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FAQs for UK sites

 

CONTACT

TRIAL DELIVERY -  PERSONNEL  

SITE IDENTIFICATION   

PROTOCOL  

CONSENT 

VACCINATION 

CONTRACTING   

DATABASE, RECRUITMENT, AND RANDOMISATION   

TRANSFER OF CARE

FOLLOW-UP AND ADVERSE EVENTS

DOCUMENTATION    

 

 

trial DELIVERY -  PERSONNEL

Who can act as a PI for the RECOVERY Trial?

The Trial Team confirmed that any adequately qualified member of trust staff (e.g. a consultant) could act as a PI and that PIs from acute trusts can act for other sites locally.

Does the PI need to provide GCP certification and a CV?

There is no need for the PI to provide a CV and GCP certificate.

I anticipate looking after many of the COVID patients in ICU. If I am PI does that mean I can’t approach for consent? If so, should I invite someone else to be PI?

The PI should not act as the legal representative, but could take consent from another legal rep (e.g. family member). Another doctor (independent of the trial) could act as the legal representative if no family member is available.

Who can deliver the treatment as required by the trial protocol?

While treatment will need to be prescribed by a doctor (or other suitably qualified prescriber), and either a doctor or a research nurse (or other suitably qualified member of staff) will need to seek consent from the patient, data capture (online form) can be undertaken by staff who are not clinically qualified (e.g. medical students).

Can patients who are consented to RECOVERY be consented to other (non CTIMP) COVID-19 studies?

Yes. They can also enter other CTIMPs assuming the protocols do not conflict. Please email the trial team if you need clarification with regards to a specific study.

‘The hospital clinicians are responsible for administration of the allocated treatment.’ Does ‘clinician’ apply to all NMC/GMC registrants?

Yes: the IMPs do not have to be given by doctors.

Can junior doctors prescribe as part of this protocol?

Yes; any doctor with a prescribing licence may prescribe.

Will trial team training be a telephone SIV or in the interests of time will we be provided with PowerPoint slides?

All training is on the trial website (www.recoverytrial.net) and is self directed. When the training has been completed, the trial teams will receive their access to the online data collection systems.

Are Co-Investigators permitted on this trial to spread workload?

Yes - we welcome co-investigators at participating centres.

Does the PI need to be a member of the Infectious Diseases staff?

PIs may be staff working in a number of disciplines, including general medicine, infectious diseases, respiratory medicine, and ICUs.

SITE IDENTIFICATION

What type of Trust are you looking to involve in the RECOVERY Trial?

Any hospital sites caring for eligible patients are suitable to take part in the trial. 

Who decides when recruitment can begin at participating centres?

Capacity and capability is to be decided by the individual Trusts. An email is all that is required to advise of this. A signed contract (or email from the signatory) is also required.

PROTOCOL
Is a trial treatment contra-indicated for my patient? All specific contraindications are listed in Appendix 2 of the latest protocol version. If the clinical scenario is outside of these parameters the responsible clinical team makes the final decision on treatment appropriateness.

Can treatment continue for longer than the specified duration if the patient is not discharged in this time?

Treatments should ideally be stopped  after the duration specified in the protocol. Continuation beyond this would be outside the trial, but the managing doctor is free to do what they think is best for the patient (and if they decided to continue a trial treatment it would not constitute a protocol deviation.
A patient has missed on one or more of their study treatment doses; what should we do? Please resume study treatment (assuming it is clinically appropriate to do so) as if the patient had received all planned doses (i.e. so the treatment end date is unaffected.)

Does the trial require any particular monitoring or screening for treatments e.g. blood count, or renal or liver function?

No – the trial protocol was designed to be pragmatic and streamlined, and so any additional investigations or monitoring are the discretion of the clinical team caring for the patient.

Whose responsibility will it be to undertake the follow up post randomisation?

There is a single follow up form to be completed, and this will be through Open Clinica. The PIs will confirm the staff who will be completing this, and the trial team will provide sites with this information.

CONSENT

Who can receive informed consent in the RECOVERY trial?

Any site staff who the principal investigator is satisfied has the necessary training and experience may receive informed consent as long as they have also completed the trial-specific consent training (available on the training page) and completed a “confirmation of training” form to that effect. From the trial’s perspective, GCP training is not required.

