Challenges of an Internet-based education intervention in a randomized clinical trial in critical care

Abstract

Randomized clinical trials (RCTs) are the gold standard for assessing causal relationships and the most rigorous design for evaluating interventions. Trials conducted by nurses are being performed with increasing frequency in critical care areas. Most of these RCTs focus on implementing new protocols of care. Internet-based interventions are being used in other settings, such as with patients and families in home and clinic settings. To our knowledge, however, there are no published reports of Internet-based interventions that target critical care nurses. The challenges of carrying out an RCT in critical care settings by using an Internet-based education intervention for nurses have not been addressed. The purpose of this column is to examine methodological issues associated with nonadherence to Internet-based interventions. We explore both the benefits and challenges of using an Internet-based education intervention in critical care, citing an example of our ongoing study in which an Internet-based education program is the primary intervention. We discuss strategies for assessing and promoting intervention fidelity in such a study and consider issues related to measuring outcomes online.