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Manyara AM, Purvis A, Ciani O, Collins GS, Taylor RS. Sample size in multistakeholder Delphi surveys: at what minimum sample size do replicability of results stabilize? J Clin Epidemiol 2024; 174:111485. [PMID: 39069013 DOI: 10.1016/j.jclinepi.2024.111485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/19/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND AND OBJECTIVE The minimum sample size for multistakeholder Delphi surveys remains understudied. Drawing from three large international multistakeholder Delphi surveys, this study aimed to: 1) investigate the effect of increasing sample size on replicability of results; 2) assess whether the level of replicability of results differed with participant characteristics: for example, gender, age, and profession. METHODS We used data from Delphi surveys to develop guidance for improved reporting of health-care intervention trials: SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) and CONSORT (Consolidated Standards of Reporting Trials) extension for surrogate end points (n = 175, 22 items rated); CONSORT-SPI [CONSORT extension for Social and Psychological Interventions] (n = 333, 77 items rated); and core outcome set for burn care (n = 553, 88 items rated). Resampling with replacement was used to draw random subsamples from the participant data set in each of the three surveys. For each subsample, the median value of all rated survey items was calculated and compared to the medians from the full participant data set. The median number (and interquartile range) of medians replicated was used to calculate the percentage replicability (and variability). High replicability was defined as ≥80% and moderate as 60% and <80% RESULTS: The average median replicability (variability) as a percentage of total number of items rated from the three datasets was 81% (10%) at a sample size of 60. In one of the datasets (CONSORT-SPI), a ≥80% replicability was reached at a sample size of 80. On average, increasing the sample size from 80 to 160 increased the replicability of results by a further 3% and reduced variability by 1%. For subgroup analysis based on participant characteristics (eg, gender, age, professional role), using resampled samples of 20 to 100 showed that a sample size of 20 to 30 resulted to moderate replicability levels of 64% to 77%. CONCLUSION We found that a minimum sample size of 60-80 participants in multistakeholder Delphi surveys provides a high level of replicability (≥80%) in the results. For Delphi studies limited to individual stakeholder groups (such as researchers, clinicians, patients), a sample size of 20 to 30 per group may be sufficient.
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Affiliation(s)
- Anthony Muchai Manyara
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK; Global Health and Ageing Research Unit, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Anthony Purvis
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Oriana Ciani
- Centre for Research on Health and Social Care Management, SDA Bocconi School of Management, Milan, Italy
| | - Gary S Collins
- UK EQUATOR Centre, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Nickolls BJ, Relton C, Hemkens L, Zwarenstein M, Eldridge S, McCall SJ, Griffin XL, Sohanpal R, Verkooijen HM, Maguire JL, McCord KA. Randomised trials conducted using cohorts: a scoping review. BMJ Open 2024; 14:e075601. [PMID: 38458814 PMCID: PMC10928784 DOI: 10.1136/bmjopen-2023-075601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 11/24/2023] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION Cohort studies generate and collect longitudinal data for a variety of research purposes. Randomised controlled trials (RCTs) increasingly use cohort studies as data infrastructures to help identify and recruit trial participants and assess outcomes. OBJECTIVE To examine the extent, range and nature of research using cohorts for RCTs and describe the varied definitions and conceptual boundaries for RCTs using cohorts. DESIGN Scoping review. DATA SOURCES Searches were undertaken in January 2021 in MEDLINE (Ovid) and EBM Reviews-Cochrane Methodology Registry (Final issue, third Quarter 2012). ELIGIBILITY CRITERIA Reports published between January 2007 and December 2021 of (a) cohorts used or planned to be used, to conduct RCTs, or (b) RCTs which use cohorts to recruit participants and/or collect trial outcomes, or (c) methodological studies discussing the use of cohorts for RCTs. DATA EXTRACTION AND SYNTHESIS Data were extracted on the condition being studied, age group, setting, country/continent, intervention(s) and comparators planned or received, unit of randomisation, timing of randomisation, approach to informed consent, study design and terminology. RESULTS A total of 175 full-text articles were assessed for eligibility. We identified 61 protocols, 9 descriptions of stand-alone cohorts intended to be used for future RCTs, 39 RCTs using cohorts and 34 methodological papers.The use and scope of this approach is growing. The thematics of study are far-ranging, including population health, oncology, mental and behavioural disorders, and musculoskeletal conditions.Authors reported that this approach can lead to more efficient recruitment, more representative samples, and lessen disappointment bias and crossovers. CONCLUSION This review outlines the development of cohorts to conduct RCTs including the range of use and innovative changes and adaptations. Inconsistencies in the use of terminology and concepts are highlighted. Guidance now needs to be developed to support the design and reporting of RCTs conducted using cohorts.
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Affiliation(s)
- Beverley Jane Nickolls
- Centre for Evaluation and Methods, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Clare Relton
- Centre for Evaluation and Methods, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Lars Hemkens
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
- Meta-Research Innovation Center Berlin (METRICS-B), Berlin Institute of Health, Berlin, Germany
| | - Merrick Zwarenstein
- Department of Family Medicine, Western University, London, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Sandra Eldridge
- Centre for Evaluation and Methods, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Stephen J McCall
- National Perinatal Epidemiology Unit, Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Ras Beirut, Lebanon
| | - Xavier Luke Griffin
- Bone and Joint Health, Blizard Institute, Queen Mary University of London, London, UK
- Barts Health NHS Trust, Royal London Hospital, London, UK
| | - Ratna Sohanpal
- Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Helena M Verkooijen
- University Medical Centre Utrecht, Utrecht, The Netherlands
- University of Utrecht, Utrecht, The Netherlands
| | - Jonathon L Maguire
- University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada
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Baba A, Tay J, Sammy A, Douglas WA, Goren K, Krause KR, Howie AH, Little J, Oskoui M, Taljaard M, Thombs BD, Potter BK, Butcher NJ, Offringa M. Paper I: Heterogeneous use of registry data for participant identification and primary outcome ascertainment is found in registry-based randomized controlled trials: A scoping review. J Clin Epidemiol 2023; 159:289-299. [PMID: 37146658 DOI: 10.1016/j.jclinepi.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/20/2023] [Accepted: 04/26/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVES Registry-based randomized controlled trials (RRCTs) have potential to address limitations of traditional clinical trials. To describe their current use, information on planned and published RRCTs was identified and synthesized. STUDY DESIGN AND SETTING A scoping review of published RRCT protocols and reports was conducted. Articles published between 2010 and 2021 identified from electronic database searching, a recent review of RRCTs, and targeted searching for recent RRCT protocols (2018-2021) were screened. Data on trial data sources, types of primary outcomes, and how these primary outcomes were described, selected, and reported were extracted. RESULTS Ninety RRCT articles (77 reports; 13 protocols) were included. Forty nine (54%) used or planned to rely on registry data for their trial, 26 (29%) used both registry and additional data, and 15 (17%) used the registry solely for recruitment. Primary outcomes were routinely collected from the registry for 66 articles (73%). Only 28 articles (31%) described any methods to promote outcome data quality during or after data collection. Core outcome sets were not used in any of the trials. CONCLUSION With improvements in registry design, outcome selection, measurement, and reporting, future RRCTs may deliver on promises of efficient, high-quality trials that address clinically relevant questions.
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Affiliation(s)
- Ami Baba
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, Canada M5G 0A4
| | - Joanne Tay
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, Canada M5G 0A4
| | - Adrian Sammy
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, Canada M5G 0A4
| | - William A Douglas
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, Canada M5G 0A4
| | - Katherine Goren
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, Canada M5G 0A4
| | - Karolin R Krause
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, 1000 Queen Street W, Toronto, Ontario, Canada M6J 1H4
| | - Alison H Howie
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, Canada K1G 5Z3
| | - Julian Little
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, Canada K1G 5Z3
| | - Maryam Oskoui
- Faculty of Medicine and Health Sciences, Department of Pediatrics, McGill University, 3605 Rue de la Montagne, Montréal, Quebec, Canada H3G 2M1
| | - Monica Taljaard
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, Canada K1G 5Z3; Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, Canada K1H 8L6
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Chem. de la Côte-Sainte-Catherine, Montréal, Quebec, Canada H3T 1E2; Departments of Psychiatry, Epidemiology, Biostatistics, and Occupational Health, Medicine, Psychology, and Biomedical Ethics Unit, McGill University, 845 Sherbrooke St W, Montreal, Quebec, Canada H3A 0G4
| | - Beth K Potter
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, Ontario, Canada K1G 5Z3
| | - Nancy J Butcher
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, Canada M5G 0A4; Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, 1000 Queen Street W, Toronto, Ontario, Canada M6J 1H4; Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, Ontario, Canada M5T 1R8
| | - Martin Offringa
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, Canada M5G 0A4; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, Ontario, Canada M5T 3M6; Division of Neonatology, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8.
