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Fryer S, Paterson C, Turner L, Moinuddin A, Faulkner J, Stoner L, Daykin A, Stone K. Localized activity attenuates the combined impact of a high fat meal and prolonged sitting on arterial stiffness: A randomized, controlled cross-over trial. Front Physiol 2023; 14:1107456. [PMID: 36818445 PMCID: PMC9929358 DOI: 10.3389/fphys.2023.1107456] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/16/2023] [Indexed: 02/04/2023] Open
Abstract
Exposure to acute prolonged sitting and consumption of a high fat (HF) meal have been shown to independently and additively impair central and peripheral cardiovascular function. This study sought to determine whether localized activity, namely leg fidgeting, offers a protective effect to these deleterious effects. Using a randomized crossover design with three trials, 18 healthy males sat uninterrupted for 180 min following the consumption of a low fat (LF, trial 1) or HF meal (trial 2). The third trial consisted of a HF meal but sitting was interrupted with 1 min of leg fidgeting (isolated bilateral plantar flexion) consisting of -250 taps per min every 5 min for the 180 min duration. Carotid-femoral pulse wave velocity (cfPWV), aortic-femoral stiffness gradient (af-SG), superficial femoral blood flow, shear-rate and PWVβ, triglyceride concentrations and lower-limb venous pooling (HHb) were assessed pre and post sitting in all trials. General linear mixed model found that following the uninterrupted HF trial, there was a significant worsening of cfPWV (mean difference (MD) = 0.57 mˑs-1; d = 1.04) and the af-SG (MD = 0.14, d = 0.50), and femoral artery blood flow (MD = 18 mlˑmin-1; d = 0.48) and shear rate (MD = 15 S1; d = 0.67) decreased. However, leg fidgeting was enough to prevent the combined deleterious effects of prolonged sitting following a HF meal. As there were no significant changes in the LF trial, the HF meal maybe the predominant driver when uninterrupted sitting is combined with a HF meal.
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Affiliation(s)
- Simon Fryer
- School of Natural, Social and Sport Sciences, University of Gloucestershire, Cheltenham, United Kingdom,*Correspondence: Simon Fryer,
| | - Craig Paterson
- School of Natural, Social and Sport Sciences, University of Gloucestershire, Cheltenham, United Kingdom,Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC, United States
| | - Louise Turner
- School of Natural, Social and Sport Sciences, University of Gloucestershire, Cheltenham, United Kingdom
| | - Arsalan Moinuddin
- School of Natural, Social and Sport Sciences, University of Gloucestershire, Cheltenham, United Kingdom
| | - James Faulkner
- Department of Sport and Exercise, University of Winchester, Winchester, United Kingdom
| | - Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina, Chapel Hill, NC, United States,Department of Epidemiology, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, United States
| | - Anne Daykin
- School of Health and Social Care, University of Gloucestershire, Gloucester, United Kingdom
| | - Keeron Stone
- School of Natural, Social and Sport Sciences, University of Gloucestershire, Cheltenham, United Kingdom,Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom
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2
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Coulman KD, Nicholson A, Shaw A, Daykin A, Selman LE, Macefield R, Shorter GW, Cramer H, Sydes MR, Gamble C, Pick ME, Taylor G, Lane JA. Understanding and optimising patient and public involvement in trial oversight: an ethnographic study of eight clinical trials. Trials 2020; 21:543. [PMID: 32552907 PMCID: PMC7302397 DOI: 10.1186/s13063-020-04495-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/10/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Trial oversight is important for trial governance and conduct. Patients and/or lay members of the public are increasingly included in trial oversight committees, influenced by international patient and public involvement (PPI) initiatives to improve the quality and relevance of research. However, there is a lack of guidance on how to undertake PPI in trial oversight and tokenistic PPI remains an issue. This paper explores how PPI functions in existing trial oversight committees and provides recommendations to optimise PPI in future trials. This was part of a larger study investigating the role and function of oversight committees in trials facing challenges. METHODS Using an ethnographic study design, we observed oversight meetings of eight UK trials and conducted semi-structured interviews with members of their trial steering committees (TSCs) and trial management groups (TMGs) including public contributors, trial sponsors and funders. Thematic analysis of data was undertaken, with findings integrated to provide a multi-perspective account of how PPI functions in trial oversight. RESULTS Eight TSC and six TMG meetings from eight trials were observed, and 66 semi-structured interviews conducted with 52 purposively sampled oversight group members, including three public contributors. PPI was reported as beneficial in trial oversight, with public members contributing a patient voice and fulfilling a patient advocacy role. However, public contributors were not always active at oversight meetings and were sometimes felt to have a tokenistic role, with trialists reporting a lack of understanding of how to undertake PPI in trial oversight. To optimise PPI in trial oversight, the following areas were highlighted: the importance of planning effective strategies to recruit public contributors; considering the level of oversight and stage(s) of trial to include PPI; support for public contributors by the trial team between and during oversight meetings. CONCLUSIONS We present evidence-based recommendations to inform future PPI in trial oversight. Consideration should be given at trial design stage on how to recruit and involve public contributors within trial oversight, as well as support and mentorship for both public contributors and trialists (in how to undertake PPI effectively). Findings from this study further strengthen the evidence base on facilitating meaningful PPI within clinical trials.
