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. 2020 Jan 20;18(1):6.
doi: 10.1186/s12916-019-1476-5.

The research burden of randomized controlled trial participation: a systematic thematic synthesis of qualitative evidence

Nivantha Naidoo  1   2 , Van Thu Nguyen  1   3 , Philippe Ravaud  1   2   4 , Bridget Young  3 , Philippe Amiel  5 , Daniel Schanté  6   7 , Mike Clarke  8 , Isabelle Boutron  9   10
Affiliations

The research burden of randomized controlled trial participation: a systematic thematic synthesis of qualitative evidence

Nivantha Naidoo et al. BMC Med. .

Abstract

Background: Participation in randomized controlled trials (RCTs) may be quite demanding and could represent an important burden for patients. We aimed to explore this research burden (i.e., the psychological, physical, and financial burdens) experienced by patients through their participation in a RCT.

Methods: We conducted a systematic review of qualitative studies exploring adult patients' experiences with RCT participation. We searched MEDLINE (PubMed), CINAHL, PSYCHINFO, and Embase (search date March 2018) for eligible reports. Qualitative data coding and indexing were assisted by NVivo. The quality of reports was assessed by using the Critical Appraisal Skills Program (CASP) tool.

Results: We included 45 qualitative studies that involved 1732 RCT participants. Important psychological burdens were identified at every stage of the trial process. Participants reported feeling anxiety and being afraid of "being a 'guinea pig'" and described undergoing randomization and allocation to a placebo as particularly difficult resulting in disappointment, anger, and depression. Patients' follow-up and trial closure were also responsible for a wide range of psychological, physical, and financial burdens. Furthermore, factors related to burdensome impacts and consequences were discerned. These factors involved trial information, poorly organized and too-demanding follow-up, and lack of appropriate management when the patient's participation ended. Trial participation was also associated with beneficial effects such as the satisfaction of feeling "useful," gaining "a sense of control," and receiving special attention.

Conclusions: Our finding provides a detailed description of research burden across the whole RCT process. Many of the burdens described could be anticipated, and some avoided in a movement toward minimally disruptive clinical research. Such an approach could improve trial recruitment and retention.

Review registration: PROSPERO CRD42018098994.

Keywords: Randomized controlled trials; Research burden; Trial participation.

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Conflict of interest statement

Isabelle Boutron is Editorial Board Member for BMC Medicine.

Figures

Fig. 1
Fig. 1
Systematic review flowchart
Fig. 2
Fig. 2
Classification of theme “Research Burden” and sub-themes “Burdensome Impacts and Consequences” and “Factors related to Burden”
See this image and copyright information in PMC

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