Tools to help patients and other stakeholders' input into choice of intercurrent event strategy for estimands in randomised trials.

backgroundEstimands can help to clarify the research questions being addressed in randomised trials. Because the choice of estimand can affect how relevant trial results are to patients and other stakeholders, such as clinicians or policymakers, it is important for them to be involved in these decisions. However, there are barriers to having these conversations. For instance, discussions around how intercurrent events (post-randomisation events which affect the interpretation or existence of the outcome) should be addressed in the estimand definition typically involve complex concepts as well as technical language. We aimed to provide tools that could facilitate conversations between researchers and patients and other stakeholders about the choice of intercurrent event strategy for estimands.

methodsWe developed three tools: (i) a video explaining the concept of an estimand and the five different ways that intercurrent events can be incorporated into the estimand definition; (ii) an infographic outlining these five strategies; and (iii) an editable PowerPoint slide which can be completed with trial-specific details to facilitate conversations around choice of estimand for a particular trial. Each tool was produced through collaboration between researchers and public partners. This involved (i) an initial meeting between researchers and public partners to discuss the aims of the tool; (ii) a draft of the tool being prepared by the research team; (iii) public partners providing feedback; and (iv) the research team updating and finalising the tool.

resultsThese resources can help to start conversations between the trial team and patients and other stakeholders about the best choice of estimand and intercurrent event strategies for a randomised trial. The video and infographic-which explain estimands and intercurrent events with reference to imagined examples-can be sent to stakeholders in advance of a consultation, or presented in the meeting itself. It is important that a member of the trial team is available to answer questions or clarify concepts following this. The editable slide can be completed by the trial team with the specific details of their trial, and then shown to patients or other stakeholders during the meeting to facilitate discussion around which intercurrent event strategy is most relevant for the trial. An example of a completed editable slide is also provided for an example weight loss trial.

conclusionsWe developed three tools to help researchers to have conversations with patients and other stakeholders about estimands, and how intercurrent events should be incorporated into the target estimand for a randomised trial. Further work to evaluate the tools in real-world settings across different stakeholder groups could help to validate the tools and reveal any further refinements necessary to improve their utility.