STUDY PUBLISHED IN BRITISH MEDICAL JOURNAL SHOWS THAT
PATIENTS ARE NOT COMPLIANT WITH CLINICAL TRIAL PROTOCOLS
Study raises serious doubts about the integrity of patient-reported
data in clinical trials
SCOTTS VALLEY, CA (May 20, 2002) A study just published
in the British Medical Journal shows that subjects in clinical
trials who are asked to make real-time written entries in a paper
diary routinely fail to do so, undermining the validity of the
patient self-report data collected in those studies.
Researchers have long suspected that subjects complete batches
of paper diary cards rather than completing them in real-time
as instructed. The resulting recall bias impacts the subjects
ability to accurately report on their condition and reaction to
medications, yielding data that is invalid or unreliable. In this
study, 79% of paper diary entries were falsified, raising serious
doubts about the validity of data collected from patients when
using paper diaries in clinical practice and research.
The study, sponsored by the National Cancer Institute with in-kind
support from invivodata, was designed to compare compliance between
subjects using a paper diary and those using an electronic diary
developed by invivodata, inc. The study was led by Drs. Arthur
Stone and Saul Shiffman, pioneers in behavioral science methods
for collecting patient data using Ecological Momentary Assessment
(EMA). EMA encompasses methods for collecting valid and reliable
patient self-report data in real time and in patients natural
environment.
The National Cancer Institute study is the first to document
subject compliance with paper diaries.Compliance with paper diaries
has been hard to assess, because the time of diary completion
is not objectively documented. What enabled this study to document
compliance was the invention of an instrumented paper diary that
electronically tracked diary use unobtrusively. Paper diary compliance
rates were compared with those achieved using the invivodata electronic
diary, which implements EMA principles.
Just as in many prior studies using paper diaries, the subjects
in this study submitted most of the required diary pages
90% of them, in fact with what appeared to be legitimate
times and dates. However, when the electronic records were checked,
only 11% of the pages could have been filled
out as required by the study protocol. In contrast, subjects using
the invivodata electronic diaries completed 94% of their entries
on time, as verified by the electronic records. The study authors
note that the timely reporting achieved by the invivodata system
is key to the validity and integrity of the data.
Patient diaries are commonly used in pharmaceutical trials. DataEdge
has estimated that 25% of all clinical trials for pharmaceutical
products use a patient diary. The companies that sponsor these
trials stand to benefit from improved integrity of patient self-report
data. Data integrity in patient self-report is critical
to our research, commented R. Michael Gendreau, M.D., Chief
Medical Officer at Cypress Bioscience, Inc. In our clinical
studies, the invivodata diary has helped us capture real-time
data from patients in their natural environment that was more
sensitive to change than data collected during routine visits
to the research site. We have observed high rates of patient acceptance
and compliance with the electronic diary in our protocols, and
the invivodata
patient management system helped produce significantly better
data than we could have ever collected using paper diaries.
Patients want to provide data that will help researchers
find cures, commented Saul Shiffman, Ph.D., co-founder and
Chief Science Officer of invivodata. Patients are the most
important element of a clinical trial, yet the most difficult
to manage. Old paper diary methods do not help the patients successfully
comply with the study protocol. We have designed and perfected
the invivodata system over the years to effectively promote compliance
in the real world. The invivodata solution helps study sponsors
gain a deeper, more accurate understanding of their new treatment
by helping patients effectively communicate how they feel while
in the study.
In the group using paper diaries, none of the patients showed
good compliance, and all showed evidence of back-filling entries
after the fact. The paper diary binder was never opened even once
on one-third of all study days, even though 90% of the diary cards
for these days were turned in. This indicates that the study protocol
was not followed and undermines the validity of the data. A large
body of research shows that when people try to remember their
experience, they introduce errors and bias into the data. This
may be magnified when patients in clinical trials complete a batch
of diaries after the fact, to make up for missed diary entries.
The noise and bias introduced into the data in this way can threaten
the validity of the clinical data, and undermine the ability of
the study to document a drugs effectiveness.
Clinical researchers, long aware of the value of accurate patient
self-report, are recognizing the value of new methods for collecting
reliable data from patients. For an increasing number of
studies, patient-reported data is a critical endpoint, noted
Ronald S. Waife, President of Waife & Associates, Inc., a
leading clinical research consulting firm. It has been clear
for some time that only through the application of the right information
technologies can the scientific validity of patient-reported data
meet the clinical research needs. This new study should help validate
proven electronic means of collecting patient-reported data, so
that sponsors and regulatory bodies will endorse the shift away
from discredited paper methods.
The study publication can be accessed from the Web site of the
British Medical Journal (www.bmj.org).
Additional study details or information on the invivodata electronic
diary solution can be obtained by visiting the invivodata website
(www.invivodata.com)
or by contacting invivodata (email: info@invivodata.com, tel:
(831) 438-9550).
About invivodata
invivodata (www.invivodata.com) provides science-based
electronic diary services for clinical trials. invivodatas
system uniquely combines behavioral science, technology, and clinical
expertise to capture clinical trial data of the highest-possible
integrity directly from patients. Far superior to paper diary
methods, invivodatas electronic patient diary solution,
the invivosystem, delivers more reliable and valid data than any
other diary method by driving patient compliance with the protocol
and eliminating recall biases that plague self-report studies.
The invivodata solution provides real-time access to study data,
giving study researchers and sponsors visibility into study progress
and improving study efficiencies. The invivosystem was developed
and validated according to a rigorous Computer System Validation
policy based on 21 CFR Part 11. It has been used in nearly 50
studies involving thousands of patients. Having collected more
than 2,000,000 patient-initiated records, invivodatas solution
is mature and market-proven. No other electronic diary solution
has
processed more patient records than the invivosystem. invivodata,
inc., a privately-held company, is headquartered in Scotts Valley,
California. The clinical trial operation center is located in
Pittsburgh, Pennsylvania.
Editors note: for additional reading please see:
"The
Science of Patient Experience" By: Doug Engfer: President
& CEO, invivodata