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Goulão B, Morris TP, Blazeby J, Gamble C, Gillies K, Laidlaw L, Ramsay C, Soulsby I, Stewart D, Totton N. Involving patients and the public In sTatistIcal Analysis pLans (INITIAL): A delphi survey. PLoS One 2023; 18:e0292257. [PMID: 38096223 PMCID: PMC10721002 DOI: 10.1371/journal.pone.0292257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 09/17/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Patient and public involvement (PPI) in trials aims to enhance research by improving its relevance and transparency. Planning for statistical analysis begins at the design stage of a trial within the protocol and is refined and detailed in a Statistical Analysis Plan (SAP). While PPI is common in design and protocol development it is less common within SAPs. This study aimed to reach consensus on the most important and relevant statistical analysis items within an SAP to involve patients and the public. METHODS We developed a UK-based, two-round Delphi survey through an iterative consultation with public partners, statisticians, and trialists. The consultation process started with 55 items from international guidance for statistical analysis plans. We aimed to recruit at least 20 participants per key stakeholder group for inclusion in the final analysis of the Delphi survey. Participants were asked to vote on each item using a Likert scale from 1 to 9, where a rating of 1 to 3 was labelled as having 'limited importance'; 4 to 6 as 'important but not critical' and 7 to 9 as 'critical' to involve patients and the public. Results from the second round determined consensus on critical items for PPI. RESULTS The consultation exercise led to the inclusion of 15 statistical items in the Delphi survey. We recruited 179 participants, of whom 72% (129: 36 statisticians, 29 patients or public partners, 25 clinical researchers or methodologists, 27 trial managers, and 12 PPI coordinators) completed both rounds. Participants were on average 48 years old, 60% were female, 84% were White, 64% were based in England and 84% had at least five years' experience in trials. Four items reached consensus regarding critical importance for patient and public involvement: presentation of results to trial participants; summary and presentation of harms; interpretation and presentation of findings in an academic setting; factors impacting how well a treatment works. No consensus was reached for the remaining 11 items. In general, the results were consistent across stakeholder groups. DISCUSSION We identified four critical items to involve patients and the public in statistical analysis plans. The remaining 11 items did not reach consensus and need to be considered in a case-by-case basis with most responders considering patient and public involvement important (but not critical). Our research provides a platform to enable focused future efforts to improve patient and public involvement in trials and enhance the relevance of statistical analyses to patients and the public.
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Affiliation(s)
- Beatriz Goulão
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Tim P. Morris
- MRC Clinical Trials Unit at UCL, London, United Kingdom
| | - Jane Blazeby
- Bristol NIHR Biomedical Research Centre, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, United Kingdom
| | - Carrol Gamble
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, United Kingdom
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Lynn Laidlaw
- Public Partner Co-author, INITIAL Advisory Group, University of Aberdeen, Aberdeen, United Kingdom
| | - Craig Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Irene Soulsby
- Public Partner Co-author, INITIAL Advisory Group, University of Aberdeen, Aberdeen, United Kingdom
| | - Derek Stewart
- Public Partner Co-author, INITIAL Advisory Group, University of Aberdeen, Aberdeen, United Kingdom
- University of Galway, Galway, Ireland
| | - Nikki Totton
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
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Pyne S, Sach TH, Lawrence M, Renz S, Eminton Z, Stuart B, Thomas KS, Francis N, Soulsby I, Thomas K, Permyakova NV, Ridd MJ, Little P, Muller I, Nuttall J, Griffiths G, Layton AM, Santer M. Cost-effectiveness of Spironolactone for Adult Female Acne (SAFA): economic evaluation alongside a randomised controlled trial. BMJ Open 2023; 13:e073245. [PMID: 38081673 PMCID: PMC10729081 DOI: 10.1136/bmjopen-2023-073245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 09/05/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE This study aims to estimate the cost-effectiveness of oral spironolactone plus routine topical treatment compared with routine topical treatment alone for persistent acne in adult women from a British NHS perspective over 24 weeks. DESIGN Economic evaluation undertaken alongside a pragmatic, parallel, double-blind, randomised trial. SETTING Primary and secondary healthcare, community and social media advertising. PARTICIPANTS Women ≥18 years with persistent facial acne judged to warrant oral antibiotic treatment. INTERVENTIONS Participants were randomised 1:1 to 50 mg/day spironolactone (increasing to 100 mg/day after 6 weeks) or matched placebo until week 24. Participants in both groups could continue topical treatment. MAIN OUTCOME MEASURES Cost-utility analysis assessed incremental cost per quality-adjusted life year (QALY) using the EQ-5D-5L. Cost-effectiveness analysis estimated incremental cost per unit change on the Acne-QoL symptom subscale. Adjusted analysis included randomisation stratification variables (centre, baseline severity (investigator's global assessment, IGA <3 vs ≥3)) and baseline variables (Acne-QoL symptom subscale score, resource use costs, EQ-5D score and use of topical treatments). RESULTS Spironolactone did not appear cost-effective in the complete case analysis (n=126 spironolactone, n=109 control), compared with no active systemic treatment (adjusted incremental cost per QALY £67 191; unadjusted £34 770). Incremental cost per QALY was £27 879 (adjusted), just below the upper National Institute for Health and Care Excellence's threshold value of £30 000, where multiple imputation took account of missing data. Incremental cost per QALY for other sensitivity analyses varied around the base-case, highlighting the degree of uncertainty. The adjusted incremental cost per point change on the Acne-QoL symptom subscale for spironolactone compared with no active systemic treatment was £38.21 (complete case analysis). CONCLUSIONS The results demonstrate a high level of uncertainty, particularly with respect to estimates of incremental QALYs. Compared with no active systemic treatment, spironolactone was estimated to be marginally cost-effective where multiple imputation was performed but was not cost-effective in complete case analysis. TRIAL REGISTRATION NUMBER ISRCTN registry (ISRCTN12892056).
