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Data and safety monitoring in social behavioral intervention trials: the REACH II experience
Sara J Czaja
Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1695 N.W. 9th Ave., Suite 3204, Miami, Florida 33136, USA; sczaja{at}med.miami.edu
Richard Schulz
University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, PA, USA
Steven H Belle
Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
Louis D Burgio
Center for Mental Health & Aging, The University of Alabama, Tuscaloosa, AL, USA
Nell Armstrong
National Institute of Nursing Research/National Institutes of Health, Bethesda, MD, USA
Laura N Gitlin
Center for Applied Research on Aging and Health, Thomas Jefferson University, Philadelphia, PA, USA
David W Coon
Department of Social & Behavioral Sciences, Arizona State University, Glendale, AZ, USA
Jennifer Martindale-Adams
University of Tennessee-Memphis Health Science Center, VA Medical Center, Memphis, TN, USA
Julie Klinger
University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, PA, USA
Sidney M Stahl
Behavioral and Social Research Program, National Institute on Aging/National Institutes of Health, Bethesda, MD, USA
Background Psychosocial and behavioral interventions trials targeting a broad range of complex social and behavioral problems such as smoking, obesity and family caregiving have proliferated in the past 30 years. At the same time the use of Data and Safety Monitoring Boards (DSMBs) to monitor the progress and quality of intervention trials and the safety of study participants has increased substantially. Most of the existing literature and guidelines for safety monitoring and reporting of adverse events focuses on medical interventions. Consequently, there is little guidance for investigators conducting social and behavior trials.
Purpose This paper summarizes how issues associated with safety monitoring and adverse event reporting were handled in the Resources for Enhancing Alzheimer's Caregiver Health (REACH II) program, a multi-site randomized clinical trial, funded by the National Institutes on Aging (NIA) and the National Institutes of Nursing Research (NINR), that tested the efficacy of a multicomponent social/behavioral intervention for caregivers of persons with Alzheimer's disease.
Methods A task force was formed to define adverse events for the trial and protocols for reporting and resolving events that occurred. The task force conducted a review of existing polices and protocols for data and safety monitoring and adverse event reporting and identified potential risks particular to the study population. An informal survey regarding data and safety monitoring procedures with investigators on psychosocial intervention trials was also conducted.
Results Two categories of events were defined for both caregivers and patients; adverse events and safety alerts. A distinction was also made between events detected at baseline assessment and those detected post-randomization. Standardized protocols were also developed for the reporting and resolution of events that occurred and training of study personnel. Results from the informal survey indicated wide variability in practices for data safety and monitoring across psychosocial intervention trials.
Conclusions Overall, the REACH II experience demonstrates that existing guidelines regarding safety monitoring and adverse event reporting pose unique challenges for social/behavioral intervention trials. Challenges encountered in the REACH II program included defining and classifying adverse events, defining "resolution" of adverse events and attributing causes for events that occurred. These challenges are highlighted and recommendations for addressing them in future studies are discussed.
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Clinical Trials, Vol. 3, No. 2,
107-118 (2006)
DOI: 10.1191/1740774506cn136oa
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