文章基本信息

标题：Managing clustering effects and learning effects in the design and analysis of multicentre randomised trials: a survey to establish current practice
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作者：Elizabeth J. Conroy ; Jane M. Blazeby ; Girvan Burnside 等
期刊名称：Trials
印刷版ISSN：1745-6215
电子版ISSN：1745-6215
出版年度：2020
卷号：21
期号：1
页码：433-445
DOI：10.1186/s13063-020-04318-x
出版社：BioMed Central
摘要：BACKGROUND :Patient outcomes can depend on the treating centre, or health professional, delivering the intervention. A health professional's skill in delivery improves with experience, meaning that outcomes may be associated with learning. Considering differences in intervention delivery at trial design will ensure that any appropriate adjustments can be made during analysis. This work aimed to establish practice for the allowance of clustering and learning effects in the design and analysis of randomised multicentre trials. METHODS :A survey that drew upon quotes from existing guidelines, references to relevant publications and example trial scenarios was delivered. Registered UK Clinical Research Collaboration Registered Clinical Trials Units were invited to participate. RESULTS :Forty-four Units participated (N = 50). Clustering was managed through design by stratification, more commonly by centre than by treatment provider. Managing learning by design through defining a minimum expertise level for treatment provider was common (89%). One-third reported experience in expertise-based designs. The majority of Units had adjusted for clustering during analysis, although approaches varied. Analysis of learning was rarely performed for the main analysis (n = 1), although it was explored by other means. The insight behind the approaches used within and reasons for, or against, alternative approaches were provided. CONCLUSIONS :Widespread awareness of challenges in designing and analysing multicentre trials is identified. Approaches used, and opinions on these, vary both across and within Units, indicating that approaches are dependent on the type of trial. Agreeing principles to guide trial design and analysis across a range of realistic clinical scenarios should be considered.
关键词：Clustering;Learning;Surgical intervention;Survey;Trial analysis;Trial design;Trials;Clinical Trials Unit;Clinical trial;Randomised controlled trial;Complex intervention