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Dixon SN, Naylor KL, Yohanna S, McKenzie S, Belenko D, Blake PG, Coghlan C, Cooper R, Elliott L, Getchell L, Ki V, Mucsi I, Nesrallah G, Patzer RE, Presseau J, Reich M, Sontrop JM, Treleaven D, Waterman AD, Zaltzman J, Garg AX. Enhance Access to Kidney Transplantation and Living Kidney Donation (EnAKT LKD): Statistical Analysis Plan of a Registry-Based, Cluster-Randomized Clinical Trial. Can J Kidney Health Dis 2022; 9:20543581221131201. [PMID: 36438439 PMCID: PMC9693773 DOI: 10.1177/20543581221131201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/05/2022] [Indexed: 11/05/2023] Open
Abstract
BACKGROUND Enhance Access to Kidney Transplantation and Living Kidney Donation (EnAKT LKD) is a quality improvement intervention designed to enhance access to kidney transplantation and living kidney donation. We conducted a cluster-randomized clinical trial to evaluate the effect of the intervention versus usual care on completing key steps toward receiving a kidney transplant. OBJECTIVE To prespecify the statistical analysis plan for the EnAKT LKD trial. DESIGN The EnAKT LKD trial is a pragmatic, 2-arm, parallel-group, registry-based, open-label, cluster-randomized, superiority, clinical trial. Randomization was performed at the level of the chronic kidney disease (CKD) programs (the "clusters"). SETTING Twenty-six CKD programs in Ontario, Canada. PARTICIPANTS More than 10 000 patients with advanced CKD (ie, patients approaching the need for dialysis or receiving maintenance dialysis) with no recorded contraindication to receiving a kidney transplant. METHODS The trial data (including patient characteristics and outcomes) will be obtained from linked administrative health care databases (the "registry"). Stratified covariate-constrained randomization was used to allocate the 26 CKD programs (1:1) to provide the intervention or usual care from November 1, 2017, to December 31, 2021 (4.17 years). CKD programs in the intervention arm received the following: (1) support for local quality improvement teams and administrative needs; (2) tailored education and resources for staff, patients, and living kidney donor candidates; (3) support from kidney transplant recipients and living kidney donors; and (4) program-level performance reports and oversight by program leaders. OUTCOMES The primary outcome is completing key steps toward receiving a kidney transplant, where up to 4 unique steps per patient will be considered: (1) patient referred to a transplant center for evaluation, (2) a potential living kidney donor begins their evaluation at a transplant center to donate a kidney to the patient, (3) patient added to the deceased donor transplant waitlist, and (4) patient receives a kidney transplant from a living or deceased donor. ANALYSIS PLAN Using an intent-to-treat approach, the primary outcome will be analyzed using a patient-level constrained multistate model adjusting for the clustering in CKD programs. TRIAL STATUS The EnAKT LKD trial period is November 1, 2017, to December 31, 2021. We expect to analyze and report the results once the data for the trial period is available in linked administrative health care databases. TRIAL REGISTRATION The EnAKT LKD trial is registered with the U.S. National Institute of Health at clincaltrials.gov (NCT03329521 available at https://clinicaltrials.gov/ct2/show/NCT03329521). STATISTICAL ANALYTIC PLAN Version 1.0 August 26, 2022.
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Affiliation(s)
- Stephanie N. Dixon
- Lawson Health Research Institute, London, Ontario, Canada
- London Health Sciences Centre, London, Ontario, Canada
- ICES, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Kyla L. Naylor
- Lawson Health Research Institute, London, Ontario, Canada
- London Health Sciences Centre, London, Ontario, Canada
- ICES, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | | | | | - Dmitri Belenko
- Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
| | - Peter G Blake
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
- Division of Nephrology, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Candice Coghlan
- Centre for Living Organ Donation, University Health Network, Toronto, Ontario, Canada
| | - Rebecca Cooper
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
- Trillium Gift of Life Network, Ontario Health, Toronto, Ontario, Canada
| | - Lori Elliott
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
| | - Leah Getchell
- Lawson Health Research Institute, London, Ontario, Canada
- London Health Sciences Centre, London, Ontario, Canada
- Can-SOLVE CKD Network, Vancouver, British Columbia, Canada
| | - Vincent Ki
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
- Trillium Health Partners, Mississauga, Ontario, Canada
| | - Istvan Mucsi
- Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
- Ajmera Transplant Center, University Health Network, Toronto, Ontario, Canada
| | - Gihad Nesrallah
- Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Humber River Regional Hospital, Toronto, Ontario, Canada
| | - Rachel E. Patzer
- Health Services Research Center, Emory University School of Medicine, Atlanta, Ontario, USA
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada
| | - Marian Reich
- Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease, Patient Council, Vancouver, British Columbia, Canada
| | - Jessica M. Sontrop
- Lawson Health Research Institute, London, Ontario, Canada
- London Health Sciences Centre, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Darin Treleaven
- McMaster University, Hamilton, Ontario, Canada
- Trillium Gift of Life Network, Ontario Health, Toronto, Ontario, Canada
| | - Amy D. Waterman
- Department of Surgery and J.C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, TX, USA
| | - Jeffrey Zaltzman
- Trillium Gift of Life Network, Ontario Health, Toronto, Ontario, Canada
- Division of Nephrology, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Amit X. Garg
- Lawson Health Research Institute, London, Ontario, Canada
- ICES, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- McMaster University, Hamilton, Ontario, Canada
- Ontario Renal Network, Ontario Health, Toronto, Ontario, Canada
- Division of Nephrology, London Health Sciences Centre, Western University, London, Ontario, Canada
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Manyara AM, Davies P, Stewart D, Weir CJ, Young A, Butcher NJ, Bujkiewicz S, Chan AW, Collins GS, Dawoud D, Offringa M, Ouwens M, Ross JS, Taylor RS, Ciani O. Protocol for the development of SPIRIT and CONSORT extensions for randomised controlled trials with surrogate primary endpoints: SPIRIT-SURROGATE and CONSORT-SURROGATE. BMJ Open 2022; 12:e064304. [PMID: 36220321 PMCID: PMC9557267 DOI: 10.1136/bmjopen-2022-064304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 09/27/2022] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Randomised controlled trials (RCTs) may use surrogate endpoints as substitutes and predictors of patient-relevant/participant-relevant final outcomes (eg, survival, health-related quality of life). Translation of effects measured on a surrogate endpoint into health benefits for patients/participants is dependent on the validity of the surrogate; hence, more accurate and transparent reporting on surrogate endpoints is needed to limit misleading interpretation of trial findings. However, there is currently no explicit guidance for the reporting of such trials. Therefore, we aim to develop extensions to the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) and CONSORT (Consolidated Standards of Reporting Trials) reporting guidelines to improve the design and completeness of reporting of RCTs and their protocols using a surrogate endpoint as a primary outcome. METHODS AND ANALYSIS The project will have four phases: phase 1 (literature reviews) to identify candidate reporting items to be rated in a Delphi study; phase 2 (Delphi study) to rate the importance of items identified in phase 1 and receive suggestions for additional items; phase 3 (consensus meeting) to agree on final set of items for inclusion in the extensions and phase 4 (knowledge translation) to engage stakeholders and disseminate the project outputs through various strategies including peer-reviewed publications. Patient and public involvement will be embedded into all project phases. ETHICS AND DISSEMINATION The study has received ethical approval from the University of Glasgow College of Medical, Veterinary and Life Sciences Ethics Committee (project no: 200210051). The findings will be published in open-access peer-reviewed publications and presented in conferences, meetings and relevant forums.
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Affiliation(s)
- Anthony Muchai Manyara
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, Glasgow, UK, University of Glasgow, Glasgow, UK
| | - Philippa Davies
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Christopher J Weir
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Amber Young
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nancy J Butcher
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluation Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sylwia Bujkiewicz
- Biostatistics Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - An-Wen Chan
- Women's College Institute Research Institute, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Dalia Dawoud
- National Institute for Health and Care Excellence, London, UK
| | - Martin Offringa
- Child Health Evaluation Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Joseph S Ross
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
- Section of General Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Rod S Taylor
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, Glasgow, UK, University of Glasgow, Glasgow, UK
- Robertson Centre for Biostatistics, School of Health and Well Being, University of Glasgow, Glasgow, UK
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McCall SJ, Imran M, Hemkens LG, Mc Cord K, Kwakkenbos L, Sampson M, Jawad S, Zwarenstein M, Relton C, Langan SM, Moher D, Fröbert O, Thombs BD, Gale C, Juszczak E. Reporting transparency and completeness in trials: Paper 4 - reporting of randomised controlled trials conducted using routinely collected electronic records - room for improvement. J Clin Epidemiol 2022; 141:198-209. [PMID: 34525409 PMCID: PMC8982641 DOI: 10.1016/j.jclinepi.2021.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 07/27/2021] [Accepted: 09/07/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To describe characteristics of randomized controlled trials (RCTs) conducted using electronic health records (EHRs), including completeness and transparency of reporting assessed against the 2021 CONSORT Extension for RCTs Conducted Using Cohorts and Routinely Collected Data (CONSORT-ROUTINE) criteria. STUDY DESIGN MEDLINE and Cochrane Methodology Register were searched for a sample of RCTs published from 2011-2018. Completeness of reporting was assessed in a random sample using a pre-defined coding form. RESULTS Of the 183 RCT publications identified, 122 (67%) used EHRs to identify eligible participants, 139 (76%) used the EHR as part of the intervention and 137 (75%) to ascertain outcomes. When 60 publications were evaluated against the CONSORT 2010 item and the corresponding extension for the 8 modified items, four items were 'adequately reported' for most trials. Five new reporting items were identified for the CONSORT-ROUTINE extension; when evaluated, one was 'adequately reported', three were reported 'inadequately or not at all', the other 'partially'. There were, however, some encouraging signs with adequate and partial reporting of many important items, including descriptions of trial design, the consent process, outcome ascertainment and interpretation. CONCLUSION Aspects of RCTs using EHRs are sub-optimally reported. Uptake of the CONSORT-ROUTINE Extension may improve reporting.
