Informing efficient randomised controlled trials: Exploration of challenges in developing progression criteria for internal pilot studies

Citation

Avery KNL, Williamson P, Gamble C, Francischetto EO, Metcalfe C, Davidson P, Williams H, Blazeby JM, Blencowe N, Bugge C, Campbell MJ, Collinson M, Cooper C, Darbyshire J & Dimairo M (2017) Informing efficient randomised controlled trials: Exploration of challenges in developing progression criteria for internal pilot studies. BMJ Open, 7 (2), Art. No.: e013537. https://doi.org/10.1136/bmjopen-2016-013537

Abstract
Objectives Designing studies with an internal pilot phase may optimise the use of pilot work to inform more efficient randomised controlled trials (RCTs). Careful selection of preagreed decision or ‘progression’ criteria at the juncture between the internal pilot and main trial phases provides a valuable opportunity to evaluate the likely success of the main trial and optimise its design or, if necessary, to make the decision not to proceed with the main trial. Guidance on the appropriate selection and application of progression criteria is, however, lacking. This paper outlines the key issues to consider in the optimal development and review of operational progression criteria for RCTs with an internal pilot phase.  Design A structured literature review and exploration of stakeholders' opinions at a Medical Research Council (MRC) Hubs for Trials Methodology Research workshop. Key stakeholders included triallists, methodologists, statisticians and funders.  Results There is considerable variation in the use of progression criteria for RCTs with an internal pilot phase, although 3 common issues predominate: trial recruitment, protocol adherence and outcome data. Detailed and systematic reporting around the decision-making process for stopping, amending or proceeding to a main trial is uncommon, which may hamper understanding in the research community about the appropriate and optimal use of RCTs with an internal pilot phase. 10 top tips for the development, use and reporting of progression criteria for internal pilot studies are presented.  Conclusions Systematic and transparent reporting of the design, results and evaluation of internal pilot trials in the literature should be encouraged in order to facilitate understanding in the research community and to inform future trials.

Notes
Natalie Blencowe, Carol Bugge, Michael Campbell, Michelle Collinson, Cindy Cooper, Janet Darbyshire, Munya Dimairo, and the following co-authors are credited as members of the Internal Pilot Trials Workshop supported by the Hubs for Trials Methodology Research rather than as explicitly co-authors: Caroline Doré, Sandra Eldridge, Simon Gilbody, Steve Goodacre, Lisa Hampson, Angelos G Kolias, Sallie Lamb, Athene Lane, John Norrie, Gillian Shorter, and Shaun Treweek.

Journal
BMJ Open: Volume 7, Issue 2