Trial Design Stage
Published Date: April 29, 2025
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Helpful Terms and Definitions
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*This list is not exhaustive, nor does CTTI officially endorse the resources created by other organizations.
Study Concept
Define Patients and Caregivers
Who makes up patients and caregivers?
- Patient organization representatives across diverse demographics and, where appropriate, across regions or countries (e.g., age, race/ethnicity, gender, disease state)
- Both experienced patients/caregivers and those with little or no clinical trial experience
- To successfully inform on the trial design, a small, focused group (typically 3–4 individuals) should be convened to allow meaningful discussion
Where will you find them?
Start by mapping groups aligned with the research focus and building relationships over time. Maintain and refresh this mapping periodically.
- Engage with patient organizations and advocacy groups relevant to the disease area
- Consider treating patient representatives as subject matter experts based on lived experience
- Allow adequate time to identify and build trust with these communities (timelines may vary depending on the disease area and access to groups)
To identify research-naïve individuals and broaden representation, consider engaging:
- Federally qualified health centers (FQHCs)
- Safety-net hospitals
- Community-based organizations and groups serving underrepresented populations
Why involve patients and caregivers now?
Early engagement helps sponsors understand the needs, preferences, and lived experiences of people affected by the disease.
It also provides an opportunity to:
- Build trust and ongoing relationships
- Validate the study rationale from a patient perspective
- Identify unmet needs and real-world care dynamics
- Understand patient burden to better inform study objectives and design
Engaging patients and caregivers at the study concept phase helps ensure the study is relevant, feasible, and meaningful to the population it aims to serve.
Questions To Ask
- Why is this study appealing to the patient community?
- How and when are patients typically diagnosed?
- Is the study flow burdensome for patients?
- Do the inclusion/exclusion criteria reflect the real-world patient population?
- Are these the outcomes that matter most to patients?
- How is patient health information being protected and used?
- What does the risk–benefit profile look like from a patient perspective?
- What types of control groups or treatments are being used, and are they acceptable to patients?
- What options are available if a patient’s condition worsens during participation?
- What is the long-term plan (e.g., open-label extension or continued access)?
- What types of providers are involved in care?
- What barriers exist to accessing treatment, and are there ways to address them?
- Is there an opportunity to engage underrepresented patient and caregiver communities?
- Are there deeper community connections available through disease-specific foundations or advocacy groups?
- How can the burden of participating in the clinical trial be reduced for the patient and their caregiver?
- If this were a study you were participating in, what would you change before enrolling yourself or someone you love?
Patient and Caregiver Resources
- Regulatory & Foundational Policy
These resources establish the "why" and the legal/ethical "how" for patient engagement. They are essential for briefing packages and regulatory interaction planning.
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- FDA Patient-Focused Drug Development Guidance Series: The authoritative FDA series for incorporating patient voices into medical product development.
- CTTI: Patient Group Engagement Recommendations: Definitive guidance on the legality and best practices for sponsor-patient group collaborations.
- Representativeness in Patient Engagement (NHC): A framework for ensuring that engagement efforts reflect the diversity of the target patient population.
- Patient Engagement in Clinical Trials: A Practical Guide (mdgroup): A high-level strategic overview of why patient engagement is critical for data quality and protocol adherence.
- Operational Planning & Co-Creation Toolkits
These tools are designed for protocol designers and clinical project leads to use during the study concept and synopsis stages.
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- Patient Protocol Engagement Toolkit (P-PET): TransCelerate’s resource for planning and executing patient engagement activities.
- Paradigm Patient Engagement Toolbox: A comprehensive suite of tools for structured, ethical engagement during the research life cycle.
- PEM Suite: Patient Engagement Training: Modules to build internal stakeholder capability for engagement.
- PEM Suite: Practical How-to Guides: Tactical guidance for specific phases, including protocol design.
- How-To Guide: Clinical Trial Protocol Design: A specialized, tactical "how-to" specifically for embedding patient input into protocol development.
- Patient Experience Mapping & Qualitative Research
These resources assist in identifying patient burdens and unmet needs to inform study endpoints and design features.
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- National Health Council: Patient Experience Map: Standardized tools for documenting the journey from pre-diagnosis to treatment.
- Community Engagement Studios (Vanderbilt): A model for gathering rapid, expert-level feedback from patient communities to refine study concepts.
- Metrics, Valuation, & Specialized Standards
These resources allow you to measure the quality of your engagement and manage the financial/logistical aspects of collaborations.
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- Patient Engagement Quality Guidance Tool: A rubric for scoring the quality of engagement activities.
- Patient Compensation Tools (NHC): Resources and Fair Market Value (FMV) guidance for compensating patient experts.
- Framework for Patient Engagement in Cancer Network Group Studies (PCORI): A specific model for oncology studies.
- Assessing Meaningful Patient Engagement (PubMed): Academic framework for evaluating the impact of engagement on clinical outcomes.
- Digital & Decentralized Trial Implementation
Resources specific to the technical and operational shift toward modern, patient-centric trial delivery.
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- CTTI: Engaging Patients and Sites in Digital Trials: Implementation questions and checklists for decentralized/digital trial design.
- Paladin Consortium: Playbook: A resource for digital and patient-centric protocol design strategies.
- Verana Health: Real-World Data White Paper: Insights on integrating real-world data to supplement traditional trial design.
Patient and Caregiver
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Regulator
IRB
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Payer