September 23, 2021: PCO Core Aims for Greater Consistency in Integrating Patient-Reported Outcomes in Research and Clinical Care

Leaders of the NIH Collaboratory’s Patient-Centered Outcomes (PCO) Core Working Group spoke in a recent Zoom-based interview about the Core’s latest accomplishments and ongoing collaborations with the NIH Collaboratory Trials.

“The purpose of the Core is to provide reusable and sustainable resources and tools to help project teams incorporate patient-centered outcomes and other patient-reported data in pragmatic clinical trials and the electronic health record,” said Dr. Emily O’Brien, an associate professor in population health sciences at Duke University and a cochair of the PCO Core.

“We address 3 components in any clinical research study: the needs of the clinician to provide care for the patient, the needs of the researcher, and the needs of the patient or the individual being treated,” added Dr. Christy Zigler, an assistant professor in population health sciences at Duke University and a cochair of the PCO Core. “To guide clinical researchers about PCO data collection, we usually think about 4 major considerations: adding IT infrastructure, deciding when PCOs are appropriate and choosing the best instrument, defining how to integrate PCO collection into the care process in a meaningful and appropriate way, and preparing for real-time reporting and statistical of PCO data,” Zigler said.

View the full video.

Last year, the PCO Core completed a survey of NIH Collaboratory Trials about cultural and linguistic adaptations of patient-centered outcome measures. The survey revealed significant barriers to researchers wanting to tailor instruments for their study populations.

“We wanted to know how and whether existing NIH Collaboratory Trials were adapting instruments for their populations of interest, either through translation, or cultural adaptation, or both,” said O’Brien. “This was really helpful to give us a sense of what barriers projects might encounter in the future… Planning ahead is critical, and having enough time and resources available to make these adaptations will be important for any projects that might benefit from having these adapted instruments available,” she said.

“We’re also thinking a lot about acceptability and burden of patient-centered outcomes,” said Dr. Zigler. “So we’re targeting PRISM NIH Collaboratory Trials within the first year of transition to implementation…and sending out a survey to gauge acceptability and burden at all levels, from the clinical care team, from the research side, and also from the patients themselves,” Zigler said.

Zigler and O’Brien also highlighted ongoing collaborations with the NIH Collaboratory’s other Core Working groups, including discussions with the Ethics and Regulatory Core about the ethical implications of integrating PCO data into clinical care and a consultation with the Electronic Health Records Core on integrating patient-centered and patient-reported outcomes into the electronic health record so that pragmatic clinical trial researchers can use them.

“Patient-centered outcomes data does not exist in a vacuum,” said O’Brien. “The data that are collected as part of NIH Collaboratory projects exist as part of both the larger study and also the larger health system within which the study is being conducted. So there are really clear connections between the PCO Core and the work that we do and all the other Cores, and those Cores have been a great resource for us as we’re advising projects on key issues that come up during the design and implementation phases of their studies,” she said.

View the full interview with Dr. Zigler and Dr. O’Brien.

 

Screen shot from video interview with Dr. Christy Zigler and Dr. Emily O'Brien

Podcast August 2, 2021: Diversity Workshop Series: Increasing Diversity in Pragmatic Clinical Trials (Dr. Boineau, Dr. Chambers, Dr. Curtis, Dr. O’Brien, Dr. Weber, Dr. Zimmerman)

This podcast summarizes the series on ‘Inclusion of Diverse Participants in Pragmatic Clinical Trials’ with a panel discussion with Dr. Robin Boineau, Dr. David Chambers, Dr. Lesley Curtis, Dr. Emily O’Brien, Dr. Wendy Weber, and Dr. Kanecia Zimmerman.

Click on the recording below to listen to the podcast.

Want to hear more? View the full Diversity workshop series Grand Rounds presentation from

May 14, 2021;  June 4, 2021; June 25, 2021; July 16, 2021; and July 30, 2021.

For alerts about new episodes, subscribe free on Apple Podcasts or SoundCloud.

Read the transcript.

July 29, 2021: COVID-19 Brings Another Real-World Challenge to Pragmatic Research

Principal investigators of the NIH Collaboratory Trials reported several common challenges to implementation of their studies as a result of the COVID-19 pandemic, according to a recent survey. Dr. Emily O’Brien discussed the results of the survey in an interview after the NIH Collaboratory’s annual steering committee meeting.

 

 

“Last spring, we started to hear reports of changes in things like care-seeking behavior, research staff working from home, pauses in recruitment at an institutional level,” said O’Brien. “But there wasn’t a lot of information on how these changes affected pragmatic clinical trials specifically,” she said.

O’Brien is a an associate professor in population health sciences at Duke University and a cochair of the NIH Collaboratory’s Patient-Centered Outcomes Core Working Group. View the full interview.

O’Brien and her colleagues at the NIH Collaboratory Coordinating Center conducted a brief survey about the impacts of the pandemic on the NIH Collaboratory Trials, such as challenges they had encountered, solutions they had implemented, and any new measures the study teams had started using. The most common findings were related to delays in trial activities, including training, modifications in the electronic health record, recruitment, and intervention delivery.

“Fortunately, pragmatic trials have a few inherent features that allow them to flex to disruptions that come about from extraneous factors, like those associated with COVID-19,” O’Brien said.

Some study investigators reported that changes in trial implementation had improved their ability to reach a wider audience through virtual interventions. Some also reported renewed commitment from partnering healthcare systems to work together as they encountered challenges in implementation.

“We really think that these silver linings represent lessons learned that can be applied more broadly when we get through the pandemic to help make research more efficient, in line with the Collaboratory’s broader goals,” O’Brien said.

 

Screen shot from an interview with Dr. Emily O'Brien
Dr. Emily O’Brien