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Affiliation(s)
- K D Coulman
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK.
| | - A Nicholson
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - A Shaw
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - A Daykin
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - L E Selman
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - R Macefield
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - G W Shorter
- Centre for Improving Health Related Quality of Life, School of Psychology, Queen's University Belfast, Belfast, BT9 5BN, UK
| | - H Cramer
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - M R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, WC1J 6JL, UK
- MRC London Hub for Trial Methodology Research, London, UK
| | - C Gamble
- MRC North West Hub for Trials Methodology Research, Institute of Translational Medicine, University of Liverpool, Liverpool, L69 3BX, UK
| | - M E Pick
- Bristol Randomised Trials Collaboration, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - G Taylor
- Bristol Randomised Trials Collaboration, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
| | - J A Lane
- MRC ConDuCT-II Hub for Trials Methodology Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2PS, UK
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3
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Kearney A, Rosala- Hallas A, Bacon N, Daykin A, Shaw ARG, Lane AJ, Blazeby JM, Clarke M, Williamson PR, Gamble C. Reducing attrition within clinical trials: The communication of retention and withdrawal within patient information leaflets. PLoS One 2018; 13:e0204886. [PMID: 30379822 PMCID: PMC6209179 DOI: 10.1371/journal.pone.0204886] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 09/17/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The recruitment and retention of patients are significant methodological challenges for trials. Whilst research has focussed on recruitment, the failure to retain recruited patients and collect outcome data can lead to additional problems and potentially biased results. Research to identify effective retention strategies has focussed on influencing patient behaviour through incentives, reminders and alleviating patient burden, but has not sought to improve patient understanding of the importance of retention. Our aim is to assess how withdrawal, retention and the value of outcome data collection is described within the Patient Information Leaflets (PIL) used during consent. METHODS Fifty adult or parent PIL from a cohort of trials starting between 2009-2012 and funded by the NIHR Health Technology Assessment programme were obtained from protocols, websites or by contacting trialists. A checklist of PIL content based on Health Research Authority (HRA) and ICH GCP Guidelines was supplemented with retention specific questions. Corresponding protocols were also evaluated to cross reference trial specific procedures with information communicated to patients. RESULTS PIL frequently reiterated the patient's right to withdraw at any time (n = 49, 98%), without having to give a reason and without penalty (n = 45, 90%). However, few informed patients they may be asked to give a withdrawal reason where willing (n = 6, 12%). Statements about the value of retention were infrequent (n = 8, 16%). Consent documents failed to include key content that might mitigate withdrawals, such as the need for treatment equipoise (n = 3, 6%). Nearly half the trials in the cohort (n = 23, 46%) wanted to continue to collect outcome data if patients withdraw. However, in 70% of PIL using prospective consent, withdrawal was described in generic terms leaving patients unaware of the difference between stopping treatment and all trial involvement. Nineteen (38%) trials offered withdrawing patients the option to delete existing data. CONCLUSIONS Withdrawal and retention is poorly described within PIL and addressing this might positively impact levels of patient attrition, reducing missing data. Consent information is unbalanced, focussing on patient's rights to withdraw without accompanying information that promotes robust consent and sustained participation. With many citing altruistic reasons for participation it is essential that PIL include more information on retention and clarify withdrawal terminology so patients are aware of how they can make a valuable contribution to clinical studies. There is a need to determine how retention can be described to patients to avoid concerns of coercion. Future research is needed to explore whether the absence of information about retention at the time of consent is impacting attrition.