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Affiliation(s)
- Stephen J McCall
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit Clinical Trials Unit, University of Oxford, Oxford, United Kingdom; Center for Research on Population and Health, American University of Beirut, Ras Beirut, Lebanon
| | - Mahrukh Imran
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Lars G Hemkens
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Kimberly Mc Cord
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Linda Kwakkenbos
- Behavioural Science Institute, Clinical Psychology, Radboud University, Nijmegen, the Netherlands
| | - Margaret Sampson
- Library Services, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Sena Jawad
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Merrick Zwarenstein
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Clare Relton
- Centre for Clinical Trials and Methodology, Barts Institute of Population Health Science, Queen Mary University, London, United Kingdom
| | - Sinéad M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Ole Fröbert
- Department of Cardiology, Faculty of Health, Örebro University, Örebro, Sweden
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health,McGill University, Montreal, Quebec, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada; Department of Psychology, McGill University, Montreal, Quebec, Canada; Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Edmund Juszczak
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit Clinical Trials Unit, University of Oxford, Oxford, United Kingdom; Nottingham Clinical Trials Unit, Applied Health Research Building, University of Nottingham, Nottingham, United Kingdom.
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Dixon SN, Sontrop JM, Al-Jaishi A, Killin L, McIntyre CW, Anderson S, Bagga A, Benjamin D, Blake P, Devereaux PJ, Iliescu E, Jain A, Lok CE, Nesrallah G, Oliver MJ, Pandeya S, Sood MM, Tam P, Wald R, Walsh M, Zwarenstein M, Garg AX. MyTEMP: Statistical Analysis Plan of a Registry-Based, Cluster-Randomized Clinical Trial. Can J Kidney Health Dis 2021; 8:20543581211041182. [PMID: 34471542 PMCID: PMC8404662 DOI: 10.1177/20543581211041182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/13/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Major Outcomes with Personalized Dialysate TEMPerature (MyTEMP) is a 4-year cluster-randomized clinical trial comparing the effect of using a personalized, temperature-reduced dialysate protocol versus a dialysate temperature of 36.5°C on cardiovascular-related death and hospitalization. Randomization was performed at the level of the dialysis center (“the cluster”). Objective: The objective is to outline the statistical analysis plan for the MyTEMP trial. Design: MyTEMP is a pragmatic, 2-arm, parallel-group, registry-based, open-label, cluster-randomized trial. Setting: A total of 84 dialysis centers in Ontario, Canada. Patients: Approximately 13 500 patients will have received in-center hemodialysis at the 84 participating dialysis centers during the trial period (April 3, 2017, to March 1, 2021, with a maximum follow-up to March 31, 2021). Methods: Patient identification, baseline characteristics, and study outcomes will be obtained primarily through Ontario administrative health care databases held at ICES. Covariate-constrained randomization was used to allocate the 84 dialysis centers (1:1) to the intervention group or the control group. Centers in the intervention group used a personalized, temperature-reduced dialysate protocol, and centers in the control group used a fixed dialysate temperature of 36.5°C. Outcomes: The primary outcome is a composite of cardiovascular-related death or major cardiovascular-related hospitalization (defined as a hospital admission with myocardial infarction, congestive heart failure, or ischemic stroke) recorded in administrative health care databases. The key secondary outcome is the mean drop in intradialytic systolic blood pressure, defined as the patients’ predialysis systolic blood pressure minus their nadir systolic blood pressure during the dialysis treatment. Anonymized data on patients’ predialysis and intradialytic systolic blood pressure were collected at monthly intervals from each dialysis center. Analysis plan: The primary analysis will follow an intent-to-treat approach. The primary outcome will be analyzed at the patient level as the hazard ratio of time-to-first event, estimated from a subdistribution hazards model. Within-center correlation will be accounted for using a robust sandwich estimator. In the primary analysis, patients’ observation time will end if they experience the primary outcome, emigrate from Ontario, or die of a noncardiovascular cause (which will be treated as a competing risk event). The between-group difference in the mean drop in intradialytic systolic blood pressure obtained during the dialysis sessions throughout the trial period will be analyzed at the center level using an unadjusted random-effects linear mixed model. Trial status: The MyTEMP trial period is April 3, 2017, to March 31, 2021. We expect to analyze and report results by 2023 once the updated data are available at ICES. Trial registration: MyTEMP is registered with the US National Institutes of Health at clincaltrials.gov (NCT02628366). Statistical analytic plan: Version 1.1 June 15, 2021.
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Affiliation(s)
- Stephanie N Dixon
- Lawson Health Research Institute, London, ON, Canada.,ICES, London, ON, Canada.,Western University, London, ON, Canada
| | - Jessica M Sontrop
- Lawson Health Research Institute, London, ON, Canada.,Western University, London, ON, Canada
| | - Ahmed Al-Jaishi
- Lawson Health Research Institute, London, ON, Canada.,ICES, London, ON, Canada.,McMaster University, Hamilton, ON, Canada
| | - Lauren Killin
- Lawson Health Research Institute, London, ON, Canada.,ICES, London, ON, Canada
| | - Christopher W McIntyre
- Lawson Health Research Institute, London, ON, Canada.,Western University, London, ON, Canada.,London Health Sciences Centre, ON, Canada
| | | | | | - Derek Benjamin
- Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | - Peter Blake
- Lawson Health Research Institute, London, ON, Canada.,Western University, London, ON, Canada.,London Health Sciences Centre, ON, Canada
| | | | | | - Arsh Jain
- ICES, London, ON, Canada.,Western University, London, ON, Canada.,London Health Sciences Centre, ON, Canada
| | | | - Gihad Nesrallah
- University of Toronto, ON, Canada.,Nephrology Program, Humber River Hospital, Toronto, ON, Canada
| | - Matthew J Oliver
- University of Toronto, ON, Canada.,Division of Nephrology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Manish M Sood
- ICES, London, ON, Canada.,Ottawa Hospital Research Institute, ON, Canada.,University of Ottawa, ON, Canada
| | - Paul Tam
- Scarborough Health Network, Toronto, ON, Canada
| | - Ron Wald
- ICES, London, ON, Canada.,University of Toronto, ON, Canada.,St. Michael's Hospital, Toronto, ON, Canada
| | - Michael Walsh
- McMaster University, Hamilton, ON, Canada.,St. Joseph's Healthcare Hamilton, ON, Canada
| | | | - Amit X Garg
- ICES, London, ON, Canada.,Western University, London, ON, Canada.,McMaster University, Hamilton, ON, Canada.,London Health Sciences Centre, ON, Canada
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8
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McCarthy M, O'Keeffe L, Williamson PR, Sydes MR, Farrin A, Lugg-Widger F, Davies G, Avery K, Chan AW, Kwakkenbos L, Thombs BD, Watkins A, Hemkens LG, Gale C, Zwarenstein M, Langan SM, Thabane L, Juszczak E, Moher D, Kearney PM. A study protocol for the development of a SPIRIT extension for trials conducted using cohorts and routinely collected data (SPIRIT-ROUTINE). HRB Open Res 2021; 4:82. [PMID: 34877471 PMCID: PMC8609390 DOI: 10.12688/hrbopenres.13314.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Protocols are an essential document for conducting randomised controlled trials (RCTs). However, the completeness of the information provided is often inadequate. To help improve the content of trial protocols, an international group of stakeholders published the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) Initiative in 2013. Presently, there is increasing use of cohorts and routinely collected data (RCD) for RCTs because these data have the potential to improve efficiencies by facilitating recruitment, simplifying, and reducing the cost of data collection. Reporting guidelines have been shown to improve the quality of reporting, but there is currently no specific SPIRIT guidance on protocols for trials conducted using cohorts and RCD. This protocol outlines steps for developing SPIRIT-ROUTINE, which aims to address this gap by extending the SPIRIT guidance to protocols for trials conducted using cohorts and RCD. Methods: The development of the SPIRIT-ROUTINE extension comprises five stages. Stage 1 consists of a project launch and a meeting to finalise the membership of the steering group and scope of the extension. In Stage 2, a rapid review will be performed to identify possible modifications to the original SPIRIT 2013 checklist. Other key reporting guidelines will be reviewed to identify areas where additional items may be needed, such as the Consolidated Standards of Reporting Trials (CONSORT) extension for trials conducted using cohorts and RCD (CONSORT-ROUTINE). Stage 3 will involve an online Delphi exercise, consisting of two rounds and involving key international stakeholders to gather feedback on the preliminary checklist items. In Stage 4, a consensus meeting of the SPIRIT-ROUTINE steering group will finalise the items to include in the extension. Stage 5 will involve the publication preparation and dissemination of the final checklist. Conclusion: The SPIRIT-ROUTINE extension will contribute to improving design of trials using cohorts and RCD and transparency of reporting.
