the successful conduct of clinical trials and the advancement of medical research.

Recruitment patterns in a large international randomized controlled trial of perioperative care in cancer patients

INTRODUCTION

The Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) randomized controlled trial (RCT) was the first study to prospectively enroll and randomize orthopedic oncology patients in multiple centers internationally. The objective of this study was to describe recruitment patterns, to examine the differences in enrollment across different PARITY sites, and to identify variables associated with differing levels of recruitment.

METHODS

Data from this study was obtained from the PARITY trial Methods Center and records of correspondence between the Methods Center and recruiting sites. We performed descriptive statistics to report the recruitment patterns over time. We compared recruitment, time to set up, and time to enroll the first patient between North American and international sites, private and public healthcare models, and the presence or absence of research personnel. Two-tailed non-paired t tests were performed to test average monthly recruitment rates between groups.

RESULTS

A total of 602 patients from 36 North American and 12 international sites were recruited from 2013 to 2019. North American sites were able to become fully enrollment-ready at an average of 19.5 months and international sites at an average of 27 months. Once enrolling, international sites were able to enroll 0.59 patients per/month whereas North American sites averaged a monthly recruitment rate of 0.2 patients/month once enrolling. Sites with research personnel reached enrollment-ready status at an average of 19.3 months and sites without research support at an average of 30.3 months. Once enrolling, the recruitment rate was 0.28 patients/month and 0.2 patients per month for sites with and without research support, respectively. Publicly funded sites had a monthly enrollment of 0.4 patients/month whereas privately funded sites had a monthly enrollment rate of 0.17 patients/month.

CONCLUSIONS

As a collaborative group, the PARITY investigators increased the pace of recruitment throughout the trial, likely by increasing the number of active sites. The longer time to start-up at international sites may be due to the complex governing regulations of pharmaceutical trials. Nevertheless, international sites should be considered essential as they recruited significantly more patients per month once active. The absence of research support personnel may lead to delays in the time to start-up. The results of the current study will provide guidance for choosing which sites to recruit for participation in future collaborative clinical trials in orthopedic oncology and other surgical specialties.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01479283 . Prospectively registered on November 24, 2011.

Present Status and Perspectives on Future Roles of Japanese Clinical Research Coordinators

Background

The new Clinical Trials Act that recently came into effect in Japan emphasizes the reliability of investigator-initiated clinical trials. Although Japanese clinical research coordinators have been mainly engaged in operational roles in industry-initiated clinical trials for drug approval (registration trials), broadening their contribution to cover more types of clinical research may lead to quality improvement of clinical research. To ultimately establish a clinical research infrastructure that meets the needs of the new era of Clinical Trials Act, here we gathered basic information on how clinical research coordinators might make such contributions.

Methods

We conducted a survey using self-reporting questionnaires in clinical research-related personnel to examine present status and the perspectives toward broader contribution of clinical research coordinators. The study participants were attendee of group discussion of a clinical research-related meeting in Shikoku area of Japan held in August 2017.

Results

Among 88 participants, 69 responded (response rate: 78.4%) and 68 respondents (98.6%) were engaged in support and management of clinical research. The main area of involvement was industry-initiated registration trials (48, 69.7%), and main roles of involvement were cooperators who plays roles under the guidance of investigators (41, 59.5%). When divided by occupation into clinical research coordinators (n = 41) and other clinical research-related personnel (n = 28), approximately half of the respondents in each group replied positively to wanting broader involvement of clinical research coordinators as a clinical research professional.

Conclusion

The present study revealed that about half of the clinical research coordinators and other clinical research-related personnel view a broadening of involvement of clinical research coordinators in research activities positively. Accordingly, a structured practical program aimed at encouraging such involvement may help to expand and strengthen their contribution into the future. Whether greater involvement of clinical research coordinators in clinical research will help to ensure the reliability of investigator-initiated clinical research warrants further study.

