Organize the trial structure

This section contains the following:


Introduction

Arrangements for the day-to-day running of the trial (Trial Co-ordinating Center which includes the trial management group), the supervision of the trial (Trial Steering Group) and monitoring of the trial (Data Monitoring and Safety Committee) should be planned at the protocol development stage.  Each group has an important role in the smooth and efficient running of the trial.

Trial Co-ordinating Center
Most trials require a Trial Co-ordinating Center to handle administrative matters once participants are being entered.  This is usually the base for the Trial Management Group.  A typical Trial Management Group consists of: principal investigator; trial manager; trial programmer; database manager and/or data clerks; trial statistician; and trial secretary.  This group should meet regularly e.g. weekly to ensure the efficient day-to-day running of the trial, to prepare reports for the steering committee, and to organize and service the data monitoring and ethics committee. 
Trial Steering Group
The Trial Steering Group should meet periodically to discuss the overall progress of the trial.  It should include at least the principal investigator, trial manager, one or two experienced investigators not otherwise involved in the trial, and a statistician.  The group should meet initially to finalize the protocol and organization.  Once the trial is running the group should meet  regularly to discuss issues such as: recruitment progress; protocol deviations; possible protocol amendments; and interim results.  The Trial Steering Group should operate in an advisory capacity leaving the principal investigator to implement any decisions.

The Data Monitoring Committee
The principal role of the Data Monitoring Committee is to monitor data and alert the organizers of the trial if they think the pattern of data – on benefits or hazards or both – is sufficiently persuasive to warrant either closing recruitment to a trial or changing the protocol, such as terminating recruitment in one or more sub-groups of trial participants.  The Data Monitoring Committee should be completely independent of the Trial and should meet regularly  to review interim results.


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Things to consider

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Illustrative example - Magpie trial

Magpie Trial Steering Committee The overall progress of the trial was monitored by a scientific and administrative steering committee.  The UK Medical Research Council convened this committee.

Magpie Trial Management Group: This group met every 2-3 months to assist with day to day running of the trial, and to prepare reports for the steering committee. 

Data Monitoring Committee: The terms of reference of the data monitoring committee are outlined earlier. 

International Advisory Board An International Advisory Board was convened to advise the Magpie Trial Management Group, as and when requested. This board had a multidisciplinary membership from around the world.


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Illustrative example - INIS trial

Trial Steering Committee

The Trial Steering Committee (TSC) provided overall supervision of the trial on behalf of the Medical Research Council. Its terms of reference were:


1. To monitor and supervise the progress of the trial towards its interim and overall objectives.

2. To review at regular intervals relevant information from other sources (e.g. related trials).

3. To consider the recommendations of the Data Monitoring and Ethics Committee.

4. In the light of 1, 2 and 3 above, to inform the MRC Council and relevant MRC Research Boards on the progress of the trial.

5. To advise the MRC Council on publicity and the presentation of all aspects of the trial.


Meetings of the TSC took place at least once per year.


Investigators’ Group

The Investigators’ Group consisted of the trial investigators, representatives of specific groups whose expertise was necessary for the trial, and investigators of any ancillary studies. This group supervised the practical aspects of the trial’s conduct. It resolved problems brought to it by the Project Management Group (see below) and was responsible for organizing reporting and dissemination of the trial’s results.


Project Management Group

The Project Management Group (PMG) oversaw the day-to-day running of the trial. The responsibilities of the Project Management Group included:


i) recruitment of participating centers

ii) distribution and supply of data collection forms and other appropriate documentation for the trial

iii) data collection and management

iv) organization of the distribution system for the treatment packs

v) organization of the follow-up of children at 2 years if age, including the distribution of questionnaires, follow-up of non-responders and liaison with local ‘follow-up’ personnel

vi) data entry and cleaning

vii) data analysis

viii) collection of adverse event data

ix) organizing and servicing the Data Monitoring and Ethics Committee.

Additional Resources

Trial Steering Committee

Picture of Dave SackettDave Sackett, Trout Research & Education Centre at Irish Lake, Canada, explains the main purpose and the composition of a trial steering committee (MP4, 1 minute 8 seconds).  Can't see the audio controller?  Play it in your media player.


What does the trial steering committee do? (MP4, 1 minute 37 seconds)  Can't see the audio controller?  Play it in your media player.



What are the key things to think about with regard to a trial steering committee? (MP4, 26 seconds).  Can't see the audio controller?  Play it in your media player.



Further reading


Pocock SJ. Clinical Trials: A Practical Approach. John Wiley and Sons, Chichester, 1983.

Ellenberg SS, Fleming TR, DeMets DL.  Data monitoring committees in clinical trials. a practical perspective.  Chichester: John Wiley and Sons, 2003.

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This page was last updated March 2009..