About Trial Forge
Large, single improvements are nice to have but rather rare. Marginal gains – small improvements to processes – start to add up if look across a whole system. Trial Forge aims to look across all trial processes with the intention of trying to improve them all, even if it’s just by a tiny amount, because these gains will start to add up when done across the whole trial system.
A paper in Trials describing the Trial Forge approach is available at https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-015-0776-0.
Making the most of what we know: TRINITY packages
Once a trial process has been identified (e.g. recruitment, retention), the next part of the Trial Forge process is to collate what we already know about that process. This is important because we don’t want to reinvent the wheel, or fail to learn what we can from existing work. To do this we’ve developed an idea called TRINITY packages. As the name suggests, these comprise three systematic reviews on the chosen process. The first summarises factors that affect the process (the Factors review). The other two reviews look at evaluations of initiatives designed to improve the process, the first covering randomised evaluations (the Randomised evaluations review), the second non-randomised evaluations (the Non-randomised evaluations review).
These reviews feed into each other. The Factors review will suggest targets for interventions and initiatives, problems that we should be aiming to reduce, or enabling factors that we should try to embrace. In other words, as well as summarising what we know, the review will suggest the things we ought to be evaluating in randomised or non-randomised evaluations. The two evaluation reviews will tell us which interventions are worth using, which need more work and which we should stop using. Both evaluation reviews could suggest that an intervention ought to be evaluated in a different way, perhaps moving the evaluation to the other review. This is particularly likely if we have promising non-randomised evaluations: the review could suggest that in future the intervention should be tested in a randomised evaluation.
The first TRINITY package is looking at recruitment and involves, among others, Heidi Gardner, Katie Gillies and Shaun Treweek in Aberdeen (see below) and Catherine Houghton and Declan Devane in Galway.
Trial Forge is coordinated from the Health Services Research Unit at the University of Aberdeen (http://www.abdn.ac.uk/hsru/) by:
Hanne Bruhn, a Research Fellow working on, among other things the Trial Forge ESP2 study. Hanne’s profile is at https://www.abdn.ac.uk/hsru/who-we-are/people/profiles/hanne.bruhn
Adel El Feky, who has just submitted a PhD called ‘Making clinical trials more efficient: Can pre-trial qualitative methodologies be used to inform successful participant recruitment and retention in randomised trials?‘ Adel has now moved to Liverpool but will be back for his viva later in 2020.
Shaun Treweek, who is leading Trial Forge and doing some other trial-related stuff, especially related to trial recruitment. Shaun’s profile is at http://www.abdn.ac.uk/hsru/people/s.treweek/.