Do remote clinical trials offer carbon savings while maintaining research quality? Experiences from the Eczema Bathing Study.

Background: Traditional clinical trials contribute significantly to the carbon footprint of healthcare. They are also expensive and take a long time to complete. Remote trials could offer part of the solution. They are a type of decentralized trial that use digital innovations to move all activities to participants' homes or online. This gives them the potential to speed up recruitment, reduce overall trial duration, improve geographical inclusion and reduce the trial's carbon footprint. Objectives: To assess whether a remote trial could reduce a trial's carbon footprint, while maintaining the research quality needed to answer the scientific questions. The primary objective was to calculate the carbon footprint of a remote eczema trial and compare it with traditional and hybrid trials; the secondary objective was to assess quality indicators of remote, hybrid and traditional eczema trials in terms of speed of recruitment, retention and adherence to interventions. Methods: Carbon footprinting of the remote Eczema Bathing Study ( Results: The carbon footprint of the Eczema Bathing Study was 14 tonnes CO Conclusions: The Eczema Bathing Study's lower carbon footprint in comparison with the other clinical trials mentioned in this study was largely due to online recruitment methods, reduced need for patient and staff travel, and reduced overall trial duration. Adherence and retention were slightly lower than for traditional trials but remained within predefined limits for the study's size calculations. In situations where remote assessment of diagnosis and outcomes is possible, and where advertising direct to participants is appropriate, running trials completely online has the potential to improve speed of recruitment, reduce overall trial duration and reduce carbon emissions.