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Affiliation(s)
- Sarah Pyne
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Tracey H Sach
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Megan Lawrence
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Susanne Renz
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Zina Eminton
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Beth Stuart
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
- Centre for Evaluation and Methods Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Kim S Thomas
- Centre for Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Nick Francis
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Irene Soulsby
- Public Contributor, Primary Care Research Centre, University of Southampton, Southampton, Hampshire, UK
| | - Karen Thomas
- Public Contributor, Primary Care Research Centre, University of Southampton, Southampton, Hampshire, UK
| | - Natalia V Permyakova
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Matthew J Ridd
- Population Health Sciences, University of Bristol, Bristol, Bristol, UK
| | - Paul Little
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Ingrid Muller
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Jacqui Nuttall
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Alison M Layton
- Skin Research Centre, Hull York Medical School, University of York, York, North Yorkshire, UK
| | - Miriam Santer
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
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Hosie A, Firdaus M, Clarkson J, Gupta E, Laidlaw L, Lamont T, Mooney M, Nevin G, Ramsay C, Rutherford S, Sardo AM, Soulsby I, Richards D, Stirling D, West M, Goulao B. Citizen science to improve patient and public involvement in GUideline Implementation in oral health and DEntistry (the GUIDE platform). Health Expect 2023; 27:e13921. [PMID: 38014917 PMCID: PMC10768863 DOI: 10.1111/hex.13921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Citizen science is a way to democratise science by involving groups of citizens in the research process. Clinical guidelines are used to improve practice, but their implementation can be limited. Involving patients and the public can enhance guideline implementation, but there is uncertainty about the best approaches to achieve this. Citizen science is a potential way to involve patients and the public in improving clinical guideline implementation. We aimed to explore the application of citizen science methods to involve patients and the public in the dissemination and implementation of clinical guidelines in oral health and dentistry. METHODS We developed GUIDE (GUideline Implementation in oral health and DEntistry), a citizen science online platform, using a participatory approach with researchers, oral health professionals, guideline developers and citizens. Recruitment was conducted exclusively online. The platform focused on prespecified challenges related to oral health assessment guidelines, and asked citizens to generate ideas, as well as vote and comment on other citizens' ideas to improve those challenges. Citizens also shared their views via surveys and two online synchronous group meetings. Data were collected on participant's demographics, platform engagement and experience of taking part. The most promising idea category was identified by an advisory group based on engagement, feasibility and relevance. We presented quantitative data using descriptive statistics and analysed qualitative data using inductive and deductive thematic analysis. RESULTS The platform was open for 6 months and we recruited 189 citizens, from which over 90 citizens actively engaged with the platform. Most citizens were over 34 years (64%), female (58%) and had a university degree (50%). They generated 128 ideas, 146 comments and 248 votes. The challenge that led to most engagement was related to prevention and oral health self-care. To take this challenge forward, citizens generated a further 36 ideas to improve a pre-existing National Health Service oral care prevention leaflet. Citizens discussed motivations to take part in the platform (understanding, values, self-care), reasons to stay engaged (communication and feedback, outputs and impact, and relevance of topics discussed) and suggestions to improve future platforms. CONCLUSION Citizen science is an effective approach to generate and prioritise ideas from a group of citizens to improve oral health and dental services. Prevention and oral health self-care were of particular interest to citizens. More research is needed to ensure recruitment of a diverse group of citizens and to improve retention in citizen science projects. PATIENT OR PUBLIC CONTRIBUTION This project was inherently conducted with the input of public partners (citizen scientists) in all key aspects of its conduct and interpretation. In addition, two public partners were part of the research team and contributed to the design of the project, as well as key decisions related to its conduct, analysis, interpretation and dissemination and are co-authors of this manuscript.
