The importance and need for SWAT coordination

Studies Within A Trial (SWATs) provide evidence for trial process decisions by evaluating alternative trial processes or exploring why processes are undertaken. SWATs can be undertaken as "individual," "individually with coordination," and "coordinated simultaneous." Using these approaches efficiently can facilitate timely and definitive identification of effective and ineffective trial processes; however, this rarely happens. This paper compares between the three approaches and offers guidance on how to use these efficiently.

Using direct experience of undertaking SWATs and data collected during the PROMoting THE USE of SWATs program, the advantages and disadvantages of each SWAT approach were identified and summarized.

"Individual" SWATs are best for simple strategies or where flexibility is needed. They do not usually reach a definitive conclusion, meaning replications and meta-analysis are required. This enables replication in a range of populations but requires significant time to reach a conclusion. SWATs conducted "individually with coordination" are like both "individual" and "coordinated simultaneous" SWATs. Coordination helps evidence accumulate more quickly, reduces intervention heterogeneity, and enables replications in specific populations; however, coordination can be difficult to facilitate. For "coordinated simultaneous" SWATs, the same intervention is evaluated at the same time in multiple trials enabling ascertainment of effectiveness in a single evaluation. Data must be combined and analyzed promptly, requiring a dedicated team to manage SWAT conduct.

Undertaking SWATs as "individual," "individually with coordination," or "coordinated simultaneous" depends on the host trial, research team preferences, resources, and the proposed SWAT. A combination of approaches may be required to reach a definitive conclusion.

The best way to find out which health or social care treatment is the best is to do a randomized controlled trial ("trial"). In trials, some patients receive one treatment being tested, and others receive a different treatment or no treatment at all. This allows researchers to compare what happens to the different groups and to see which treatment is best. Trials are the best way to test this; however, we do not currently have good information to tell us the best ways to plan and run trials, for example, how to best ask people to take part in trials and how to keep them engaged with this. To understand how best to plan and run a trial, researchers can do a study within a trial ("SWAT"). These SWATs need to be done several times so that we can be sure that the process we are testing is the best one. Lots of SWATs have been done by researchers, but often these are done on their own and not repeated quickly. This means that it takes a long time to find out whether a process does or does not work. If researchers work together and do these SWATs at the same or a similar time, this can help us to find an answer quicker. There are many advantages to doing this; however, there are also some difficulties. This article provides information about the advantages and disadvantages of doing SWATs at the same or similar time so that researchers can better plan how to do SWATs more efficiently.