Is verbal consent from a NOK over the phone permitted, as hospital visiting is limited?

In cases such as these, legal representative consent can be used instead of that from the NOK (for example, consent from an independent doctor).

Is there any scope to include consent waivers for this trial?

Consent waivers are not possible for the trial.

How should consent for the RECOVERY Trial be obtained?

Consent should be obtained from the patient face-to-face, if the patient is well enough to provide consent.

A witness can sign for a patient who is able to review but not sign (this may be relevant where paperwork cannot be taken out of an isolation room).

For patients who are too unwell to consent there is the option of consent being secured from their legal representative.

If a patient is too unwell to consent and no legal representative is available the patient can be entered into the Study and consent obtained as soon as possible thereafter (see Protocol for further details).

If paper versions cannot be stored in the patient notes for infection control reasons, please try to capture an image which can be stored in the electronic health record.

 

Who should have the consent form (or a scanned copy)?

1 for participant 

1 for local site file (e-mail to your local lead PI or designated local staff) 

1 for medical notes (or scan into EHR)

We cannot take paper out of rooms in which patients with COVID-19 are quarantined - how should we proceed?

The following procedure has NHSE approval (Linda Dempster, Head of Infection Control)

  • The consent form remains with the individual obtaining the consent and not placed/left in the patient's immediate environment
  • The patient’s hands are decontaminated with soap and water or with alcohol hand wash
  • The patient signs the consent form with a pen
  • The signed paper consent form may leave the room without need for additional decontamination
  • The pen stays with the patient or is cleaned before leaving the room.
  • The person taking consent follows all other IPC guidance as instructed by Trust

If this is not accepted by the trust infection control policy then either place in a ‘polypocket’ and clean (and remove from the room the next day), if this is acceptable, or get an image and transfer to the electronic record (or print for notes) as long as this complies with local Information Governance policies.

Should patients only be recruited from infectious disease units?

Patients eligible for the RECOVERY Trial are likely to enter secondary and tertiary care via many avenues and patients may be recruited regardless of their point of admission.

Why are you collecting name, date of birth and NHS number? 

This is to allow linkage with NHS England (and similar bodies) to collect real-time information on progress to supplement the follow-up form data (and to provide longer-term followup).

What do we do if a participant who entered the trial on the basis of consent from a legal representative regains capacity and declines consent for the trial?

If they have not completed their medication and refuse to do so, then please stop it. Please discuss whether they would be willing to allow the follow-up form to be completed, but if they refuse permission for this too ask about registry-based follow-up. Please email recoverytrial@ndph.ox.ac.uk with their study ID and their final decision.

What should happen if the participant doesn’t speak English?

If the PIS/ICF has been translated into a language they can speak, then please provide that. If they have any questions, family or friends should not be used as translators but a service such as LanguageLine (or equivalent) should be used to answer their questions. If a doctor (or someone else who can take consent) does speak their language, they can answer these questions directly. 

If the PIS/ICF has not been translated into an appropriate language, then LanguageLine (or equivalent) should be used to help provide a verbal translation, and to help answer any questions if necessary. Hospital staff should not translate the PIS/ICF for the participant, but can assist by answering their questions. In this scenario please document in the medical notes how the consent discussion was conducted. 

We recognise that there are many languages used in the UK for which we do not have a translation. It is not possible to provide translations in every language, but the languages provided were chosen on the basis of how commonly they are spoken in the UK.

Vaccination

 
Are there any implications of trial treatments for SARS-CoV-2 vaccination?

No

DATABASE, RECRUITMENT, AND RANDOMISATION

Should recruitment data for the RECOVERY Trial be uploaded to LPMS?

No; the RECOVERY trial will have a manual upload route, and all recruitment information will be provided by the central Trial team.

Is there a paper CRF, or should data be added straight to the database?

There is no paper CRF and all data entry should be done directly online. Examples of the CRFs are available on the website. 

What is the process for issuing usernames and passwords for the randomisation server?

Site teams do not need to know their username as the system pre-populates this for them once they select their site name.

Will team members have their own randomisation server log-ins?

Randomisation passwords are provided to each site, not individual.

 

Is recruitment time limited? E.g. within 24 hours of a positive result?

No, recruitment is not time limited, but we would not recommend randomising a patient who is already getting better.

A patient has a positive SARS-CoV-2 swab but no symptoms, are they eligible for RECOVERY?