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Affiliation(s)
- Annabel Hosie
- Health Services Research UnitUniversity of AberdeenAberdeenUK
| | - Maria Firdaus
- Health Services Research UnitUniversity of AberdeenAberdeenUK
| | - Jan Clarkson
- Dental Health Services Research Unit, Dundee Dental SchoolThe University of DundeeDundeeUK
| | - Ekta Gupta
- Institute of DentistryUniversity of AberdeenAberdeenUK
| | | | - Thomas Lamont
- Dental Health Services Research Unit, Dundee Dental SchoolThe University of DundeeDundeeUK
| | - Margaret Mooney
- Scottish Dental Clinical Effectiveness Programme (SDCEP)NHS Education for ScotlandEdinburghUK
| | - Gillian Nevin
- NHS Education for Scotland (Dental), DundeeScotlandUK
| | - Craig Ramsay
- Health Services Research UnitUniversity of AberdeenAberdeenUK
| | - Samantha Rutherford
- Scottish Dental Clinical Effectiveness Programme (SDCEP)NHS Education for ScotlandEdinburghUK
| | | | | | - Derek Richards
- Dental Health Services Research Unit, Dundee Dental SchoolThe University of DundeeDundeeUK
| | - Douglas Stirling
- Scottish Dental Clinical Effectiveness Programme (SDCEP)NHS Education for ScotlandEdinburghUK
| | - Michele West
- Scottish Dental Clinical Effectiveness Programme (SDCEP)NHS Education for ScotlandEdinburghUK
| | - Beatriz Goulao
- Health Services Research UnitUniversity of AberdeenAberdeenUK
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Boxall C, Renz S, Eminton Z, Nuttall J, Saji A, Cluff C, Wilcox C, Muller I, Layton AM, Soulsby I, Santer M. Factors that influence women's enrolment and ongoing participation in a partially decentralised randomised controlled dermatology trial: a qualitative interview study with participants in the SAFA (Spironolactone for Adult Female Acne) trial. Trials 2023; 24:661. [PMID: 37821899 PMCID: PMC10568833 DOI: 10.1186/s13063-023-07630-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/07/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND The use of decentralised clinical trials (which bring trials to patients through remote processes and technology versus central on-site visits) has been thought to be a potential solution to common recruitment and retention barriers. However, there is a lack of evidence to understand the experiences, needs and preferences of the public to inform trial methodologies that appeal to different populations. We report participant experiences of SAFA, a partially decentralised randomised clinical trial, to inform the methodology used in future dermatology trials that aim to appeal to women aged 18 and over. METHODS Participants of the SAFA (Spironolactone for Adult Female Acne) trial were invited to take part in a qualitative semi-structured interview to explore their experience and perspectives of taking part in the trial. Questions focused on their experience of using decentralised methods to access and enrol in the trial (e.g. social media advertising), in addition to the decentralised trial visit and data collection methods used throughout. Interviews were conducted remotely, recorded, and transcribed. Data were analysed using reflexive thematic analysis. RESULTS Twelve SAFA participants (all women, age range 22-36 years) were interviewed. Initially, participants were influenced to enrol by trusted online information, the feeling of validation the trial provided, and the convenience and flexibility offered by the decentralised methods and research staff made participants feel valued and enabled them to engage in the trial with minimal interference to existing commitments. SAFA participants were generally accepting of trial demands, such as the text-heavy paperwork and on-site visits for blood collection and highlighted several areas relevant for trial conduct going forwards including where decentralised methods may (and may not) be accepted and how trial accessibility and understanding could be improved. CONCLUSIONS The study has shown that decentralised methods used by responsive and approachable staff were widely accepted in the SAFA trial. Interviewees found the methods adopted in the SAFA trial helped the trial to fit with their needs and promoted a sense of feeling valued that encouraged ongoing trial engagement. Decentralised methods should be considered favourably when designing a dermatology trial as they can potentially enhance both recruitment and retention. TRIAL REGISTRATION NUMBER ISRCTN 12892056. Registered on October 15, 2018.
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Affiliation(s)
- Cherish Boxall
- Southampton Clinical Trials Unit, University of Southampton, Southampton, SO16 6YD, UK.
| | - Susanne Renz
- Southampton Clinical Trials Unit, University of Southampton, Southampton, SO16 6YD, UK
| | - Zina Eminton
- Southampton Clinical Trials Unit, University of Southampton, Southampton, SO16 6YD, UK
| | - Jacqueline Nuttall
- Southampton Clinical Trials Unit, University of Southampton, Southampton, SO16 6YD, UK
| | - Alan Saji
- Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
| | - Charlotte Cluff
- Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
| | - Christopher Wilcox
- Primary Care Research Centre, University of Southampton, Southampton, SO16 6YD, UK
| | - Ingrid Muller
- Primary Care Research Centre, University of Southampton, Southampton, SO16 6YD, UK
| | | | - Irene Soulsby
- Southampton Clinical Trials Unit, University of Southampton, Southampton, SO16 6YD, UK
| | - Miriam Santer
- Primary Care Research Centre, University of Southampton, Southampton, SO16 6YD, UK
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Toumpakari Z, Valerino-Perea S, Willis K, Adams J, White M, Vasiljevic M, Ternent L, Brown J, Kelly MP, Bonell C, Cummins S, Majeed A, Anderson S, Robinson T, Araujo-Soares V, Watson J, Soulsby I, Green D, Sniehotta FF, Jago R. Exploring views of members of the public and policymakers on the acceptability of population level dietary and active-travel policies: a qualitative study. Int J Behav Nutr Phys Act 2023; 20:64. [PMID: 37259093 DOI: 10.1186/s12966-023-01465-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 05/06/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND There is limited evidence on what shapes the acceptability of population level dietary and active-travel policies in England. This information would be useful in the decision-making process about which policies should be implemented and how to increase their effectiveness and sustainability. To fill this gap, we explored public and policymakers' views about factors that influence public acceptability of dietary and active-travel policies and how to increase public acceptability for these policies. METHODS We conducted online, semi-structured interviews with 20 members of the public and 20 policymakers in England. A purposive sampling frame was used to recruit members of the public via a recruitment agency, based on age, sex, socioeconomic status and ethnicity. Policymakers were recruited from existing contacts within our research collaborations and via snowball sampling. We explored different dietary and active-travel policies that varied in their scope and focus. Interviews were transcribed verbatim and analysed using thematic reflexive analysis with both inductive and deductive coding. RESULTS We identified four themes that informed public acceptability of dietary and active-travel policies: (1) perceived policy effectiveness, i.e., policies that included believable mechanisms of action, addressed valued co-benefits and barriers to engage in the behaviour; (2) perceived policy fairness, i.e., policies that provided everyone with an opportunity to benefit (mentioned only by the public), equally considered the needs of various population subgroups and rewarded 'healthy' behaviours rather than only penalising 'unhealthy' behaviours; (3) communication of policies, i.e., policies that were visible and had consistent and positive messages from the media (mentioned only by policymakers) and (4) how to improve policy support, with the main suggestion being an integrated strategy addressing multiple aspects of these behaviours, inclusive policies that consider everyone's needs and use of appropriate channels and messages in policy communication. CONCLUSIONS Our findings highlight that members' of the public and policymakers' support for dietary and active-travel policies can be shaped by the perceived effectiveness, fairness and communication of policies and provide suggestions on how to improve policy support. This information can inform the design of acceptable policies but can also be used to help communicate existing and future policies to maximise their adoption and sustainability.
