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Table 1 Overview of ZQOL study challenges, solutions and implications

From: Challenges in quantifying the patient-reported burden of herpes zoster and post-herpetic neuralgia in the UK: learnings from the Zoster Quality of Life (ZQOL) study

Key challenges Solutions Future implications
1) Identification of centres willing/able to participate in the study
• Identifying centres with interest/capacity to participate in research and the correct people to discuss participation with proved difficult via conventional means (unsolicited mail/email).
• Limitations in dedicating time or resources to external research projects due to clinical workloads and lack of designated support staff were common reasons for non-participation cited by centres. Levels of remuneration provided to centres for participation in the study were considered insufficient by some centres.
• Availability of NHS staff participating in research having completed Good Clinical Practice (GCP) training.
• The ZQOL study was accepted into the National Institute for Health Research Clinical Research Network (NIHR CRN) portfolio. NIHR were able to offer wide range of support services including:
o Access to existing networks of centres with interests in participating in research.
o Provision of support to centres interesting in participating in research.
o Exploring centre eligibility for additional remuneration for participation in NIHR CRN-approved studies.
o Delivering GCP training to centres interesting in participating in studies.
• Experiences indicate the need for greater links between commissioners of research and primary/secondary care centres.
• A refocusing of targets for primary care centres, to provide staff with opportunities and incentives for partaking in research is needed.
• Current R&D approval process makes no concessions for non-interventional research. R&D requirements should be proportionate to the risks associated with patient participation in such studies.
2) Obtaining Ethics and Research & Development (R&D) Management Approval
• Information and documentation required to support R&D applications was a barrier to participation for a number of centres.
• Significant variation in timelines for R&D approval at a local and regional level (i.e. England, Scotland, Wales & Northern Ireland) led to significant delays in the study.
• R&D approval process requires that extensive tri-partite agreements between the study sponsor, co-ordinating CRO and R&D department be agreed and signed. However, there is no standard template available for such agreements.
• ZQOL study organisers implemented a number of practical solutions including:
o Minimising the number of R&D approvals by seeking participation of clusters of centres in the same NHS trust.
o Implemented a staged study roll-out such that R&D applications for key centres were prioritised and R&D applications could occur in parallel to patient recruitment.
NIHR CRN can also provide assistance:
o As a NIHR-CRN portfolio adopted study, more likely to be considered for priority review by R&D depts.
o NIHR CRN local research network teams are able to offer support and guidance to co-ordinating CROs throughout England.
• Current R&D approval process makes no concessions for non-interventional research. R&D requirements should be proportionate to the risks associated with patient participation in such studies.
• A move to standardise R&D approval process across NHS trusts in England would reduce burden (and barriers) to research for study organisers and NHS staff interested in participating in research.
3) Recruitment of Study Participants
• Recruitment of HZ patients in primary care was slower than envisaged, a likely result of practical and organisational factors:
o As an acute condition, HZ patients had to be recruited on initial presentation to physicians and did not allow searches of eligible participants via patient medical records.
o At the time of the study there will only limited opportunities for notifications and reminders to be incorporated into electronic-record systems on presentation of incident cases.
• Lack of unique identifiers or codes in electronic-record systems made it difficult to identify PHN patients for participation in the ZQOL study.
• To ensure that study recruitment quotas were met, additional centres were recruited for participation in the study and study timelines were extended.
• NIHR CRN local research networks and the co-ordinating CRO were in regular contact with centre staff so to ensure to provide support where needed.
• Standardisation of medical record keeping and greater integration of record and monitoring systems would be to the benefit of facilitating real-world research.
• Centres having systems in place to confirm the feasibility of recruitment numbers and having opportunity to work alongside study organisers could facilitate the development of study inclusion/exclusion criteria that are less restrictive to recruitment in real-world practice.