Difficulties of conventional trial designs when studying healthcare settings

Posted on 19 October 2016

A CRD methodological study has just been published in BMC Health Services Research which describes the particular challenges faced when undertaking randomised trials which compare the benefits of receiving treatment in different healthcare settings - such as outpatient wards, community healthcare facilities or home treatment.

This exploratory review, by Mark Corbett and colleagues at CRD and the York Trials Unit, aimed to identify challenges which might be encountered in ‘setting’ trials so that they might be minimised in future trials. It found that recruitment into setting trials may be seriously affected by pre-trial patient preferences for a particular setting. Although alternative trial designs exist to minimise the impact of preferences, they are not frequently used. The review also highlighted examples which illustrate why careful thought is needed when choosing comparator settings and outcome measures, and the importance of considering that many settings may be complex interventions.

Corbett MS, Watson J, Eastwood A. Randomised trials comparing different healthcare settings: an exploratory review of the impact of pre-trial preferences on participation, and discussion of other methodological challenges. BMC Health Services Research 2016;16:589