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Affiliation(s)
- Z Toumpakari
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ, UK.
| | - S Valerino-Perea
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ, UK
| | - K Willis
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - J Adams
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - M White
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - M Vasiljevic
- Fuse - Centre for Translational Research in Public Health, Newcastle, UK
- Department of Psychology, Durham University, Durham, UK
| | - L Ternent
- Fuse - Centre for Translational Research in Public Health, Newcastle, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - J Brown
- Department of Behavioural Science and Health, University College London, London, UK
- SPECTRUM Consortium, London, UK
| | - M P Kelly
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - C Bonell
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - S Cummins
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - A Majeed
- Department of Primary Care and Public Health, Imperial College London, London, W6 8RP, UK
| | - S Anderson
- Fuse - Centre for Translational Research in Public Health, Newcastle, UK
- Department of Psychology, Durham University, Durham, UK
| | - T Robinson
- Fuse - Centre for Translational Research in Public Health, Newcastle, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
- The National Institute for Health Research, Applied Research Collaboration Northeast and North Cumbria (NIHR ARC NENC), St Nicholas' Hospital, Newcastle Upon Tyne, Jubilee Road, Gosforth, NE3 3XT, UK
| | - V Araujo-Soares
- Fuse - Centre for Translational Research in Public Health, Newcastle, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Faculty of Behavioural, Management and Social Sciences, Department of Health Technology and Services Research, University of Twente, Twente, The Netherlands
| | - J Watson
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ, UK
- South Gloucestershire Council, Badminton Road, Yate, Bristol, BS37 5AF, UK
| | - I Soulsby
- Fuse - Centre for Translational Research in Public Health, Newcastle, UK
| | - D Green
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - F F Sniehotta
- Fuse - Centre for Translational Research in Public Health, Newcastle, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
- Department for Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - R Jago
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
- Applied Research Collaboration West (NIHR ARC West), The National Institute for Health Research, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, BS1 2NT, UK
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Santer M, Lawrence M, Renz S, Eminton Z, Stuart B, Sach TH, Pyne S, Ridd MJ, Francis N, Soulsby I, Thomas K, Permyakova N, Little P, Muller I, Nuttall J, Griffiths G, Thomas KS, Layton AM. Effectiveness of spironolactone for women with acne vulgaris (SAFA) in England and Wales: pragmatic, multicentre, phase 3, double blind, randomised controlled trial. BMJ 2023; 381:e074349. [PMID: 37192767 PMCID: PMC10543374 DOI: 10.1136/bmj-2022-074349] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2023] [Indexed: 05/18/2023]
Abstract
OBJECTIVE To assess the effectiveness of oral spironolactone for acne vulgaris in adult women. DESIGN Pragmatic, multicentre, phase 3, double blind, randomised controlled trial. SETTING Primary and secondary healthcare, and advertising in the community and on social media in England and Wales. PARTICIPANTS Women (≥18 years) with facial acne for at least six months, judged to warrant oral antibiotics. INTERVENTIONS Participants were randomly assigned (1:1) to either 50 mg/day spironolactone or matched placebo until week six, increasing to 100 mg/day spironolactone or placebo until week 24. Participants could continue using topical treatment. MAIN OUTCOME MEASURES Primary outcome was Acne-Specific Quality of Life (Acne-QoL) symptom subscale score at week 12 (range 0-30, where higher scores reflect improved QoL). Secondary outcomes were Acne-QoL at week 24, participant self-assessed improvement; investigator's global assessment (IGA) for treatment success; and adverse reactions. RESULTS From 5 June 2019 to 31 August 2021, 1267 women were assessed for eligibility, 410 were randomly assigned to the intervention (n=201) or control group (n=209) and 342 were included in the primary analysis (n=176 in the intervention group and n=166 in the control group). Baseline mean age was 29.2 years (standard deviation 7.2), 28 (7%) of 389 were from ethnicities other than white, with 46% mild, 40% moderate, and 13% severe acne. Mean Acne-QoL symptom scores at baseline were 13.2 (standard deviation 4.9) and at week 12 were 19.2 (6.1) for spironolactone and 12.9 (4.5) and 17.8 (5.6) for placebo (difference favouring spironolactone 1.27 (95% confidence interval 0.07 to 2.46), adjusted for baseline variables). Scores at week 24 were 21.2 (5.9) for spironolactone and 17.4 (5.8) for placebo (difference 3.45 (95% confidence interval 2.16 to 4.75), adjusted). More participants in the spironolactone group reported acne improvement than in the placebo group: no significant difference was reported at week 12 (72% v 68%, odds ratio 1.16 (95% confidence interval 0.70 to 1.91)) but significant difference was noted at week 24 (82% v 63%, 2.72 (1.50 to 4.93)). Treatment success (IGA classified) at week 12 was 31 (19%) of 168 given spironolactone and nine (6%) of 160 given placebo (5.18 (2.18 to 12.28)). Adverse reactions were slightly more common in the spironolactone group with more headaches reported (20% v 12%; p=0.02). No serious adverse reactions were reported. CONCLUSIONS Spironolactone improved outcomes compared with placebo, with greater differences at week 24 than week 12. Spironolactone is a useful alternative to oral antibiotics for women with acne. TRIAL REGISTRATION ISRCTN12892056.