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Affiliation(s)
- Megan McCarthy
- School of Public Health, University College Cork, Cork, T12 XF62, Ireland
| | - Linda O'Keeffe
- School of Public Health, University College Cork, Cork, T12 XF62, Ireland
| | - Paula R. Williamson
- MRC/NIHR Trials Methodology Research Partnership, Department of Health Data Science, a member of Liverpool Health Partners, University of Liverpool, Liverpool, L69 3BX, UK
| | - Matthew R. Sydes
- MRC Clinical Trials Unit at UCL, University College London, London, WC1V 6LJ, UK
| | - Amanda Farrin
- CTRU at Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Fiona Lugg-Widger
- Centre for Trials Research, Cardiff University, Cardiff, CF14 4YS, UK
| | - Gwyneth Davies
- UCL Great Ormond Street Institute of Child Health, University College London, London, WC1N 1EH, UK
| | - Kerry Avery
- National Institute for Health Research Bristol Biomedical Research Centre and Bristol Centre for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, 1QU BS8, UK
| | - An-Wen Chan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5T 3M6, Canada
| | - Linda Kwakkenbos
- Department of Psychology, Radboud University, Nijmegen, 6525 XZ, The Netherlands
| | - Brett D. Thombs
- Faculty of Medicine, McGill University, Lady Davis Institute of Medical Research, Jewish General Hospital, Montreal, H3T 1E2, Canada
| | - Alan Watkins
- Swansea University Medical School, Swansea University, Swansea, SA2 8QA, UK
| | - Lars G. Hemkens
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Imperial College London, Chelsea and Westminster campus, London, SW7 2AZ, UK
| | | | - Sinead M. Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, L8S 4K1, Canada
| | - Edmund Juszczak
- Nottingham Clinical Trials Unit, School of Medicine, University of Nottingham, Nottingham, NG7 2RD, UK
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada
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9
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Rogers JR, Lee J, Zhou Z, Cheung YK, Hripcsak G, Weng C. Contemporary use of real-world data for clinical trial conduct in the United States: a scoping review. J Am Med Inform Assoc 2021; 28:144-154. [PMID: 33164065 DOI: 10.1093/jamia/ocaa224] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/11/2020] [Accepted: 09/02/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Real-world data (RWD), defined as routinely collected healthcare data, can be a potential catalyst for addressing challenges faced in clinical trials. We performed a scoping review of database-specific RWD applications within clinical trial contexts, synthesizing prominent uses and themes. MATERIALS AND METHODS Querying 3 biomedical literature databases, research articles using electronic health records, administrative claims databases, or clinical registries either within a clinical trial or in tandem with methodology related to clinical trials were included. Articles were required to use at least 1 US RWD source. All abstract screening, full-text screening, and data extraction was performed by 1 reviewer. Two reviewers independently verified all decisions. RESULTS Of 2020 screened articles, 89 qualified: 59 articles used electronic health records, 29 used administrative claims, and 26 used registries. Our synthesis was driven by the general life cycle of a clinical trial, culminating into 3 major themes: trial process tasks (51 articles); dissemination strategies (6); and generalizability assessments (34). Despite a diverse set of diseases studied, <10% of trials using RWD for trial process tasks evaluated medications or procedures (5/51). All articles highlighted data-related challenges, such as missing values. DISCUSSION Database-specific RWD have been occasionally leveraged for various clinical trial tasks. We observed underuse of RWD within conducted medication or procedure trials, though it is subject to the confounder of implicit report of RWD use. CONCLUSION Enhanced incorporation of RWD should be further explored for medication or procedure trials, including better understanding of how to handle related data quality issues to facilitate RWD use.
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Affiliation(s)
- James R Rogers
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Junghwan Lee
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Ziheng Zhou
- Institute of Human Nutrition, Columbia University, New York, New York, USA
| | - Ying Kuen Cheung
- Department of Biostatistics, Columbia University, New York, New York, USA, and
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, New York, USA.,Medical Informatics Services, New York-Presbyterian Hospital, New York, New York, USA
| | - Chunhua Weng
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
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10
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Kwakkenbos L, Imran M, McCall SJ, McCord KA, Fröbert O, Hemkens LG, Zwarenstein M, Relton C, Rice DB, Langan SM, Benchimol EI, Thabane L, Campbell MK, Sampson M, Erlinge D, Verkooijen HM, Moher D, Boutron I, Ravaud P, Nicholl J, Uher R, Sauvé M, Fletcher J, Torgerson D, Gale C, Juszczak E, Thombs BD. CONSORT extension for the reporting of randomised controlled trials conducted using cohorts and routinely collected data (CONSORT-ROUTINE): checklist with explanation and elaboration. BMJ 2021; 373:n857. [PMID: 33926904 PMCID: PMC8082311 DOI: 10.1136/bmj.n857] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2021] [Indexed: 12/30/2022]
Affiliation(s)
- Linda Kwakkenbos
- Behavioural Science Institute, Clinical Psychology, Radboud University, Nijmegen, Netherlands
| | - Mahrukh Imran
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - Stephen J McCall
- National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Ras Beirut, Lebanon
| | - Kimberly A McCord
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ole Fröbert
- Örebro University, Faculty of Health, Department of Cardiology, Örebro, Sweden
| | - Lars G Hemkens
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Palo Alto, USA
- Meta-Research Innovation Centre Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
| | - Merrick Zwarenstein
- Department of Family Medicine, Western University, London, Canada
- ICES, Toronto, Canada
| | - Clare Relton
- Centre for Clinical Trials and Methodology, Barts Institute of Population Health Science, Queen Mary University, London, UK
| | - Danielle B Rice
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Psychology, McGill University, Montréal, Québec, Canada
| | - Sinéad M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Eric I Benchimol
- ICES, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
- Division of Gastroenterology, Hepatology, and Nutrition and Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | | | - Margaret Sampson
- Library Services, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Helena M Verkooijen
- University Medical Centre Utrecht, Utrecht, Netherlands
- University of Utrecht, Utrecht, Netherlands
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Isabelle Boutron
- Université de Paris, Centre of Research Epidemiology and Statistics (CRESS), Inserm, INRA, Paris, France
- Centre d'Épidémiologie Clinique, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Hôtel Dieu, Paris, France
| | - Philippe Ravaud
- Université de Paris, Centre of Research Epidemiology and Statistics (CRESS), Inserm, INRA, Paris, France
- Centre d'Épidémiologie Clinique, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Hôtel Dieu, Paris, France
| | - Jon Nicholl
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Maureen Sauvé
- Scleroderma Society of Ontario, Hamilton, Canada
- Scleroderma Canada, Hamilton, Canada
| | | | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, Chelsea and Westminster campus, London, UK
| | - Edmund Juszczak
- National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Nottingham Clinical Trials Unit, University of Nottingham, University Park, Nottingham, UK
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Departments of Psychiatry; Epidemiology, Biostatistics, and Occupational Health; Medicine; and Educational and Counselling Psychology; and Biomedical Ethics Unit, McGill University, Montreal, Canada
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11
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Imran M, Kwakkenbos L, McCall SJ, McCord KA, Fröbert O, Hemkens LG, Zwarenstein M, Relton C, Rice DB, Langan SM, Benchimol EI, Thabane L, Campbell MK, Sampson M, Erlinge D, Verkooijen HM, Moher D, Boutron I, Ravaud P, Nicholl J, Uher R, Sauvé M, Fletcher J, Torgerson D, Gale C, Juszczak E, Thombs BD. Methods and results used in the development of a consensus-driven extension to the Consolidated Standards of Reporting Trials (CONSORT) statement for trials conducted using cohorts and routinely collected data (CONSORT-ROUTINE). BMJ Open 2021; 11:e049093. [PMID: 33926985 PMCID: PMC8094349 DOI: 10.1136/bmjopen-2021-049093] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Randomised controlled trials conducted using cohorts and routinely collected data, including registries, electronic health records and administrative databases, are increasingly used in healthcare intervention research. A Consolidated Standards of Reporting Trials (CONSORT) statement extension for trials conducted using cohorts and routinely collected data (CONSORT-ROUTINE) has been developed with the goal of improving reporting quality. This article describes the processes and methods used to develop the extension and decisions made to arrive at the final checklist. METHODS The development process involved five stages: (1) identification of the need for a reporting guideline and project launch; (2) conduct of a scoping review to identify possible modifications to CONSORT 2010 checklist items and possible new extension items; (3) a three-round modified Delphi study involving key stakeholders to gather feedback on the checklist; (4) a consensus meeting to finalise items to be included in the extension, followed by stakeholder piloting of the checklist; and (5) publication, dissemination and implementation of the final checklist. RESULTS 27 items were initially developed and rated in Delphi round 1, 13 items were rated in round 2 and 11 items were rated in round 3. Response rates for the Delphi study were 92 of 125 (74%) invited participants in round 1, 77 of 92 (84%) round 1 completers in round 2 and 62 of 77 (81%) round 2 completers in round 3. Twenty-seven members of the project team representing a variety of stakeholder groups attended the in-person consensus meeting. The final checklist includes five new items and eight modified items. The extension Explanation & Elaboration document further clarifies aspects that are important to report. CONCLUSION Uptake of CONSORT-ROUTINE and accompanying Explanation & Elaboration document will improve conduct of trials, as well as the transparency and completeness of reporting of trials conducted using cohorts and routinely collected data.
