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Encouraging retention in clinical trials (ERIC)


Project Description

Clinical trials often require longer term follow-up measures, collected months or years after completion of the intervention. Such trials struggle to retain participants, leading to: i) reduced sample size; ii) informative (not missing at random) attrition. The first can be addressed by allowance for increased sample size at the design stage but with resource implications. The second has led to substantial interest in methods such as multiple imputation that rely on the untestable assumption that the data is missing at random. Neither is ideal: this project will explore methods to improve retention by trial design.

This studentship will build on the growing body of retention research [1.2], focusing on two aspects of retention: (i) retention in RCTs where the outcome measure is collected at a clinical appointment. This is an important but novel approach: only a small handful of retention trials are concerned with clinic appointments, most look at the return of questionnaires[2]; (ii) communication strategies to promote retention based on behaviour change theory.

1) Systematic review and meta-epidemiological analysis of RCTs with an outcome collected at a clinic appointment to identify trial-level factors associated with attrition, including the extent of the problem, strategies to improve (coded using the Behaviour Change Taxonomy),[3] and analytical approaches.
2) Identification of suitable communication strategies to reduce attrition at clinical appointments, drawing on behaviour change theory[3] and studies of trial recruitment,[4] trial retention,[1] retention in surveys.[5]
3) Simulation study. Retention strategies may have heterogeneous treatment effects, encouraging response among the trial faithful and discouraging the resentfully demoralised. Simulation studies will explore the possible trade-off between increased retention (precision) and heterogeneous response (bias).
4) Embedded trial. Design and pilot an embedded trial across several host trials based at the MAHSC CTU, assessing the effect of the most promising approach(es) on trial retention.


For international students we also offer a unique 4 year PhD programme that gives you the opportunity to undertake an accredited Teaching Certificate whilst carrying out an independent research project across a range of biological, medical and health sciences. For more information please visit http://www.internationalphd.manchester.ac.uk.

Funding Notes

Applicants are expected to hold, or about to obtain a minimum upper second class undergraduate degree (or equivalent) in biostatistics, psychology or a related health or social science discipline, with a substantial statistics component. A Masters qualification at merit or distinction level in a relevant discipline would be a significant advantage. Clinical trials research experience would be useful.

This project has a standard fee. Details of our fee bands can be found here (View Website). For information on how to apply for this project, please visit our website (View Website).

Informal enquiries may be made directly to the primary supervisor.

References

References
1. Bower P, Brueton V, Gamble C, et al. Interventions to improve recruitment and retention in clinical trials: a survey and workshop to assess current practice and future priorities. Trials. 2014; 15: 399.
2. Brueton VC, Tierney J, Stenning S, et al. Strategies to improve retention in randomised trials. The Cochrane database of systematic reviews. 2013; 12: Mr000032.
3. Michie S, Richardson M, Johnston M, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine. 2013; 46: 81-95.
4. Rick J, Bower P, Collier D, Eldridge S, Graffy J and Kennedy A. Systematic techniques for assisting recruitment to trials (START): developing the science of recruitment. Trials. 2013; 14 Suppl 1.
5. Edwards PJ, Roberts I, Clarke MJ, et al. Methods to increase response to postal and electronic questionnaires. Cochrane Database of Systematic Reviews. 2009; 8.

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