Barriers and facilitators of high-quality RCTs in pediatric critical care: A survey of trialists
Duffett M, Choong K, Foster J, Meade MO, Menon K, Parker M, Cook DJ.
Aims & objectives
The care of all critically ill children should be informed by evidence from high-quality RCTs. Unfortunately such evidence is not always available. The number of RCTs conducted is limited; they are generally small and difficult to complete. The objective of this survey was to identify the self-reported barriers and facilitators of conducting high-quality RCTs in pediatric critical care.
We surveyed 2 authors from each of the published pediatric critical care RCTs. Respondents rated barriers and facilitators on a 7-point scale with 1 corresponding to "not a barrier at all" or "not an effective facilitator" and 7 corresponding to "a very large barrier" or a "very effective facilitator".
116 researchers (31.6%) from 25 countries responded, including representation from 143 (48.6%) of the published RCTs in pediatric critical care. Respondents reported a median (Q1, Q3) of 21 (15, 26) yr of experience and 41 (36.6%) authored more than one RCT. The 5 most important barriers were primarily funding-related: funding available for large RCTs, funding available for pediatric critical care research. The 5 most effective facilitators were: protected time for research, ability to recruit participants 24hr per day, 7 days per week, conducting RCTs in collaboration with a research network, funding from government agencies specifically for RCTs in critically ill children, and academic department support for conducting RCTs. Respondent experience and country income level were strongly associated with importance ratings (14 of 41 barriers). There were fewer differences for facilitators.
Lack of funding and time are major barriers to conducting rigorous pediatric critical care RCTs. In addition to increased funding, respondents identified other strategies within the sphere of influence of the research community, in particular research networks, to facilitate the conduct of the rigorous RCTs needed in this population.