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Affiliation(s)
- Anna Kearney
- North West Hub for Trials Methodology Research/ Clinical Trial Research Centre, Biostatistics, University of Liverpool, Liverpool, United Kingdom
- * E-mail:
| | - Anna Rosala- Hallas
- Clinical Trial Research Centre, Biostatistics, University of Liverpool, Liverpool, United Kingdom
| | - Naomi Bacon
- Clinical Trial Research Centre, Biostatistics, University of Liverpool, Liverpool, United Kingdom
| | - Anne Daykin
- ConDuCT-II Hub for Trials Methodology Research, University of Bristol, Bristol, United Kingdom
| | - Alison R. G. Shaw
- ConDuCT-II Hub for Trials Methodology Research, University of Bristol, Bristol, United Kingdom
| | - Athene J. Lane
- ConDuCT-II Hub for Trials Methodology Research, University of Bristol, Bristol, United Kingdom
| | - Jane M. Blazeby
- ConDuCT-II Hub for Trials Methodology Research, University of Bristol, Bristol, United Kingdom
| | - Mike Clarke
- Centre for Public Health, Queen’s University of Belfast, Belfast, United Kingdom
| | - Paula R. Williamson
- North West Hub for Trials Methodology Research/ Clinical Trial Research Centre, Biostatistics, University of Liverpool, Liverpool, United Kingdom
| | - Carrol Gamble
- North West Hub for Trials Methodology Research/ Clinical Trial Research Centre, Biostatistics, University of Liverpool, Liverpool, United Kingdom
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Daykin A, Clement C, Gamble C, Kearney A, Blazeby J, Clarke M, Lane JA, Shaw A. 'Recruitment, recruitment, recruitment' - the need for more focus on retention: a qualitative study of five trials. Trials 2018; 19:76. [PMID: 29378618 PMCID: PMC5789584 DOI: 10.1186/s13063-018-2467-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 12/20/2017] [Indexed: 11/20/2022] Open
Abstract
Background Loss to follow-up (attrition) is a frequent problem in clinical trials and can introduce bias or reduce power. So, understanding retention issues and strategies to address these are important. As part of a multi-method project, this qualitative study aimed to explore retention strategies used by trial teams and factors which may influence strategy adoption. Method A purposive sample of active trials was selected from the UK NIHR HTA portfolio of ongoing trials in 2014/2015. Semi-structured interviews with several trial team members from each trial and supplementary interviews with experienced trial managers explored strategies in collecting clinical outcome data and retaining participants. Interview data were analysed thematically using techniques of constant comparison. Results Twenty-two semi-structured interviews with trial team members including chief investigators, trial managers, nurses and research administrators revealed strategies used to enhance retention. Some were recognised methods and planned from trial outset whilst others were implemented more responsively. Interviewees placed great value on fostering positive relationships with trial participants to enhance retention. However, these strategies took time which was not always appreciated by the wider trial team or funding bodies. The national focus on recruitment targets in networks posed a challenge to staff and was deemed detrimental to retention. The ‘moral compass’ of individual researchers relied on their own beliefs and values and research experience and the factors affected their confidence to pursue participant data during follow-up. Conclusion The role of trial staff and their underlying behaviours influence retention practices and, combined with emphasis on recruitment targets, can be detrimental to motivation and retention activities. There is a need to consider how to train and support trial staff involved in retention practices and recognition of retention from funding bodies and oversight organisations.
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Affiliation(s)
- Anne Daykin
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Clare Clement
- Bristol Medical School, University of Bristol, Bristol, UK. .,Bristol Randomised Trials Collaboration (BRTC), University of Bristol, Bristol, UK. .,Collaboration and innovation in Difficult and Complex randomised controlled Trials In Invasive procedures (ConDuCT II Hub), University of Bristol, Bristol, UK.