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Affiliation(s)
- Mahrukh Imran
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Québec, Canada
| | - Linda Kwakkenbos
- Behavioural Science Institute, Clinical Psychology, Radboud University, Nijmegen, Netherlands
| | - Stephen J McCall
- National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Ras Beirut, Lebanon
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Kimberly A McCord
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ole Fröbert
- Faculty of Health, Department of Cardiology, Örebro University, Örebro, Sweden
| | - Lars G Hemkens
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Merrick Zwarenstein
- Department of Family Medicine, Western University, London, Ontario, Canada
- IC/ES Western, London, Ontario, Canada
| | - Clare Relton
- Centre for Clinical Trials and Methodology, Barts Institute of Population Health Science, Queen Mary University, London, UK
| | - Danielle B Rice
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Québec, Canada
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Sinéad M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Eric I Benchimol
- Department of Pediatrics and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | - Margaret Sampson
- Library Services, Children's Hospital of Eastern Ontario, Ontario, Ottawa, Canada
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Helena M Verkooijen
- University Medical Center Utrecht, Utrecht, Netherlands
- University of Utrecht, Utrecht, Netherlands
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Isabelle Boutron
- INSERM, Paris, France
- Centre d'Épidémiologie Clinique, Hôpital Hôtel Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
- Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Philippe Ravaud
- INSERM, Paris, France
- Centre d'Épidémiologie Clinique, Hôpital Hôtel Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
- Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Jon Nicholl
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Maureen Sauvé
- Scleroderma Society of Ontario, Hamilton, Ontario, Canada
- Scleroderma Canada, Hamilton, Ontario, Canada
| | | | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Edmund Juszczak
- National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Québec, Canada
- Departments of Psychiatry; Epidemiology, Biostatistics and Occupational Health; Medicine; and Educational and Counselling Psychology; and Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada
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12
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Mc Cord KA, Ewald H, Agarwal A, Glinz D, Aghlmandi S, Ioannidis JPA, Hemkens LG. Treatment effects in randomised trials using routinely collected data for outcome assessment versus traditional trials: meta-research study. BMJ 2021; 372:n450. [PMID: 33658187 PMCID: PMC7926294 DOI: 10.1136/bmj.n450] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To compare effect estimates of randomised clinical trials that use routinely collected data (RCD-RCT) for outcome ascertainment with traditional trials not using routinely collected data. DESIGN Meta-research study. DATA SOURCE Studies included in the same meta-analysis in a Cochrane review. ELIGIBILITY CRITERIA FOR STUDY SELECTION Randomised clinical trials using any type of routinely collected data for outcome ascertainment, including from registries, electronic health records, and administrative databases, that were included in a meta-analysis of a Cochrane review on any clinical question and any health outcome together with traditional trials not using routinely collected data for outcome measurement. REVIEW METHODS Effect estimates from trials using or not using routinely collected data were summarised in random effects meta-analyses. Agreement of (summary) treatment effect estimates from trials using routinely collected data and those not using such data was expressed as the ratio of odds ratios. Subgroup analyses explored effects in trials based on different types of routinely collected data. Two investigators independently assessed the quality of each data source. RESULTS 84 RCD-RCTs and 463 traditional trials on 22 clinical questions were included. Trials using routinely collected data for outcome ascertainment showed 20% less favourable treatment effect estimates than traditional trials (ratio of odds ratios 0.80, 95% confidence interval 0.70 to 0.91, I2=14%). Results were similar across various types of outcomes (mortality outcomes: 0.92, 0.74 to 1.15, I2=12%; non-mortality outcomes: 0.71, 0.60 to 0.84, I2=8%), data sources (electronic health records: 0.81, 0.59 to 1.11, I2=28%; registries: 0.86, 0.75 to 0.99, I2=20%; administrative data: 0.84, 0.72 to 0.99, I2=0%), and data quality (high data quality: 0.82, 0.72 to 0.93, I2=0%). CONCLUSIONS Randomised clinical trials using routinely collected data for outcome ascertainment show smaller treatment benefits than traditional trials not using routinely collected data. These differences could have implications for healthcare decision making and the application of real world evidence.
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Affiliation(s)
- Kimberly A Mc Cord
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - Hannah Ewald
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
- University Medical Library, University of Basel, Basel, Switzerland
| | - Arnav Agarwal
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dominik Glinz
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - Soheila Aghlmandi
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - John P A Ioannidis
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
| | - Lars G Hemkens
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Palo Alto, CA, USA
- Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
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13
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The IDEAL Reporting Guidelines: A Delphi Consensus Statement Stage Specific Recommendations for Reporting the Evaluation of Surgical Innovation. Ann Surg 2021; 273:82-85. [PMID: 32649459 DOI: 10.1097/sla.0000000000004180] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this study was to define reporting standards for IDEAL format studies. BACKGROUND The IDEAL Framework and Recommendations establish an integrated pathway for evaluation of new surgical techniques and complex therapeutic technologies. However guidance on implementation has been incomplete, and incorrect use is commonly seen. We describe the consensus development of reporting guidelines for the IDEAL stages, and plans for their dissemination and evaluation. METHODS Using the EQUATOR Network recommendations, participants with knowledge of IDEAL were surveyed to determine which IDEAL stages needed reporting guidelines. Draft checklists for stages 1, 2a, 2b, and 4 were subsequently developed by 3 researchers (N.B., A.H., P.M.), and revised through a 2-round Delphi consensus process. A final consensus teleconference resolved outstanding disagreements and clarified wording for checklist items. RESULTS Sixty-one participants completed the initial survey, a clear majority indicating that new reporting guidelines were needed for IDEAL Stage 1 (69.5%), Stage 2a (78%), Stage 2b (74.6%), and Stage 4 (66%). A proposed set of checklists was modified by survey participants in 2 online Delphi rounds (n = 54 and n = 47, respectively), resulting in a penultimate checklist for each stage. Fourteen expert working group members finalized the checklist items and successfully resolved any outstanding areas without agreement on a consensus call. CONCLUSIONS Participants familiar with IDEAL called for reporting guidelines for studies in all IDEAL stages except stage 3. The checklists developed have the potential to improve standards of reporting and thereby advance the quality of research on surgery and complex interventions and technologies, but require further evaluation in use.
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14
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Wake M, Hu YJ, Warren H, Danchin M, Fahey M, Orsini F, Pacilli M, Perrett KP, Saffery R, Davidson A. Integrating trials into a whole-population cohort of children and parents: statement of intent (trials) for the Generation Victoria (GenV) cohort. BMC Med Res Methodol 2020; 20:238. [PMID: 32972373 PMCID: PMC7512047 DOI: 10.1186/s12874-020-01111-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/02/2020] [Indexed: 12/14/2022] Open
Abstract
Background Very large cohorts that span an entire population raise new prospects for the conduct of multiple trials that speed up advances in prevention or treatment while reducing participant, financial and regulatory burden. However, a review of literature reveals no blueprint to guide this systematically in practice. This Statement of Intent proposes how diverse trials may be integrated within or alongside Generation Victoria (GenV), a whole-of-state Australian birth cohort in planning, and delineates potential processes and opportunities. Methods Parents of all newborns (estimated 160,000) in the state of Victoria, Australia, will be approached for two full years from 2021. The cohort design comprises four elements: (1) consent soon after birth to follow the child and parent/s until study end or withdrawal; retrospective and prospective (2) linkage to clinical and administrative datasets and (3) banking of universal and clinical biosamples; and (4) GenV-collected biosamples and data. GenV-collected data will focus on overarching outcome and phenotypic measures using low-burden, universal-capable electronic interfaces, with funding-dependent face-to-face assessments tailored to universal settings during the early childhood, school and/or adult years. Results For population or registry-type trials within GenV, GenV will provide all outcomes data and consent via traditional, waiver, or Trials Within Cohorts models. Trials alongside GenV consent their own participants born within the GenV window; GenV may help identify potential participants via opt-in or opt-out expression of interest. Data sharing enriches trials with outcomes, prior data, and/or access to linked data contingent on custodian’s agreements, and supports modeling of causal effects to the population and between-trials comparisons of costs, benefits and utility. Data access will operate under the Findability, Accessibility, Interoperability, and Reusability (FAIR) and Care and Five Safes Principles. We consider governance, ethical and shared trial oversight, and expectations that trials will adhere to the best practice of the day. Conclusions Children and younger adults can access fewer trials than older adults. Integrating trials into mega-cohorts should improve health and well-being by generating faster, larger-scale evidence on a longer and/or broader horizon than previously possible. GenV will explore the limits and details of this approach over the coming years.