Research ethics consultation: an attempt and 5-year experience in a Japanese University Hospital

Objective

Research ethics consultation is an advisory activity that differs from ethics committees, and its role is not yet widely known in Japan. Research ethics consultations were started in 2012 by members of the Clinical Trial Center of Tokushima University Hospital, a support section for clinical trials. We analyzed the research ethics consultation records from Tokushima University Hospital during the 5-year period of 2012–2016 to examine the Japanese context of research ethics consultation.

Results

During the study period, 125 research ethics consultations were carried out, 115 (91%) before starting studies. All but one request were from investigators at Tokushima University. The main issue was compatibility with guidance and regulations (n = 74, 67.2%), such as ethical handling of human biological specimens and information utilized in research; only 6 (4.8%) requests involved research ethics issues that investigators face in their research. Therefore, it is necessary to expand the consultation function, with a nationwide system of consultant education and data sharing. Moreover, standardization of consultation should be considered.

Patients' level of medical term recognition as estimated by healthcare workers

To render risk communication between patients and healthcare workers more effective, gaps in the patients' level of medical term recognition as estimated by healthcare workers was examined. This was a cross-sectional study conducted via an Internet survey. A total of 244 nurses and 211 medical doctors were surveyed. We examined 90 medical terms, including 57 medical terms examined by the National Institute for Japanese Language and 33 newly added medical terms. Differences between medical doctors and nurses with respect to the estimation of patients' level of medical term recognition were assessed. The level of medical term recognition by patients was higher when estimated by nurses than when estimated by medical doctors. As members of team care, nurses must consider that patients find technical medical terms to be more difficult than anticipated and that patients are aware of these terms only to a certain extent while receiving healthcare information, such as drug information. Currently, nurses are expected to perform activities as clinical research coordinators and also are requested to work as home-visiting nurses. Therefore they also need ensure that patients understand the medical information provided to them.

A worldwide investigation of critical care research coordinators' self-reported role and professional development priorities: the winner survey

AIMS AND OBJECTIVES

To describe the self-reported role and professional development priorities of research coordinators in different regions of the world.

BACKGROUND

Research coordinators employed in critical care settings provide clinical and technical expertise in the development, conduct and completion of clinical research studies. Knowledge of this specialised role is well established in some parts of the world, yet emerging in others.

DESIGN

Descriptive exploratory study involving research coordinators outside of Australia and New Zealand.

METHOD

An anonymous, structured, multiple-choice, web-based questionnaire conducted between April-May 2011.

RESULTS

There were 80 respondents from North America (61%), Europe (29%) and Latin America (10%). The majority of respondents performed data collection and obtained informed consent, and half had presented study findings at conferences or wrote scholarly articles, despite a greater willingness to do so. Requisite skills for the research coordinator role included clinical research knowledge, creative problem solving and the ability to identify/resolve ethical questions. 'Best' reported aspects of the role were promotion of evidence-based clinical practice, intellectual stimulation and autonomy. 'Worst' aspects included heavy workload, lack of funding and recognition.

CONCLUSION

Research coordinators working in critical care settings collect data, require clinical research knowledge and problem-solving skills and are interested in, but have less confidence in, dissemination of research findings. They feel isolated with a lack of support and inadequate remuneration for the effort and time required to maintain the high standards of their role. This is outweighed by the satisfaction derived from promoting the research process and autonomy. Further observational studies aimed at clarifying and advancing the role of the research coordinator is warranted.

RELEVANCE TO CLINICAL PRACTICE

This study offers insight into the global roles and responsibilities as reported by research coordinators employed in critical care settings.

Solving the challenges of large multicenter trials in anesthesia

This paper describes many of the challenges encountered when establishing a large multicentre trial in cardiac anesthesia. We address funding, authorship, multisite ethics review, patient recruitment, data quality management, communication with individual sites, and strategies to enhance cooperation and patient recruitment.