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Review
. 2021 Mar 26;22(1):232.
doi: 10.1186/s13063-021-05185-w.

Understanding implementability in clinical trials: a pragmatic review and concept map

Miranda S Cumpston  1 , Steven A Webb  2 , Philippa Middleton  3 , Greg Sharplin  4 , Sally Green  2 ; Australian Clinical Trials Alliance Reference Group on Impact and Implementation of CTN Trials
Collaborators, Affiliations
Review

Understanding implementability in clinical trials: a pragmatic review and concept map

Miranda S Cumpston et al. Trials. .

Abstract

Background: The translation of evidence from clinical trials into practice is complex. One approach to facilitating this translation is to consider the 'implementability' of trials as they are designed and conducted. Implementability of trials refers to characteristics of the design, execution and reporting of a late-phase clinical trial that can influence the capacity for the evidence generated by that trial to be implemented. On behalf of the Australian Clinical Trials Alliance (ACTA), the national peak body representing networks of clinician researchers conducting investigator-initiated clinical trials, we conducted a pragmatic literature review to develop a concept map of implementability.

Methods: Documents were included in the review if they related to the design, conduct and reporting of late-phase clinical trials; described factors that increased or decreased the capacity of trials to be implemented; and were published after 2009 in English. Eligible documents included systematic reviews, guidance documents, tools or primary studies (if other designs were not available). With an expert reference group, we developed a preliminary concept map and conducted a snowballing search based on known relevant papers and websites of key organisations in May 2019.

Results: Sixty-five resources were included. A final map of 38 concepts was developed covering the domains of validity, relevance and usability across the design, conduct and reporting of a trial. The concepts drew on literature relating to implementation science, consumer engagement, pragmatic trials, reporting, research waste and other fields. No single resource addressed more than ten of the 38 concepts in the map.

Conclusions: The concept map provides trialists with a tool to think through a range of areas in which practical action could enhance the implementability of their trials. Future work could validate the strength of the associations between the concepts identified and implementability of trials and investigate the effectiveness of steps to address each concept. ACTA will use this concept map to develop guidance for trialists in Australia.

Trial registration: This review did not include health-related outcomes and was therefore not eligible for registration in the PROSPERO register.

Keywords: Applicability; Clinical trials; Implementability; Implementation; Knowledge translation; Late-phase trials; Pragmatic trials.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Evidence and implementation cycle. Adapted from: Australia’s next generation evidence ecosystem: Maximising the value of research for better health, Federal Budget Submission 2018–2019, Cochrane Australia; 2018
Fig. 2
Fig. 2
Preliminary concept framework. Broad concepts expected to be relevant to implementability at each stage of the trial process
Fig. 3
Fig. 3
PRISMA flow diagram of documents identified in the search
Fig. 4
Fig. 4
Final map of concepts enhancing implementability in clinical trials
See this image and copyright information in PMC

References

    1. ICTRP (International Clinical Trials Registry Platform). Joint statement on public disclosure of results from clinical trials. 2017. Available from: https://www.who.int/news/item/18-05-2017-joint-statement-on-registration.
    1. Macleod MR, Michie S, Roberts I, Dirnagl U, Chalmers I, Ioannidis JPA, Salman RAS, Chan AW, Glasziou P. Biomedical research: increasing value, reducing waste. Lancet. 2014;383(9912):101–104. doi: 10.1016/S0140-6736(13)62329-6. - DOI - PubMed
    1. National Health and Medical Research Council. Research Impact 2019. Available from: https://www.nhmrc.gov.au/research-policy/research-translation-and-impact.... Accessed 6 Dec 2019.
    1. National Institute for Health Research. Making a difference 2019. Available from: https://www.nihr.ac.uk/about-us/making-a-difference/. Accessed 6 Dec 2019.
    1. National Institutes of Health. Impact of NIH Research 2019. Available from: https://www.nih.gov/about-nih/what-we-do/impact-nih-research. Accessed 6 Dec 2019.

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