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Affiliation(s)
- Miriam Santer
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Megan Lawrence
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Susanne Renz
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Zina Eminton
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Beth Stuart
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton, UK
- Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, Yvonne Carter Building, London, UK
| | - Tracey H Sach
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Sarah Pyne
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Matthew J Ridd
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, UK
| | - Nick Francis
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Irene Soulsby
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Karen Thomas
- Primary Care Research Centre, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Natalia Permyakova
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- National Institute for Health and Care Research, Research Design Service South Central, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul Little
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Ingrid Muller
- Primary Care Research Centre, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jacqui Nuttall
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, Applied Health Services Research Building, University Park, Nottingham, UK
| | - Alison M Layton
- Skin Research Centre, Hull York Medical School, University of York, York, UK
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Green D, Bryant V, Edwards S, Kemp C, McKenzie M, Shah S, Soulsby I. Then there were seven: a commentary on creating a public involvement strategy group for a policy research unit in behavioural science. Res Involv Engagem 2023; 9:1. [PMID: 36739420 PMCID: PMC9899059 DOI: 10.1186/s40900-023-00413-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
The National Institute for Health and Care Research (NIHR) Policy Research Unit in Behavioural Science (PRU-BS) was funded to inform government on the application of behavioural science in health and social care policy. What makes this unit different to other topic specific ones, was the wide range of its brief. Because of this, the PPI group would need to include a wide range of experience and expertise and be prepared to learn. We were a different type of public group for a different type of task. This paper deals with how we approached this. In this paper we outline how the PPI plan in the funding proposal for the PRU-BS was adapted to real world challenges. We describe the stages in the formation of the PPI Strategy Group and how a virtual platform was created to ensure good communication. We discuss our pragmatic approach of developing Terms of Reference and a PPI strategy document. Given the restrictions imposed by the Covid-19 pandemic we explain how we tackled PPI SG member induction sessions, meetings and training sessions. To illustrate how the group operates we provide an example of our involvement in a PRU-BS project. Central to our paper is the lessons we learned. We hope the challenges we met in forming the unique PPI SG, how these were overcome, and our recommendations will help others faced with a similar task.
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Affiliation(s)
- Dave Green
- Policy Research Unit Behavioural Science, Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, NE2 4AX, England, UK.
| | - Val Bryant
- Policy Research Unit Behavioural Science, Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, NE2 4AX, England, UK
| | - Stuart Edwards
- Policy Research Unit Behavioural Science, Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, NE2 4AX, England, UK
| | - Caroline Kemp
- Policy Research Unit Behavioural Science, Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, NE2 4AX, England, UK
| | - Maisie McKenzie
- Policy Research Unit Behavioural Science, Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, NE2 4AX, England, UK
| | - Sudhir Shah
- Policy Research Unit Behavioural Science, Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, NE2 4AX, England, UK
| | - Irene Soulsby
- Policy Research Unit Behavioural Science, Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, NE2 4AX, England, UK
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Macgregor A, McCormack B, Spilsbury K, Hockley J, Rutherford A, Ogden M, Soulsby I, McKenzie M, Hanratty B, Forbat L. Supporting care home residents in the last year of life through 'Needs Rounds': Development of a pre-implementation programme theory through a rapid collaborative online approach. Front Health Serv 2022; 2:1019602. [PMID: 36925884 PMCID: PMC10012649 DOI: 10.3389/frhs.2022.1019602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/12/2022] [Indexed: 01/12/2023]
Abstract
Background Realist evaluation aims to address the knowledge to practice gap by explaining how an intervention is expected to work, as well as what is likely to impact upon the success of its implementation, by developing programme theories that link contexts, mechanisms and outcomes. Co-production approaches to the development of programme theories offer substantial benefits in addressing power relations, including and valuing different types of knowledge, and promoting buy-in from stakeholders while navigating the complex social systems in which innovations are embedded. This paper describes the co-production of an initial programme theory of how an evidence based intervention developed in Australia - called 'Palliative Care Needs Rounds' - might work in England and Scotland to support care home residents approaching their end of life. Methods Using realist evaluation and iPARIHS (integrated Promoting Action on Research Implementation in Health Services) we sought to determine how contexts and mechanisms of change might shape implementation outcomes. Pre-intervention online interviews (n = 28) were conducted (February-April 2021), followed by four co-design online workshops with 43 participants (April-June 2021). The online interviews and workshops included a range of stakeholders, including care home staff, specialist palliative care staff, paramedics, general practitioners, and relatives of people living in care homes. Results This methodology paper reports developments in realist evaluation and co-production methodologies, and how they were used to develop context, mechanisms, outcomes (CMOs) configurations, and chains of inference. The initial (pre-intervention) programme theory is used to illustrate this process. Two developments to iPARIHS are described. First, involving stakeholders in the collaborative co-design workshops created opportunities to commence facilitation. Second, we describe developing iPARIHS' innovation component, to include novel stakeholder interpretations, perceptions and anticipated use of the intervention as they participated in workshop discussions. Conclusions This rapid and robust co-production methodology draws on interactive collaborative research practices (interviews, workshop discussions of data, illustrative vignettes and visual methods). These innovative and engaging methods can be packaged for online processes to develop, describe and interrogate the CMOs in order to co-produce a programme theory. These approaches also commence facilitation and innovation, and can be adopted in other implementation science and realist studies.