| | - Carrol Gamble
- MRC North West Hub for Trials Methodology Research, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Anna Kearney
- MRC North West Hub for Trials Methodology Research, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Jane Blazeby
- Bristol Medical School, University of Bristol, Bristol, UK.,Collaboration and innovation in Difficult and Complex randomised controlled Trials In Invasive procedures (ConDuCT II Hub), University of Bristol, Bristol, UK
| | - Mike Clarke
- Queen's University Belfast, Belfast, Northern Ireland
| | - J Athene Lane
- Bristol Medical School, University of Bristol, Bristol, UK.,Bristol Randomised Trials Collaboration (BRTC), University of Bristol, Bristol, UK.,Collaboration and innovation in Difficult and Complex randomised controlled Trials In Invasive procedures (ConDuCT II Hub), University of Bristol, Bristol, UK
| | - Alison Shaw
- Bristol Medical School, University of Bristol, Bristol, UK
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Daykin A, Selman LE, Cramer H, McCann S, Shorter GW, Sydes MR, Gamble C, Macefield R, Lane JA, Shaw A. 'We all want to succeed, but we've also got to be realistic about what is happening': an ethnographic study of relationships in trial oversight and their impact. Trials 2017; 18:612. [PMID: 29273060 PMCID: PMC5741863 DOI: 10.1186/s13063-017-2305-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/01/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The oversight and conduct of a randomised controlled trial involves several stakeholders, including a Trial Steering Committee (TSC), Trial Management Group (TMG), Data Monitoring Committee (DMC), funder and sponsor. We aimed to examine how the relationships between these stakeholders affect the trial oversight process and its rigour, to inform future revision of Good Clinical Practice guidelines. METHODS Using an ethnographic study design, we observed the oversight processes of eight trials and conducted semi-structured interviews with members of the trials' TSCs and TMGs, plus other relevant informants, including sponsors and funders of trials. Data were analysed thematically, and findings triangulated and integrated to give a multi-perspective account of current oversight practices in the UK. RESULTS Eight TSC and six TMG meetings from eight trials were observed and audio-recorded, and 66 semi-structured interviews conducted with 52 purposively sampled key informants. Five themes are presented: (1) Collaboration within the TMG and role of the CTU; (2) Collaboration and conflict between oversight committees; (3) Priorities; (4) Communication between trial oversight groups and (5) Power and accountability. There was evidence of collaborative relationships, based on mutual respect, between CTUs, TMGs and TSCs, but also evidence of conflict. Relationships between trial oversight committees were influenced by stakeholders' priorities, both organisational and individual. Good communication following specific, recognised routes played a central role in ensuring that relationships were productive and trial oversight efficient. Participants described the possession of power over trials as a shifting political landscape, and there was lack of clarity regarding the roles and accountability of each committee, the sponsor and funder. Stakeholders' perceptions of their own power over a trial, and the power of others, influenced relationships between those involved in trial oversight. CONCLUSIONS Recent developments in trial design and conduct have been accompanied by changes in roles and relationships between trial oversight groups. Recognising and respecting the value of differing priorities among those involved in running trials is key to successful relationships between committees, funders and sponsors. Clarity regarding appropriate lines of communication, roles and accountability is needed. We present 10 evidence-based recommendations to inform updates to international trial guidance, particularly the Medical Research Council guidelines.
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Affiliation(s)
- Anne Daykin
- MRC ConDuCT Hub for Trials Methodology Research, Population Health Sciences, University of Bristol, Bristol, UK
| | - Lucy E. Selman
- MRC ConDuCT Hub for Trials Methodology Research, Population Health Sciences, University of Bristol, Bristol, UK
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Helen Cramer
- MRC ConDuCT Hub for Trials Methodology Research, Population Health Sciences, University of Bristol, Bristol, UK
| | - Sharon McCann
- Formerly: Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Gillian W. Shorter
- Psychotraumatology, Mental Health and Suicidal Behaviour, Psychology Research Institute, Ulster University, Belfast, UK
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Matthew R. Sydes
- MRC Clinical Trials Unit at UCL, London, UK
- MRC London Hub for Trial Methodology Research, London, UK
| | - Carrol Gamble
- MRC North West Hub for Trials Methodology Research, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Rhiannon Macefield
- MRC ConDuCT Hub for Trials Methodology Research, Population Health Sciences, University of Bristol, Bristol, UK
| | - J. Athene Lane
- MRC ConDuCT Hub for Trials Methodology Research, Population Health Sciences, University of Bristol, Bristol, UK
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Alison Shaw
- MRC ConDuCT Hub for Trials Methodology Research, Population Health Sciences, University of Bristol, Bristol, UK
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6