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Affiliation(s)
- Melissa Wake
- Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia. .,Department of Paediatrics, The University of Melbourne, Parkville, VIC, 3052, Australia.
| | - Yanhong Jessika Hu
- Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, 3052, Australia
| | - Hayley Warren
- Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Margie Danchin
- Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, 3052, Australia.,The Royal Children's Hospital, Parkville, VIC, 3052, Australia
| | - Michael Fahey
- Department of Paediatrics, Monash University, Clayton, VIC, 3168, Australia.,Monash Children's Hospital, Clayton, VIC, 3168, Australia
| | - Francesca Orsini
- Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Maurizio Pacilli
- Department of Paediatrics, Monash University, Clayton, VIC, 3168, Australia.,Monash Children's Hospital, Clayton, VIC, 3168, Australia
| | - Kirsten P Perrett
- Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, 3052, Australia.,The Royal Children's Hospital, Parkville, VIC, 3052, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, 3052, Australia
| | - Andrew Davidson
- Murdoch Children's Research Institute, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, VIC, 3052, Australia.,The Royal Children's Hospital, Parkville, VIC, 3052, Australia
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15
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Thombs BD, Kwakkenbos L, Carrier ME, Bourgeault A, Tao L, Harb S, Gagarine M, Rice D, Bustamante L, Ellis K, Duchek D, Wu Y, Bhandari PM, Neupane D, Carboni-Jiménez A, Henry RS, Krishnan A, Sun Y, Levis B, He C, Turner KA, Benedetti A, Culos-Reed N, El-Baalbaki G, Hebblethwaite S, Bartlett SJ, Dyas L, Patten S, Varga J. Protocol for a partially nested randomised controlled trial to evaluate the effectiveness of the scleroderma patient-centered intervention network COVID-19 home-isolation activities together (SPIN-CHAT) program to reduce anxiety among at-risk scleroderma patients. J Psychosom Res 2020; 135:110132. [PMID: 32521358 PMCID: PMC7224675 DOI: 10.1016/j.jpsychores.2020.110132] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/03/2020] [Accepted: 05/04/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Contagious disease outbreaks and related restrictions can lead to negative psychological outcomes, particularly in vulnerable populations at risk due to pre-existing medical conditions. No randomised controlled trials (RCTs) have tested interventions to reduce mental health consequences of contagious disease outbreaks. The primary objective of the Scleroderma Patient-centered Intervention Network COVID-19 Home-isolation Activities Together (SPIN-CHAT) Trial is to evaluate the effect of a videoconference-based program on symptoms of anxiety. Secondary objectives include evaluating effects on symptoms of depression, stress, loneliness, boredom, physical activity, and social interaction. METHODS The SPIN-CHAT Trial is a pragmatic RCT that will be conducted using the SPIN-COVID-19 Cohort, a sub-cohort of the SPIN Cohort. Eligible participants will be SPIN-COVID-19 Cohort participants without a positive COVID-19 test, with at least mild anxiety (PROMIS Anxiety 4a v1.0 T-score ≥ 55), not working from home, and not receiving current counselling or psychotherapy. We will randomly assign 162 participants to intervention groups of 7 to 10 participants each or waitlist control. We will use a partially nested RCT design to reflect dependence between individuals in training groups but not in the waitlist control. The SPIN-CHAT Program includes activity engagement, education on strategies to support mental health, and mutual participant support. Intervention participants will receive the 4-week (3 sessions per week) SPIN-CHAT Program via videoconference. The primary outcome is PROMIS Anxiety 4a score immediately post-intervention. ETHICS AND DISSEMINATION The SPIN-CHAT Trial will test whether a brief videoconference-based intervention will improve mental health outcomes among at-risk individuals during contagious disease outbreak.
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Affiliation(s)
- Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Department of Psychology, McGill University, Montreal, Quebec, Canada; Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada; Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada.
| | - Linda Kwakkenbos
- Department of Clinical Psychology, Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - Marie-Eve Carrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Angelica Bourgeault
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Lydia Tao
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Sami Harb
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Maria Gagarine
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Danielle Rice
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Laura Bustamante
- Department of Applied Human Sciences, Concordia University, Montreal, Quebec, Canada
| | - Kelsey Ellis
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Delaney Duchek
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Yin Wu
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Parash Mani Bhandari
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Dipika Neupane
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Andrea Carboni-Jiménez
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Richard S Henry
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Ankur Krishnan
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Ying Sun
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Brooke Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Centre for Prognosis Research, School of Primary, Community and Social Care, Keele University, Staffordshire, UK
| | - Chen He
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Kimberly A Turner
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nicole Culos-Reed
- Department of Applied Human Sciences, Concordia University, Montreal, Quebec, Canada; Department of Oncology, Cumming School of Medicine, Calgary, Canada; Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Ghassan El-Baalbaki
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Shannon Hebblethwaite
- Department of Applied Human Sciences, Concordia University, Montreal, Quebec, Canada
| | - Susan J Bartlett
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Laura Dyas
- Scleroderma Foundation Michigan Chapter, Southfield, MI, USA
| | - Scott Patten
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Hotchkiss Brain Institute and O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - John Varga
- Northwestern Scleroderma Program, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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16
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Karanatsios B, Prang KH, Verbunt E, Yeung JM, Kelaher M, Gibbs P. Defining key design elements of registry-based randomised controlled trials: a scoping review. Trials 2020; 21:552. [PMID: 32571382 PMCID: PMC7310018 DOI: 10.1186/s13063-020-04459-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 05/26/2020] [Indexed: 01/09/2023] Open
Abstract
Background Traditional randomised controlled trials remain the gold standard for improving clinical care but they do have their limitations, including their associated high costs, high failure rate and limited external validity. An alternative methodology is the newly defined, prospective, registry-based randomised controlled trial (RRCT), where treatment and outcome data is collected in an existing registry. This scoping review explores the current literature regarding RRCTs to help identify the key design elements of RRCTs and the characteristics of clinical registries on which they are reliant on. Methods A scoping review methodology conducted in accordance with the Joanna Briggs Institute guidelines was performed. Four databases were searched for articles published from inception to June 2018: Medline; Embase; the Cumulative Index to Nursing and Allied Health Literature and; Scopus. The search strategy included MeSH and text words related to RRCT. Results We identified 2369 articles of which 75 were selected for full-text screening. Of these, only 17 articles satisfied our inclusion criteria. All studies were published between 1996 and 2017 and all were investigator-initiated. Study designs were mainly multi-site comparative/effectiveness studies incorporating the use of disease registries (n = 8), procedure registries (n = 8) and a health services registry (n = 1). The low cost, reduced administrative burden and enhanced external validity of RRCTs make them an attractive research methodology which can be used to address questions of public health importance. We identified that that there are variable definitions of what constituted a RRCT and that issues related to ethical conduct and data integrity, completeness, timeliness, validation and endpoint adjudication need to be carefully addressed. Conclusion RRCTs potentially have an important role to play in informing best clinical practice and health policy. There are a number of issues that need to be addressed to optimise the utility of this approach, including establishing universally accepted criteria for the definition of a RRCT.
