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“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

Daykin, Anne, Selman, Lucy E, Cramer, Helen, McCann, Sharon, Shorter, Gillian W, Sydes, Matthew R, Gamble, Carrol, Macefield, Rhiannon, Lane, J Athene and Shaw, Alison (2017) “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, 18 (612). pp. 1-16. [Journal article]

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URL: https://doi.org/10.1186/s13063-017-2305-9

DOI: 10.1186/s13063-017-2305-9

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. Findings Eight TSC and six TMG meetings from eight trials were observed and audio-recorded, and 66 semistructured interviews conducted with 52 purposively sampled key informants. Five themes are presented: Collaboration within the TMG and role of the CTU; Collaboration and conflict between oversight committees; Priorities; Communication between trial oversight groups; and 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 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

Item Type:Journal article
Keywords:Randomised Controlled Trials Randomized Controlled Trials Trial Oversight Trial Steering Committee Trial Management Ethnography Qualitative Research
Faculties and Schools:Faculty of Life and Health Sciences
Faculty of Life and Health Sciences > School of Psychology
Research Institutes and Groups:Psychology Research Institute > Psychotraumatology, Mental Health & Suicidal Behaviour
Psychology Research Institute
ID Code:38981
Deposited By: Dr Gillian Shorter
Deposited On:22 Jan 2018 09:24
Last Modified:22 Jan 2018 09:24

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