Operationalizing a Decision-Making for Adverse Event Reporting Toolkit (DART) for Aging and Serious Illness Research

Monitoring adverse events (AEs) assures patient safety in clinical trials. Studies involving seriously ill and older adults can have a high volume of AEs related to underlying courses of illness rather than study procedures. Trials not regulated by the Food and Drug Administration (FDA) can incur excessive reporting burden beyond that required for compliance or patient safety assurance. In 2021, a working group proposed an alternative approach to AE evaluation, emphasizing routine, aggregate reporting, and reserving expedited reporting of individual AEs for serious events at least possibly related to study procedures and not aligned with goals of care. Another outcome was a call to operationalize the approach for eventual implementation.

A panel comprising 31 leaders from government agencies, professional organizations, aging and serious illness research communities, research administration, and medical ethics met five times in 2024-2025. The panel advised on deliverables, assessed concept acceptability, and reviewed tools; a multidisciplinary project team generated content and incorporated feedback. Research compliance experts reviewed the final decision algorithm.

The resulting Decision-Making for Adverse Event Reporting Toolkit Tailored to Social, Behavioral and Health Services Studies involving Seriously Ill and Older Adult Populations (DART) is a novel research tool to support researchers in AE evaluation. The decision algorithm assesses: (1) relatedness, (2) goals of care alignment, (3) seriousness, and (4) greater risk of harm. The toolkit includes a case series, frequently asked questions, and reporting form. Feedback emphasized DART applies to any study population and intervention type not regulated by the FDA.

DART provides a novel solution to AE reporting challenges faced by aging and serious illness researchers. While its design centers on seriously ill older adults, DART can likely be applied to research in any population and intervention type not regulated by the FDA. Future pilot testing will inform implementation.