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Kearney A, Daykin A, Shaw ARG, Lane AJ, Blazeby JM, Clarke M, Williamson P, Gamble C. Identifying research priorities for effective retention strategies in clinical trials. Trials 2017; 18:406. [PMID: 28859674 PMCID: PMC5580283 DOI: 10.1186/s13063-017-2132-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 03/07/2017] [Accepted: 07/27/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The failure to retain patients or collect primary-outcome data is a common challenge for trials and reduces the statistical power and potentially introduces bias into the analysis. Identifying strategies to minimise missing data was the second highest methodological research priority in a Delphi survey of the Directors of UK Clinical Trial Units (CTUs) and is important to minimise waste in research. Our aim was to assess the current retention practices within the UK and priorities for future research to evaluate the effectiveness of strategies to reduce attrition. METHODS Seventy-five chief investigators of NIHR Health Technology Assessment (HTA)-funded trials starting between 2009 and 2012 were surveyed to elicit their awareness about causes of missing data within their trial and recommended practices for improving retention. Forty-seven CTUs registered within the UKCRC network were surveyed separately to identify approaches and strategies being used to mitigate missing data across trials. Responses from the current practice surveys were used to inform a subsequent two-round Delphi survey with registered CTUs. A consensus list of retention research strategies was produced and ranked by priority. RESULTS Fifty out of seventy-five (67%) chief investigators and 33/47 (70%) registered CTUs completed the current practice surveys. Seventy-eight percent of trialists were aware of retention challenges and implemented strategies at trial design. Patient-initiated withdrawal was the most common cause of missing data. Registered CTUs routinely used newsletters, timeline of participant visits, and telephone reminders to mitigate missing data. Whilst 36 out of 59 strategies presented had been formally or informally evaluated, some frequently used strategies, such as site initiation training, have had no research to inform practice. Thirty-five registered CTUs (74%) participated in the Delphi survey. Research into the effectiveness of site initiation training, frequency of patient contact during a trial, the use of routinely collected data, the frequency and timing of reminders, triggered site training and the time needed to complete questionnaires was deemed critical. Research into the effectiveness of Christmas cards for site staff was not of critical importance. CONCLUSION The surveys of current practices demonstrates that a variety of strategies are being used to mitigate missing data but with little evidence to support their use. Six retention strategies were deemed critically important within the Delphi survey and should be a primary focus of future retention research.
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Affiliation(s)
- Anna Kearney
- North West Hub for Trials Methodology Research/Clinical Trial Research Centre, Biostatistics, University of Liverpool, Institute of Child Health, Alder Hey NHS Trust, Liverpool, L12 2AP UK
| | - Anne Daykin
- ConDuCT-II Hub for Trials Methodology Research, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Alison R. G. Shaw
- ConDuCT-II Hub for Trials Methodology Research, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Athene J. Lane
- ConDuCT-II Hub for Trials Methodology Research, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Jane M. Blazeby
- ConDuCT-II Hub for Trials Methodology Research, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Mike Clarke
- Centre for Public Health, Queen’s University of Belfast, University Road, Belfast, BT7 1NN UK
| | - Paula Williamson
- North West Hub for Trials Methodology Research/Clinical Trial Research Centre, Biostatistics, University of Liverpool, Block F Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL UK
| | - Carrol Gamble
- North West Hub for Trials Methodology Research/Clinical Trial Research Centre, Biostatistics, University of Liverpool, Institute of Child Health, Alder Hey NHS Trust, Liverpool, L12 2AP UK
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Daykin A, Selman LE, Cramer H, McCann S, Shorter GW, Sydes MR, Gamble C, Macefield R, Lane JA, Shaw A. What are the roles and valued attributes of a Trial Steering Committee? Ethnographic study of eight clinical trials facing challenges. Trials 2016; 17:307. [PMID: 27369866 PMCID: PMC4930562 DOI: 10.1186/s13063-016-1425-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 06/03/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Clinical trials oversight by a Trial Steering Committee (TSC) is mandated by Good Clinical Practice. This study used qualitative methods to explore the role and valued attributes of the TSC to inform planned updates of Medical Research Council guidance and TSC terms of reference. METHODS An ethnographic study was conducted during 2013-2014. TSC and Trial Management Group meetings from eight trials were observed and audio-recorded, and semi-structured interviews conducted with purposively sampled key informants: independent and non-independent TSC members, trial sponsor representatives, funder representatives and chief investigators. The selected trials were currently recruiting and dealing with challenging scenarios. Data were analysed thematically and findings triangulated and integrated to give a multi-perspective account of the role and valued attributes of a TSC. RESULTS Eight TSC meetings and six Trial Management Group meetings were observed. Sixty-five interviews were conducted with 51 informants. The two main roles played by the TSC were quality assurance and patient advocacy. Quality assurance involved being a 'critical friend' or a provider of 'tough love'. Factors influencing the ability of the TSC to fulfil this role included the TSC Chair, other independent TSC members and the model of the TSC and its fit with the trial subject. The role of the TSC as an advocate for patient well-being was perceived as paramount. Two attributes of TSC members emerged as critical: experience (of running a trial, trial oversight or in a clinical/methodological area) and independence. While independence was valued for giving impartiality, the lack of consensus about its definition and strict requirements of some funders made it difficult to operationalise. CONCLUSIONS We found tensions and ambiguities in the roles expected of TSCs and the attributes valued of TSC members. In particular, the requirements of independence and experience could conflict, impacting the TSCs' quality assurance role. Concerns were raised regarding whose interests are served by funders' criteria of independence; in particular, funders' selection of TSC members was thought to potentially inhibit TSCs' ability to fulfil their patient advocacy role. These findings should be incorporated in revising guidance and terms of reference for TSCs.