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Affiliation(s)
- Aisha Macgregor
- Faculty of Social Sciences, University of Stirling, Stirling, Scotland
| | - Brendan McCormack
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia
| | | | - Jo Hockley
- College of Medicine and Veterinary Science, University of Edinburgh, Scotland
| | | | | | | | | | | | - Liz Forbat
- Faculty of Social Sciences, University of Stirling, Stirling, Scotland
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9
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Renz S, Chinnery F, Stuart B, Day L, Muller I, Soulsby I, Nuttall J, Thomas K, Thomas KS, Sach T, Stanton L, Ridd MJ, Francis N, Little P, Eminton Z, Griffiths G, Layton AM, Santer M. Spironolactone for adult female acne (SAFA): protocol for a double-blind, placebo-controlled, phase III randomised study of spironolactone as systemic therapy for acne in adult women. BMJ Open 2021; 11:e053876. [PMID: 34446504 PMCID: PMC8395279 DOI: 10.1136/bmjopen-2021-053876] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Acne is one of the most common inflammatory skin diseases worldwide and can have significant psychosocial impact and cause permanent scarring. Spironolactone, a potassium-sparing diuretic, has antiandrogenic properties, potentially reducing sebum production and hyperkeratinisation in acne-prone follicles. Dermatologists have prescribed spironolactone for acne in women for over 30 years, but robust clinical study data are lacking. This study seeks to evaluate whether spironolactone is clinically effective and cost-effective in treating acne in women. METHODS AND ANALYSIS Women (≥18 years) with persistent facial acne requiring systemic therapy are randomised to receive one tablet per day of 50 mg spironolactone or a matched placebo until week 6, increasing to up to two tablets per day (total of 100 mg spironolactone or matched placebo) until week 24, along with usual topical therapy if desired. Study treatment stops at week 24; participants are informed of their treatment allocation and enter an unblinded observational follow-up period for up to 6 months (up to week 52 after baseline). Primary outcome is the Acne-specific Quality of Life (Acne-QoL) symptom subscale score at week 12. Secondary outcomes include Acne-QoL total and subscales; participant acne self-assessment recorded on a 6-point Likert scale at 6, 12, 24 weeks and up to 52 weeks; Investigator's Global Assessment at weeks 6 and 12; cost and cost effectiveness are assessed over 24 weeks. Aiming to detect a group difference of 2 points on the Acne-QoL symptom subscale (SD 5.8, effect size 0.35), allowing for 20% loss to follow-up, gives a sample size of 398 participants. ETHICS AND DISSEMINATION This protocol was approved by Wales Research Ethics Committee (18/WA/0420). Follow-up to be completed in early 2022. Findings will be disseminated to participants, peer-reviewed journals, networks and patient groups, on social media, on the study website and the Southampton Clinical Trials Unit website to maximise impact. TRIAL REGISTRATION NUMBER ISRCTN12892056;Pre-results.
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Affiliation(s)
- Susanne Renz
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Fay Chinnery
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Beth Stuart
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
- Primary Care Research Centre, Faculty of Medicine, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Laura Day
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Ingrid Muller
- Primary Care Research Centre, Faculty of Medicine, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | | | - Jacqui Nuttall
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Karen Thomas
- Acne Support, PPI representative, Cambridgeshire, UK
| | - Kim Suzanne Thomas
- School of Medicine, Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Tracey Sach
- Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Louise Stanton
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Matthew J Ridd
- Population Health Sciences, University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Nick Francis
- Primary Care Research Centre, Faculty of Medicine, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Paul Little
- Primary Care Research Centre, Faculty of Medicine, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Zina Eminton
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | | | - Miriam Santer
- Primary Care Research Centre, Faculty of Medicine, School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
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10
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Stuart B, Maund E, Wilcox C, Sridharan K, Sivaramakrishnan G, Regas C, Newell D, Soulsby I, Tang KF, Finlay AY, Bucher HC, Little P, Layton AM, Santer M. Topical preparations for the treatment of mild-to-moderate acne vulgaris: systematic review and network meta-analysis. Br J Dermatol 2021; 185:512-525. [PMID: 33825196 DOI: 10.1111/bjd.20080] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Acne is very common and can have a substantial impact on wellbeing. Guidelines suggest first-line management with topical treatments, but there is little evidence regarding which treatments are most effective. OBJECTIVES To identify the most effective and best tolerated topical treatments for acne using network meta-analysis. METHODS CENTRAL, MEDLINE, Embase and World Health Organization Trials Registry were searched from inception to June 2020 for randomized trials that included participants with mild/moderate acne. Primary outcomes were self-reported improvement in acne, and trial withdrawal. Secondary outcomes included change in lesion counts, Investigator's Global Assessment, change in quality of life and total number of adverse events. Network meta-analysis was undertaken using a frequentist approach. Risk of bias was assessed using the Cochrane Risk of Bias Tool and confidence in evidence was assessed using CINeMA. RESULTS A total of 81 papers were included, reporting 40 trials with a total of 18 089 participants. Patient Global Assessment of Improvement was reported in 11 trials. Based on the pooled network estimates, compared with vehicle, benzoyl peroxide (BPO) was effective (35% vs. 26%) for improving self-reported acne. The combinations of BPO with adapalene (54% vs. 35%) or with clindamycin (49% vs. 35%) were ranked more effective than BPO alone. The withdrawal of participants from the trial was reported in 35 trials. The number of patients withdrawing owing to adverse events was low for all treatments. Rates of withdrawal were slightly higher for BPO with adapalene (2·5%) or clindamycin (2·7%) than BPO (1·6%) or adapalene alone (1·0%). Overall confidence in the evidence was low. CONCLUSIONS Adapalene in combination with BPO may be the most effective treatment for acne but with a slightly higher incidence of withdrawal than monotherapy. Inconsistent reporting of trial results precluded firmer conclusions.