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Affiliation(s)
- Bill Karanatsios
- Department of Surgery, The University of Melbourne, Parkville, VIC, Australia. .,Western Health Chronic Disease Alliance, Western Health, St Albans, VIC, Australia.
| | - Khic-Houy Prang
- Centre for Health Policy, The University of Melbourne, Parkville, VIC, Australia
| | - Ebony Verbunt
- Centre for Health Policy, The University of Melbourne, Parkville, VIC, Australia
| | - Justin M Yeung
- Department of Surgery, The University of Melbourne, Parkville, VIC, Australia.,Western Health Chronic Disease Alliance, Western Health, St Albans, VIC, Australia
| | - Margaret Kelaher
- Centre for Health Policy, The University of Melbourne, Parkville, VIC, Australia
| | - Peter Gibbs
- Systems Biology and Personalised Medicine Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.,Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Center, Parkville, VIC, Australia
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17
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Lensen S, Macnair A, Love SB, Yorke-Edwards V, Noor NM, Martyn M, Blenkinsop A, Diaz-Montana C, Powell G, Williamson E, Carpenter J, Sydes MR. Access to routinely collected health data for clinical trials - review of successful data requests to UK registries. Trials 2020; 21:398. [PMID: 32398093 PMCID: PMC7218527 DOI: 10.1186/s13063-020-04329-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 04/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical trials generally each collect their own data despite routinely collected health data (RCHD) increasing in quality and breadth. Our aim is to quantify UK-based randomised controlled trials (RCTs) accessing RCHD for participant data, characterise how these data are used and thereby recommend how more trials could use RCHD. METHODS We conducted a systematic review of RCTs accessing RCHD from at least one registry in the UK between 2013 and 2018 for the purposes of informing or supplementing participant data. A list of all registries holding RCHD in the UK was compiled. In cases where registries published release registers, these were searched for RCTs accessing RCHD. Where no release register was available, registries were contacted to request a list of RCTs. For each identified RCT, information was collected from all publicly available sources (release registers, websites, protocol etc.). The search and data extraction were undertaken between January and May 2019. RESULTS We identified 160 RCTs accessing RCHD between 2013 and 2018 from a total of 22 registries; this corresponds to only a very small proportion of all UK RCTs (about 3%). RCTs accessing RCHD were generally large (median sample size 1590), commonly evaluating treatments for cancer or cardiovascular disease. Most of the included RCTs accessed RCHD from NHS Digital (68%), and the most frequently accessed datasets were mortality (76%) and hospital visits (55%). RCHD was used to inform the primary trial (82%) and long-term follow-up (57%). There was substantial variation in how RCTs used RCHD to inform participant outcome measures. A limitation was the lack of information and transparency from registries and RCTs with respect to which datasets have been accessed and for what purposes. CONCLUSIONS In the last five years, only a small minority of UK-based RCTs have accessed RCHD to inform participant data. We ask for improved accessibility, confirmed data quality and joined-up thinking between the registries and the regulatory authorities. TRIAL REGISTRATION PROSPERO CRD42019123088.
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Affiliation(s)
- Sarah Lensen
- MRC Clinical Trials Unit at UCL, Health Data Research, London, WC1V 6LJ UK
| | - Archie Macnair
- MRC Clinical Trials Unit at UCL, Health Data Research, London, WC1V 6LJ UK
| | - Sharon B. Love
- MRC Clinical Trials Unit at UCL, Health Data Research, London, WC1V 6LJ UK
| | | | - Nurulamin M. Noor
- MRC Clinical Trials Unit at UCL, Health Data Research, London, WC1V 6LJ UK
| | - Meredith Martyn
- MRC Clinical Trials Unit at UCL, Health Data Research, London, WC1V 6LJ UK
| | | | | | - Graham Powell
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, L69 3BX UK
| | | | - James Carpenter
- MRC Clinical Trials Unit at UCL, Health Data Research, London, WC1V 6LJ UK
- Medical Statistics, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
| | - Matthew R. Sydes
- MRC Clinical Trials Unit at UCL, Health Data Research, London, WC1V 6LJ UK
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18
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McKay AJ, Jones AP, Gamble CL, Farmer AJ, Williamson PR. Use of routinely collected data in a UK cohort of publicly funded randomised clinical trials. F1000Res 2020; 9:323. [PMID: 33163157 PMCID: PMC7607478 DOI: 10.12688/f1000research.23316.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 10/04/2023] Open
Abstract
Routinely collected data about health in medical records, registries and hospital activity statistics is now routinely collected in an electronic form. The extent to which such sources of data are now being routinely accessed to deliver efficient clinical trials, is unclear. The aim of this study was to ascertain current practice amongst a United Kingdom (UK) cohort of recently funded and ongoing randomised controlled trials (RCTs) in relation to sources and use of routinely collected outcome data. Recently funded and ongoing RCTs were identified for inclusion by searching the National Institute for Health Research journals library. Trials that have a protocol available were assessed for inclusion and those that use or plan to use routinely collected health data (RCHD) for at least one outcome were included. RCHD sources and outcome information were extracted. Of 216 RCTs, 102 (47%) planned to use RCHD. A RCHD source was the sole source of outcome data for at least one outcome in 46 (45%) of those 102 trials. The most frequent sources are Hospital Episode Statistics (HES) and Office for National Statistics (ONS), with the most common outcome data to be extracted being on mortality, hospital admission, and health service resource use. Our study has found that around half of publicly funded trials in a UK cohort (NIHR HTA funded trials that had a protocol available) plan to collect outcome data from routinely collected data sources.
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Affiliation(s)
- Andrew J. McKay
- Liverpool Clinical Trials Centre, University of Liverpool, a member of Liverpool Health Partners, Liverpool, UK
| | - Ashley P. Jones
- Liverpool Clinical Trials Centre, University of Liverpool, a member of Liverpool Health Partners, Liverpool, UK
| | - Carrol L. Gamble
- Liverpool Clinical Trials Centre, University of Liverpool, a member of Liverpool Health Partners, Liverpool, UK
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Andrew J. Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paula R. Williamson
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, UK
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19
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McKay AJ, Jones AP, Gamble CL, Farmer AJ, Williamson PR. Use of routinely collected data in a UK cohort of publicly funded randomised clinical trials. F1000Res 2020; 9:323. [PMID: 33163157 PMCID: PMC7607478 DOI: 10.12688/f1000research.23316.3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 11/29/2022] Open
Abstract
Routinely collected data about health in medical records, registries and hospital activity statistics is now routinely collected in an electronic form. The extent to which such sources of data are now being routinely accessed to deliver efficient clinical trials, is unclear. The aim of this study was to ascertain current practice amongst a United Kingdom (UK) cohort of recently funded and ongoing randomised controlled trials (RCTs) in relation to sources and use of routinely collected outcome data. Recently funded and ongoing RCTs were identified for inclusion by searching the National Institute for Health Research journals library. Trials that have a protocol available were assessed for inclusion and those that use or plan to use routinely collected health data (RCHD) for at least one outcome were included. RCHD sources and outcome information were extracted. Of 216 RCTs, 102 (47%) planned to use RCHD. A RCHD source was the sole source of outcome data for at least one outcome in 46 (45%) of those 102 trials. The most frequent sources are Hospital Episode Statistics (HES) and Office for National Statistics (ONS), with the most common outcome data to be extracted being on mortality, hospital admission, and health service resource use. Our study has found that around half of publicly funded trials in a UK cohort (NIHR HTA funded trials that had a protocol available) plan to collect outcome data from routinely collected data sources.
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Affiliation(s)
- Andrew J McKay
- Liverpool Clinical Trials Centre, University of Liverpool, a member of Liverpool Health Partners, Liverpool, UK
| | - Ashley P Jones
- Liverpool Clinical Trials Centre, University of Liverpool, a member of Liverpool Health Partners, Liverpool, UK
| | - Carrol L Gamble
- Liverpool Clinical Trials Centre, University of Liverpool, a member of Liverpool Health Partners, Liverpool, UK.,MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Andrew J Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paula R Williamson
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, UK
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20
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Carrier ME, Kwakkenbos L, Nielson WR, Fedoruk C, Nielsen K, Milette K, Pope J, Frech T, Gholizadeh S, Hummers L, Johnson SR, Piotrowski P, Jewett L, Gordon J, Chung L, Bilsker D, Turner KA, Cumin J, Welling J, Fortune C, Leite C, Gottesman K, Sauve M, Rodríguez-Reyna TS, Hudson M, Larche M, van Breda W, Suarez-Almazor ME, Bartlett SJ, Malcarne VL, Mayes MD, Boutron I, Mouthon L, Wigley F, Thombs BD. The Scleroderma Patient-Centered Intervention Network Self-Management Program: Protocol for a Randomized Feasibility Trial. JMIR Res Protoc 2020; 9:e16799. [PMID: 32329747 PMCID: PMC7210498 DOI: 10.2196/16799] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/18/2020] [Accepted: 01/24/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Systemic sclerosis (SSc), or scleroderma, is a rare disease that often results in significant disruptions to activities of daily living and can negatively affect physical and psychological well-being. Because there is no known cure, SSc treatment focuses on reducing symptoms and disability and improving health-related quality of life (HRQoL). Self-management programs are known to increase self-efficacy for disease management in many chronic diseases. The Scleroderma Patient-centered Intervention Network (SPIN) developed a Web-based self-management program (SPIN self-management; SPIN-SELF) to increase self-efficacy for disease management and to improve HRQoL for patients with SSc. OBJECTIVE The proposed study aims to assess the feasibility of conducting a full-scale randomized controlled trial (RCT) of the SPIN-SELF program by evaluating the trial implementation processes, required resources and management, scientific aspects, and participant acceptability and usage of the SPIN-SELF program. METHODS The SPIN-SELF feasibility trial will be conducted via the SPIN Cohort. The SPIN Cohort was developed as a framework for embedded pragmatic trials using the cohort multiple RCT design. In total, 40 English-speaking SPIN Cohort participants with low disease management self-efficacy (Self-Efficacy for Managing Chronic Disease Scale score ≤7), who have indicated interest in using a Web-based self-management program, will be randomized with a 3:2 ratio into the SPIN-SELF program or usual care for 3 months. Feasibility outcomes include trial implementation processes, required resources and management, scientific aspects, and patient acceptability and usage of the SPIN-SELF program. RESULTS Enrollment of the 40 participants occurred between July 5, 2019, and July 27, 2019. By November 25, 2019, data collection of trial outcomes was completed. Data analysis is underway, and results are expected to be published in 2020. CONCLUSIONS The SPIN-SELF program is a self-help tool that may improve disease-management self-efficacy and improve HRQoL in patients with SSc. The SPIN-SELF feasibility trial will ensure that trial methodology is robust, feasible, and consistent with trial participant expectations. The results will guide adjustments that need to be implemented before undertaking a full-scale RCT of the SPIN-SELF program. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/16799.
