Patient and public involvement
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Patient and Public Involvement
Patient and Public Involvement (PPI) in RCTs refers to the active engagement of patients, caregivers, and members of the public throughout the research process—not just as participants, but as partners. Involving patients can improve study design, enhance relevance, and strengthen recruitment, retention, and dissemination of findings.
1. Levels of Patient Involvement
PPI can occur at different levels of intensity and engagement:
Consultation: Patients provide feedback on specific aspects of the trial such as study design, outcome measures, or recruitment materials. Example: A focus group reviews draft consent forms to improve clarity and accessibility.
Collaboration: Patients serve as members of the research team and contribute to various phases including protocol development, trial conduct, and knowledge translation. Example: A patient partner helps co-design the intervention based on their lived experience.
Leadership: Patients take leading roles in the research, such as co-developing funding applications, defining research questions, or co-presenting study results. Example: A patient advocacy group leads dissemination efforts to ensure the findings reach affected communities.
2. Why Involve Patients in RCTs?
Involving patients in trials brings several benefits:
Improved Relevance and Feasibility: Research questions become more aligned with patient priorities, and eligibility criteria can be refined for better real-world representation.
Enhanced Recruitment and Retention: Patient-informed materials tend to be more engaging, and patients can help address logistical barriers like travel and accessibility.
Increased Ethical and Practical Acceptability: Patients may identify concerns about burden or fairness that might otherwise be overlooked.
Stronger Dissemination and Knowledge Translation: Patients can help ensure findings are shared through accessible channels and interpreted in ways that matter to the target audience.
3. How to Involve Patients in RCTs
Patient involvement can span the entire trial lifecycle:
Study Design: Include patients in defining research questions and writing the protocol. Seek input on the acceptability of the intervention and outcome measures.
Recruitment and Consent: Co-create recruitment materials and test them for clarity. Conduct mock consent interviews to identify confusing language.
Data Collection and Monitoring: Train patients to serve as advisors or members of the Data Monitoring Committee (DMC). Ensure outcomes include patient-reported measures.
Analysis and Interpretation: Include patient perspectives when interpreting results, especially when exploring subgroup findings or real-world implications.
Dissemination and Implementation: Co-author publications and develop patient-facing outputs such as blogs, infographics, or podcasts. Involve advocacy groups to expand reach.
4. Challenges and Considerations
Tokenism: Avoid symbolic inclusion by giving patients meaningful roles and decision-making power. Offer training where needed.
Diversity and Inclusion: Engage a broad range of patient voices, including those from underserved or minority communities. Collaborate with community organizations to support this goal.
Time and Resource Constraints: PPI requires adequate funding and time. Budget for honoraria, training, and logistical support.
Balancing Scientific Rigor and Patient Preferences: Patient input may differ from conventional methods; researchers should find a balance that respects both perspectives.
5. Budgeting for Patient Involvement
Involving patients meaningfully in RCTs requires dedicated resources. Common budget items include:
| Category | Description |
|---|---|
| Honoraria and Compensation | Payment for participation (e.g., $50–$200 per meeting) |
| Travel and Accommodation | Cover transport and lodging costs for patient partners |
| Training and Support | Capacity-building workshops and mentorship |
| Meeting Costs | Venue rental and refreshments |
| Knowledge Translation | Lay summaries, infographics, and public engagement |
| Technology | Online meeting platforms and accessibility tools |
6. Reporting Patient Involvement
Use established frameworks to transparently report PPI:
- GRIPP2 – Guidance for Reporting Involvement of Patients and the Public
- CONSORT-PRO Extension – For reporting trials that include patient-reported outcomes
Reporting should describe how patients were involved, what changes were made as a result, and how their contributions shaped dissemination.
7. Examples of Patient Involvement in RCTs
- ADAPT Trial (Canada): Patients helped co-design a chronic pain intervention.
- PRECISION Pain Trial: Patients defined what counts as meaningful pain relief.
- UK NIHR Trials: Many UK trials now embed patients on trial steering committees.
8. Conclusion
Meaningful patient and public involvement enhances the quality, relevance, and impact of RCTs. It requires commitment to diversity, adequate funding, and respect for lived experience. When done well, PPI leads to more ethical, inclusive, and actionable research.
Bibliography
- Brett J, Staniszewska S, Mockford C, et al. Mapping the impact of patient and public involvement on health and social care research: a systematic review. Health Expectations. 2014;17(5):637–650.
- INVOLVE. Briefing notes for researchers: public involvement in NHS, public health and social care research. National Institute for Health Research (NIHR); 2012. Available from: https://www.invo.org.uk
- Staniszewska S, Brett J, Simera I, et al. GRIPP2 reporting checklists: tools to improve reporting of patient and public involvement in research. BMJ. 2017;358:j3453.
- Domecq JP, Prutsky G, Elraiyah T, et al. Patient engagement in research: a systematic review. BMC Health Services Research. 2014;14:89.
- Esmail L, Moore E, Rein A. Evaluating patient and stakeholder engagement in research: moving from theory to practice. Journal of Comparative Effectiveness Research. 2015;4(2):133–145.
Adapted for educational use. Please cite relevant trial methodology sources when using this material in research or teaching.