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Dangosydd eitem ddigidol (DOI)

  • Bernie Carter
    Edge Hill University
  • Lucy Bray
    Edge Hill University
  • Nadia Al-Najjar
    Department of Molecular and Clinical Pharmacology, University of Liverpool
  • Agnès Tort Piella
    Liverpool University
  • Catrin Tudur Smith
    Department of Molecular and Clinical Pharmacology, University of Liverpool
  • Catherine Spowart
    Department of Molecular and Clinical Pharmacology, University of Liverpool
  • Amber Collingwood
    King's College London
  • Holly Crudgington
    King's College London
  • Janet Currier
    Independent consultant
  • Dyfrig Hughes
  • Eifiona Wood
  • Rachael Martin
    Edge Hill University
  • Christopher Morris
    College of Life and Environmental Sciences, University of Exeter, Penryn Campus, Penryn, 9 TR10 9EZ, UK.
  • Deborah Roberts
    Independent consultant
  • Alison Rouncefield-Swales
    Edge Hill University
  • Heather Sutherland
    Edge Hill University
  • Victoria Watson
    Department of Molecular and Clinical Pharmacology, University of Liverpool
  • Georgia Cook
    Department of Sport and Health Sciences, Oxford Brookes University, Oxford
  • Luci Wiggs
    Department of Sport and Health Sciences, Oxford Brookes University, Oxford
  • Paul Gringas
    Evelina London Children’s Hospital, London
  • Deb Pal
    King's College London
In paediatric epilepsy, the evidence of effectiveness of antiseizure treatment is inconclusive for some types of epilepsy. As with other paediatric clinical trials, researchers undertaking paediatric epilepsy clinical trials face a range of challenges that may compromise external validity

Main body
In this paper, we critically reflect upon the factors which impacted recruitment to the pilot phase of a phase IV unblinded, randomised controlled 3×2 factorial trial examining the effectiveness of two antiseizure medications (ASMs) and a sleep behaviour intervention in children with Rolandic epilepsy. We consider the processes established to support recruitment, public and patient involvement and engagement (PPIE), site induction, our oversight of recruitment targets and figures, and the actions we took to help us understand why we failed to recruit sufficient children to continue to the substantive trial phase.

The key lessons learned were about parent preference, children’s involvement and collaboration in decision-making, potential and alternative trial designs, and elicitation of stated preferences pre-trial design.

Despite pre-funding PPIE during the trial design phase, we failed to anticipate the scale of parental treatment preference for or against antiseizure medication (ASMs) and consequent unwillingness to be randomised. Future studies should ensure more detailed and in-depth consultation to ascertain parent and/or patient preferences. More intense engagement with parents and children exploring their ideas about treatment preferences could, perhaps, have helped predict some recruitment issues. Infrequent seizures or screening children close to natural remission were possible explanations for non-consent. It is possible some clinicians were unintentionally unable to convey clinical equipoise influencing parental decision against participation. We wanted children to be involved in decisions about trial participation. However, despite having tailored written and video information to explain the trial to children we do not know whether these materials were viewed in each consent conversation or how much input children had towards parents’ decisions to participate. Novel methods such as parent/patient preference trials and/or discrete choice experiments may be the way forward.

Conclusion
The importance of diligent consultation, the consideration of novel methods such as parent/patient preference trials and/or discrete choice experiments in studies examining the effectiveness of ASMs versus no-ASMs cannot be overemphasised even in the presence of widespread clinician equipoise.
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Dynodwyr Gwrthrych Digidol (DOIs)
StatwsCyhoeddwyd - 6 Chwef 2023

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