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Affiliation(s)
- Marie-Eve Carrier
- Lady Davis Institute of the Jewish General Hospital, Montreal, QC, Canada
| | - Linda Kwakkenbos
- Behavioural Science Institute, Clinical Psychology, Radboud University, Nijmegen, Netherlands
| | | | - Claire Fedoruk
- Lady Davis Institute of the Jewish General Hospital, Montreal, QC, Canada
| | - Karen Nielsen
- Scleroderma Society of Ontario, Hamilton, ON, Canada
| | - Katherine Milette
- Lady Davis Institute of the Jewish General Hospital, Montreal, QC, Canada
| | - Janet Pope
- University of Western Ontario, London, ON, Canada
| | - Tracy Frech
- University of Utah, Salt Lake City, UT, United States
| | - Shadi Gholizadeh
- California School of Professional Psychology/Alliant, Los Angeles, CA, United States
| | - Laura Hummers
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Sindhu R Johnson
- Toronto Scleroderma Program, Mount Sinai Hospital & Toronto Western Hospital, Toronto, ON, Canada.,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | | | - Lisa Jewett
- Lady Davis Institute of the Jewish General Hospital, Montreal, QC, Canada
| | - Jessica Gordon
- Hospital for Special Surgery, New York, NY, United States
| | - Lorinda Chung
- Departments of Pediatrics, Biomedical Data Science, Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Dan Bilsker
- Simon Fraser University, Burnaby, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - Kimberly A Turner
- Lady Davis Institute of the Jewish General Hospital, Montreal, QC, Canada
| | - Julie Cumin
- Lady Davis Institute of the Jewish General Hospital, Montreal, QC, Canada
| | - Joep Welling
- NVLE Dutch patient organization for systemic autoimmune diseases, Utrecht, Netherlands
| | | | | | | | - Maureen Sauve
- Scleroderma Society of Ontario, Hamilton, ON, Canada.,Scleroderma Canada, Hamilton, ON, Canada
| | | | - Marie Hudson
- Lady Davis Institute of the Jewish General Hospital, Montreal, QC, Canada.,Department of Medicine, McGill University, Montreal, QC, Canada
| | | | - Ward van Breda
- Faculty of Behavioural and Movement Sciences, Vrije University, Amsterdam, Netherlands
| | | | | | | | - Maureen D Mayes
- University of Texas McGovern School of Medicine, Houston, TX, United States
| | - Isabelle Boutron
- Université Paris Descartes, Paris, France.,Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Luc Mouthon
- Université Paris Descartes, Paris, France.,Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Fredrick Wigley
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Brett D Thombs
- Lady Davis Institute of the Jewish General Hospital, Montreal, QC, Canada.,Department of Medicine, McGill University, Montreal, QC, Canada.,Department of Psychiatry, McGill University, Montreal, QC, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.,Department of Psychology, McGill University, Montreal, QC, Canada.,Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
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21
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Hemkens LG. Commentary on Bertagnolli et al: Clinical trial designs with routinely collected real-world data-issues of data quality and beyond. Clin Trials 2020; 17:247-250. [PMID: 32266840 DOI: 10.1177/1740774520913845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Lars G Hemkens
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
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22
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Wilkinson J, Brison DR, Duffy JMN, Farquhar CM, Lensen S, Mastenbroek S, van Wely M, Vail A. Don’t abandon RCTs in IVF. We don’t even understand them. Hum Reprod 2019. [PMCID: PMC6994932 DOI: 10.1093/humrep/dez199] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The conclusion of the Human Fertilisation and Embryology Authority that ‘add-on’ therapies in IVF are not supported by high-quality evidence has prompted new questions regarding the role of the randomized controlled trial (RCT) in evaluating infertility treatments. Critics argue that trials are cumbersome tools that provide irrelevant answers. Instead, they argue that greater emphasis should be placed on large observational databases, which can be analysed using powerful algorithms to determine which treatments work and for whom. Although the validity of these arguments rests upon the sciences of statistics and epidemiology, the discussion to date has largely been conducted without reference to these fields. We aim to remedy this omission, by evaluating the arguments against RCTs in IVF from a primarily methodological perspective. We suggest that, while criticism of the status quo is warranted, a retreat from RCTs is more likely to make things worse for patients and clinicians.
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Affiliation(s)
- J Wilkinson
- Centre for Biostatistics, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - D R Brison
- Department of Reproductive Medicine, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Maternal and Fetal Health Research Centre, Faculty of Life Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - J M N Duffy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Balliol College, University of Oxford, Oxford, UK
| | - C M Farquhar
- Cochrane Gynecology and Fertility Group, Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - S Lensen
- Cochrane Gynecology and Fertility Group, Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - S Mastenbroek
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine, Amsterdam Reproduction & Development Research Institute, Amsterdam, Netherlands
| | - M van Wely
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine, Amsterdam Reproduction & Development Research Institute, Amsterdam, Netherlands
| | - A Vail
- Centre for Biostatistics, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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23
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Marquis-Gravel G, Roe MT, Turakhia MP, Boden W, Temple R, Sharma A, Hirshberg B, Slater P, Craft N, Stockbridge N, McDowell B, Waldstreicher J, Bourla A, Bansilal S, Wong JL, Meunier C, Kassahun H, Coran P, Bataille L, Patrick-Lake B, Hirsch B, Reites J, Mehta R, Muse ED, Chandross KJ, Silverstein JC, Silcox C, Overhage JM, Califf RM, Peterson ED. Technology-Enabled Clinical Trials. Circulation 2019; 140:1426-1436. [DOI: 10.1161/circulationaha.119.040798] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The complexity and costs associated with traditional randomized, controlled trials have increased exponentially over time, and now threaten to stifle the development of new drugs and devices. Nevertheless, the growing use of electronic health records, mobile applications, and wearable devices offers significant promise for transforming clinical trials, making them more pragmatic and efficient. However, many challenges must be overcome before these innovations can be implemented routinely in randomized, controlled trial operations. In October of 2018, a diverse stakeholder group convened in Washington, DC, to examine how electronic health record, mobile, and wearable technologies could be applied to clinical trials. The group specifically examined how these technologies might streamline the execution of clinical trial components, delineated innovative trial designs facilitated by technological developments, identified barriers to implementation, and determined the optimal frameworks needed for regulatory oversight. The group concluded that the application of novel technologies to clinical trials provided enormous potential, yet these changes needed to be iterative and facilitated by continuous learning and pilot studies.
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Affiliation(s)
| | - Matthew T. Roe
- Duke Clinical Research Institute, Durham, NC (G.M.-G., M.T.R., B.P.-L., E.D.P.)
| | - Mintu P. Turakhia
- Center for Digital Health (M.P.T.), Stanford University, CA
- VA Palo Alto Health Care System, CA (M.P.T.)
| | - William Boden
- Boston University and VA New England Health Care System, MA (W.B.)
| | - Robert Temple
- U.S. Food and Drug Administration, Silver Spring, MD (R.T., N.S.)
| | - Abhinav Sharma
- Division of Cardiology (A.S.), Stanford University, CA
- Division of Cardiology, McGill University Health Centre, Montreal, QC, Canada (A.S.)
| | | | - Paul Slater
- Life Sciences Innovation, Microsoft, Seattle, WA (P.S.)
| | | | | | | | | | | | | | | | | | | | | | - Lauren Bataille
- The Michael J. Fox Foundation for Parkinson’s Research, New York (L.B.)
| | - Bray Patrick-Lake
- Duke Clinical Research Institute, Durham, NC (G.M.-G., M.T.R., B.P.-L., E.D.P.)
| | | | | | | | - Evan D. Muse
- Scripps Research Translational Institute; Division of Cardiovascular Disease, Scripps Clinic, Scripps Health, La Jolla, CA (E.D.M.)
| | | | | | | | | | - Robert M. Califf
- Department of Medicine (R.M.C.), Stanford University, CA
- Duke Forge, Duke University School of Medicine, Durham, NC (R.M.C.)
- Verily Life Sciences (Alphabet), South San Francisco, CA (R.M.C.)
| | - Eric D. Peterson
- Duke Clinical Research Institute, Durham, NC (G.M.-G., M.T.R., B.P.-L., E.D.P.)
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