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Affiliation(s)
- Anne Daykin
- MRC ConDuCT Hub for Trials Methodology Research, School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK.
| | - Lucy E Selman
- MRC ConDuCT Hub for Trials Methodology Research, School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK
| | - Helen Cramer
- MRC ConDuCT Hub for Trials Methodology Research, School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK
| | - Sharon McCann
- Formerly: Health Services Research Unit, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Gillian W Shorter
- Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin, Belfast, BT12 6BJ, UK
- National Institute for Mental Health Research, ANU College of Medicine Biology & Environment, The Australian National University, Canberra, ACT 0200, Australia
| | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, London, WC2B 6NH, UK
- MRC London Hub for Trial Methodology Research, London, UK
| | - Carrol Gamble
- MRC North West Hub for Trials Methodology Research, Institute of Translational Medicine, University of Liverpool, Liverpool, L69 3BX, UK
| | - Rhiannon Macefield
- MRC ConDuCT Hub for Trials Methodology Research, School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK
| | - J Athene Lane
- MRC ConDuCT Hub for Trials Methodology Research, School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK
| | - Alison Shaw
- MRC ConDuCT Hub for Trials Methodology Research, School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS, UK
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Kearney A, Daykin A, Heawood A, Lane A, Blazeby J, Clarke M, Williamson P, Gamble C. A review of the description of patient withdrawal in trial protocols and patient information sheets (PIS). Trials 2015. [PMCID: PMC4658689 DOI: 10.1186/1745-6215-16-s2-p46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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9
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Kearney A, Bacon N, Rosala-Hallas A, Daykin A, Heawood A, Lane A, Blazeby J, Clarke M, Williamson P, Gamble C. Reported reasons for missing data and the interplay with trial setting. Trials 2015. [PMCID: PMC4660107 DOI: 10.1186/1745-6215-16-s2-p101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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10
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Nicholson A, Daykin A, Macefield R, McCann S, Shorter G, Sydes M, Gamble C, Shaw A, Lane JA. Enhancing public involvement in trial oversight committees through qualitative research with eight trials facing challenges. Trials 2015. [PMCID: PMC4660224 DOI: 10.1186/1745-6215-16-s2-p78] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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11
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Kearney A, Daykin A, Heawood A, Lane A, Blazeby J, Clarke M, Williamson P, Gamble C. Pragmatic approaches to mitigating missing data and research priorities to assess the effectiveness of interventions. Trials 2015. [PMCID: PMC4660324 DOI: 10.1186/1745-6215-16-s2-p238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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12
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Daykin A, Lane A, Gamble C, Kearney A, Blazeby J, Clarke M, Williamson P, Heawood A. “To have, to hold, from this day forward”: understanding current practice regarding the retention of trial participants. Trials 2015. [PMCID: PMC4660140 DOI: 10.1186/1745-6215-16-s2-p104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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13
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Daykin A, Heawood A, Lane A, Macefield R, Gamble C, McCann S, Shorter G, Sydes MR. An ethnographic study of group decision making to understand and improve how trial steering committees contribute to trial conduct. Trials 2013. [PMCID: PMC3980686 DOI: 10.1186/1745-6215-14-s1-o79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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14
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Hansen Z, Daykin A, Lamb S. A cognitive-behavioural programme for the management of low back pain in primary care: a description and justification of the intervention used in the Back Skills Training Trial (BeST; ISRCTN 54717854). Physiotherapy 2010; 96:87-94. [DOI: 10.1016/j.physio.2009.09.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Accepted: 09/18/2009] [Indexed: 10/19/2022]
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15
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Simmonds M, Daykin A. Physiotherapy compared with advice for low back pain: targeting "physical factors" alone is not evidence based practice. BMJ 2004; 329:1402; discussion 1403. [PMID: 15591573 PMCID: PMC535465 DOI: 10.1136/bmj.329.7479.1402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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