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Affiliation(s)
- B Stuart
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - E Maund
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - C Wilcox
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - K Sridharan
- Department of Pharmacology & Therapeutics, College of Medicine & Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
| | - G Sivaramakrishnan
- Department of Dental Training, Ministry of Health, Manama, Kingdom of Bahrain
| | - C Regas
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - D Newell
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - I Soulsby
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - K F Tang
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - A Y Finlay
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - H C Bucher
- Basel Institute for Clinical Epidemiology and Biostatistics (CEB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - P Little
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - A M Layton
- Hull York Medical School, York University, Heslington, York, UK.,Harrogate and District NHS Foundation Trust, Harrogate, UK
| | - M Santer
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
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11
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Treweek S, Banister K, Bower P, Cotton S, Devane D, Gardner HR, Isaacs T, Nestor G, Oshisanya A, Parker A, Rochester L, Soulsby I, Williams H, Witham MD. Developing the INCLUDE Ethnicity Framework-a tool to help trialists design trials that better reflect the communities they serve. Trials 2021; 22:337. [PMID: 33971916 PMCID: PMC8108025 DOI: 10.1186/s13063-021-05276-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [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: 01/22/2021] [Accepted: 04/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background Ensuring that a trial is designed so that its participants reflect those who might benefit from the results, or be spared harms, is key to the potential benefits of the trial reaching all they should. This paper describes the process, facilitated by Trial Forge, that was used between July 2019 and October 2020 to develop the INCLUDE Ethnicity Framework, part of the wider INCLUDE initiative from the National Institute for Health Research to improve inclusion of under-served groups in clinical research studies. Methods Development of the Framework was done in seven phases: (1) outline, (2) initial draft, (3) stakeholder meeting, (4) modify draft, (5) Stakeholder feedback, (6) applying the Framework and (7) packaging. Phases 2 and 3 were face-to-face meetings. Consultation with stakeholders was iterative, especially phases 4 to 6. Movement to the next phase was done once all or most stakeholders were comfortable with the results of the current phase. When there was a version of the Framework that could be considered final, the Framework was applied to six trials to create a set of examples (phase 6). Finally, the Framework, guidance and examples were packaged ready for dissemination (phase 7). Results A total of 40 people from stakeholder groups including patient and public partners, clinicians, funders, academics working with various ethnic groups, trial managers and methodologists contributed to the seven phases of development. The Framework comprises two parts. The first part is a list of four key questions:
Who should my trial apply to? Are the groups identified likely to respond in different ways? Will my study intervention make it harder for some groups to engage? Will the way I have designed the study make it harder for some groups to engage?
The second part is a set of worksheets to help trial teams address these questions. The Framework can be used for any stage of trial, for a healthcare intervention in any disease area. The Framework was launched on 1st October 2020 and is available open access at the Trial Forge website: https://www.trialforge.org/trial-forge-centre/include/. Conclusion Thinking about the number of people in our trials is not enough: we need to start thinking more carefully about who our participants are. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05276-8.
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Affiliation(s)
- Shaun Treweek
- Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Aberdeen, AB25 2ZD, UK.
| | - Katie Banister
- Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Aberdeen, AB25 2ZD, UK
| | - Peter Bower
- NIHR Clinical Research Network, Manchester Academic Health Science Centre, Centre for Primary Care and Health Services Research, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Seonaidh Cotton
- Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Aberdeen, AB25 2ZD, UK
| | - Declan Devane
- National University of Ireland Galway, School of Nursing and Midwifery, University Road, Galway, Ireland
| | - Heidi R Gardner
- Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Aberdeen, AB25 2ZD, UK
| | - Talia Isaacs
- UCL Centre for Applied Linguistics, UCL Institute of Education, University College London, London, UK
| | - Gary Nestor
- NIHR Clinical Research Network Cluster E, Campus for Ageing and Vitality, Newcastle University, Newcastle, NE4 5PL, UK
| | | | - Adwoa Parker
- York Clinical Trials Unit, University of York, York, UK
| | - Lynn Rochester
- Translational and Clinical Research Institute; NIHR Clinical Research Network Cluster E, Campus for Ageing and Vitality, Newcastle University, Newcastle, NE4 5PL, UK
| | | | - Hywel Williams
- Centre of Evidence-Based Dermatology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - Miles D Witham
- NIHR Newcastle Biomedical Research Centre, Campus for Ageing and Vitality, Newcastle University and Newcastle upon Tyne NHS Trust, Newcastle, NE4 5PL, UK
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12
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Macgregor A, Rutherford A, McCormack B, Hockley J, Ogden M, Soulsby I, McKenzie M, Spilsbury K, Hanratty B, Forbat L. Palliative and end-of-life care in care homes: protocol for codesigning and implementing an appropriate scalable model of Needs Rounds in the UK. BMJ Open 2021; 11:e049486. [PMID: 33619205 PMCID: PMC7903098 DOI: 10.1136/bmjopen-2021-049486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Palliative and end-of-life care in care homes is often inadequate, despite high morbidity and mortality. Residents can experience uncontrolled symptoms, poor quality deaths and avoidable hospitalisations. Care home staff can feel unsupported to look after residents at the end of life. Approaches for improving end-of-life care are often education-focused, do not triage residents and rarely integrate clinical care. This study will adapt an evidence-based approach from Australia for the UK context called 'Palliative Care Needs Rounds' (Needs Rounds). Needs Rounds combine triaging, anticipatory person-centred planning, case-based education and case-conferencing; the Australian studies found that Needs Rounds reduce length of stay in hospital, and improve dying in preferred place of care, and symptoms at the end of life. METHODS AND ANALYSIS This implementation science study will codesign and implement a scalable UK model of Needs Rounds. The Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework will be used to identify contextual barriers and use facilitation to enable successful implementation. Six palliative care teams, working with 4-6 care homes each, will engage in two phases. In phase 1 (February 2021), stakeholder interviews (n=40) will be used to develop a programme theory to meet the primary outcome of identifying what works, for whom in what circumstances for UK Needs Rounds. Subsequently a workshop to codesign UK Needs Rounds will be run. Phase 2 (July 2021) will implement the UK model for a year. Prospective data collection will focus on secondary outcomes regarding hospitalisations, residents' quality of death and care home staff capability of adopting a palliative approach. ETHICS AND DISSEMINATION Frenchay Research Ethics Committee (287447) approved the study. Findings will be disseminated to policy-makers, care home/palliative care practitioners, residents/relatives and academic audiences. An implementation package will be developed for practitioners to provide the tools and resources required to adopt UK Needs Rounds. REGISTRATION DETAILS Registration details: ISRCTN15863801.
