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Witham MD, Anderson E, Carroll C, Dark PM, Down K, Hall AS, Knee J, Maier RH, Mountain GA, Nestor G, Oliva L, Prowse SR, Tortice A, Wason J, Rochester L. Developing a roadmap to improve trial delivery for under-served groups: results from a UK multi-stakeholder process. Trials 2020; 21:694. [PMID: 32738919 PMCID: PMC7395975 DOI: 10.1186/s13063-020-04613-7] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 07/15/2020] [Indexed: 11/23/2022] Open
Abstract
Background Participants in clinical research studies often do not reflect the populations for which healthcare interventions are needed or will be used. Enhancing representation of under-served groups in clinical research is important to ensure that research findings are widely applicable. We describe a multicomponent workstream project to improve representation of under-served groups in clinical trials. Methods The project comprised three main strands: (1) a targeted scoping review of literature to identify previous work characterising under-served groups and barriers to inclusion, (2) surveys of professional stakeholders and participant representative groups involved in research delivery to refine these initial findings and identify examples of innovation and good practice and (3) a series of workshops bringing together key stakeholders from funding, design, delivery and participant groups to reach consensus on definitions, barriers and a strategic roadmap for future work. The work was commissioned by the UK National Institute for Health Research Clinical Research Network. Output from these strands was integrated by a steering committee to generate a series of goals, workstream plans and a strategic roadmap for future development work in this area. Results ‘Under-served groups’ was identified and agreed by the stakeholder group as the preferred term. Three-quarters of stakeholders felt that a clear definition of under-served groups did not currently exist; definition was challenging and context-specific, but exemplar groups (e.g. those with language barriers or mental illness) were identified as under-served. Barriers to successful inclusion of under-served groups could be clustered into communication between research teams and participant groups; how trials are designed and delivered, differing agendas of research teams and participant groups; and lack of trust in the research process. Four key goals for future work were identified: building long-term relationships with under-served groups, developing training resources to improve design and delivery of trials for under-served groups, developing infrastructure and systems to support this work and working with funders, regulators and other stakeholders to remove barriers to inclusion. Conclusions The work of the INCLUDE group over the next 12 months will build on these findings by generating resources customised for different under-served groups to improve the representativeness of trial populations.
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Affiliation(s)
- Miles D Witham
- NIHR Clinical Research Network Cluster E, Campus for Ageing and Vitality, Newcastle University, Newcastle, NE4 5PL, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Trust, Newcastle, UK
| | - Eleanor Anderson
- NIHR Clinical Research Network Cluster E, Campus for Ageing and Vitality, Newcastle University, Newcastle, NE4 5PL, UK
| | - Camille Carroll
- University of Plymouth, Faculty of Health, Plymouth, Devon, UK
| | - Paul M Dark
- NIHR Manchester Biomedical Research Centre, University of Manchester and Northern Care Alliance NHS Group, Manchester, UK
| | - Kim Down
- NIHR Clinical Research Network Cluster E, Campus for Ageing and Vitality, Newcastle University, Newcastle, NE4 5PL, UK
| | - Alistair S Hall
- Cardiology Department, Leeds General Infirmary, Leeds, LS1 3EX, UK
| | - Joanna Knee
- NIHR Clinical Research Network Coordinating Centre, 21 Queen Street, Leeds, LS1 2TW, UK
| | - Rebecca H Maier
- Newcastle Clinical Trials Unit, 1-4 Claremont Terrace, Newcastle University, Newcastle upon Tyne, NE2 4AE, UK
| | - Gail A Mountain
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Gary Nestor
- NIHR Clinical Research Network Cluster E, Campus for Ageing and Vitality, Newcastle University, Newcastle, NE4 5PL, UK
| | - Laurie Oliva
- NIHR Clinical Research Network Coordinating Centre, London, UK
| | - Sarah R Prowse
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Amanda Tortice
- NIHR Yorkshire and Humber Local Clinical Research Network, Yorkshire and Humber, UK
| | - James Wason
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Lynn Rochester
- NIHR Clinical Research Network Cluster E, Campus for Ageing and Vitality, Newcastle University, Newcastle, NE4 5PL, UK. .,Translational Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.
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