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Affiliation(s)
- Aisha Macgregor
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | | | - Brendan McCormack
- Divisions of Nursing, Occupational Therapy & Arts Therapies, Queen Margaret University, Edinburgh, UK
| | - Jo Hockley
- Usher Institute, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Margaret Ogden
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Irene Soulsby
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Maisie McKenzie
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | | | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Liz Forbat
- Faculty of Social Sciences, University of Stirling, Stirling, UK
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13
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Brunsdon D, Biesty L, Brocklehurst P, Brueton V, Devane D, Elliott J, Galvin S, Gamble C, Gardner H, Healy P, Hood K, Jordan J, Lanz D, Maeso B, Roberts A, Skene I, Soulsby I, Stewart D, Torgerson D, Treweek S, Whiting C, Wren S, Worrall A, Gillies K. What are the most important unanswered research questions in trial retention? A James Lind Alliance Priority Setting Partnership: the PRioRiTy II (Prioritising Retention in Randomised Trials) study. Trials 2019; 20:593. [PMID: 31615577 PMCID: PMC6794792 DOI: 10.1186/s13063-019-3687-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 08/29/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND One of the top three research priorities for the UK clinical trial community is to address the gap in evidence-based approaches to improving participant retention in randomised trials. Despite this, there is little evidence supporting methods to improve retention. This paper reports the PRioRiTy II project, a Priority Setting Partnership (PSP) that identified and prioritised unanswered questions and uncertainties around trial retention in collaboration with key stakeholders. METHODS This PSP was conducted in collaboration with the James Lind Alliance, a non-profit making initiative, to support key stakeholders (researchers, patients, and the public) in jointly identifying and agreeing on priority research questions. There were three stages. (1) First an initial online survey was conducted consisting of six open-ended questions about retention in randomised trials. Responses were coded into thematic groups to create a longlist of questions. The longlist of questions was checked against existing evidence to ensure that they had not been answered by existing research. (2) An interim stage involved a further online survey where stakeholders were asked to select questions of key importance from the longlist. (3) A face-to-face consensus meeting was held, where key stakeholder representatives agreed on an ordered list of 21 unanswered research questions for methods of improving retention in randomised trials. RESULTS A total of 456 respondents yielded 2431 answers to six open-ended questions, from which 372 questions specifically about retention were identified. Further analysis included thematically grouping all data items within answers and merging questions in consultation with the Steering Group. This produced 27 questions for further rating during the interim survey. The top 21 questions from the interim online survey were brought to a face-to-face consensus meeting in which key stakeholder representatives prioritised the order. The 'Top 10' of these are reported in this paper. The number one ranked question was 'What motivates a participant's decision to complete a clinical trial?' The entire list will be available at www.priorityresearch.ie . CONCLUSION The Top 10 list can inform the direction of future research on trial methods and be used by funders to guide projects aiming to address and improve retention in randomised trials.
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Affiliation(s)
- Dan Brunsdon
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Linda Biesty
- School of Nursing and Midwifery, Evidence Synthesis Ireland, NUI Galway, Galway, Ireland
| | - Peter Brocklehurst
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Valerie Brueton
- Department of Adult Nursing, Kings College London, London, UK
| | - Declan Devane
- Health Research Board-Trials Methodology Research Network, Galway, Ireland
| | - Jim Elliott
- Health Research Authority, National Health Service, London, UK
| | - Sandra Galvin
- Health Research Board-Trials Methodology Research Network, Galway, Ireland
| | - Carrol Gamble
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Heidi Gardner
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Patricia Healy
- School of Nursing and Midwifery, Evidence Synthesis Ireland, NUI Galway, Galway, Ireland
| | - Kerenza Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Doris Lanz
- Women’s Health Research Unit, Queen Mary University of London, London, UK
| | - Beccy Maeso
- James Lind Alliance, Wessex Institute, University of Southampton, Southampton, UK
| | - Amanda Roberts
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Irene Soulsby
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Derek Stewart
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Caroline Whiting
- James Lind Alliance, Wessex Institute, University of Southampton, Southampton, UK
| | - Sharon Wren
- Action on Hearing Loss, British Deaf Association, Deafscotland, Glasgow, UK
| | - Andrew Worrall
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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