No, patients recruited to RECOVERY should have an acute respiratory presentation, as outlined in the protocol eligibility criteria.

I accidentally ticked the wrong box in the randomisation form and the patient got assigned a drug which is not clinically appropriate/not available; what should I do?

There is no way of correcting this. The patient should continue with usual care and not be given the study drug. The follow-up form captures if the patient received the study drug they were allocated and for how long.
I entered the wrong date of birth/gender/NHS number upon randomisation; what should I do? Please inform the trial team of the details of the incorrect data using the RECOVERY inbox.

transfer of care 

Participants may be transferred to a different hospital during their care for Covid-19.

What should I do if a participant is transferred to another hospital?

During the course of their care, RECOVERY participants may be transferred from one hospital to another for various reasons:

  •  “Step-up” transfers e.g. for ventilation or ECMO as the original hospital cannot offer such interventions.
  •  “Step-across” transfers e.g. to re-distribute patient numbers, some patients may be moved from one location to another (perhaps to a Nightingale hospital) to relieve pressure on the original hospital.
  • “Step-down” transfers e.g. for rehabilitation once the acute phase of treatment is over.

Step-down transfers

For the purposes of RECOVERY, step-down transfers would be considered discharge from acute care so the study treatment should be stopped on transfer and the trial’s Follow-up form can be completed at the time of transfer.

Step-up or step-across transfers

By contrast, step-up or step-across transfers would be considered ongoing acute care which raises a number of trial-related issues. Any receiving hospital of such patients will also be a RECOVERY site (as the trial has agreements with every acute NHS trust/health board in the UK and HRA approval for the same).

The issues to consider are:

1. Communication
It is essential that the sending hospital inform the receiving hospital that the patient is participating in RECOVERY, when they were randomised and their treatment allocation. This can be done by printing the Randomisation summary from the trial’s web-based Randomisation system and sending it with the participant.

2. Treatment
All study treatments are given on a standard doctor’s prescription in RECOVERY so any remaining course should be prescribed by a doctor at the receiving hospital. If the sending hospital has ‘packed down’ a treatment course for the participant, this may be transferred with them (like their usual medication). If treatment is not available at the receiving hospital then it will have to be withheld until this can be rectified.

3. Consent
If a participant who was consented using a legal representative at the admitting hospital later regains capacity at the receiving hospital where they are still receiving acute care, then trial staff at the receiving hospital should endeavour to obtain written informed consent from the participant. A copy of this consent form should be sent securely (eg, sending a scanned copy using NHSmail) to the admitting hospital for them to keep in their site file.

4. Investigator oversight

The receiving hospital will have a Principal Investigator who will undertake to oversee the trial for all trial participants at their site (regardless of where they were randomised). If this PI holds a contract with the sending hospital then they can be considered a sub-investigator at the sending hospital as well, but this is not essential. This includes being responsible for assessing any possible study-treatment related serious adverse events and ensuring they are reported to the sponsor in a timely fashion.

5. Follow-up data collection
The Follow-up form will have to be completed by staff from the sending hospital (as they will have access to the participant’s record on the OpenClinica system). It is not possible to grant staff at the receiving hospital access to the OpenClinica database for the sending hospital (as it contains data on many participants not under their care), so it is therefore vital that they establish a connection with a link person(s) at the receiving hospital who they can contact when the 28 day Follow-up form is due. It is suggested that the Follow-up form is completed by staff at the sending hospital while speaking to their link person at the receiving hospital on the phone who can provide the limited details required (medication, ventilatory and renal support received during the hospitalisation and date of discharge or death).

Who is responsible for trial-related activities?

The PI at the recruiting hospital remains responsible for trial-related activities (specifically follow-up) even when a participant is transferred to a new hospital. Please print off the randomisation form from the randomisation website to go with the patient when transferred so the receiving team know they are participating in RECOVERY and what their treatment allocation is.

Can participant trial records be moved to the new hospital if they are a RECOVERY site?

 No. The participants must remain on the trial records of the recruiting hospital. It would be sensible to ensure a copy of their consent form is sent with them.
Is it possible to re-randomise a participant when they arrive at the new hospital? No. If a patient has been randomised into RECOVERY they must not be entered into the trial again with a new randomisation.

How should follow-up be conducted if a patient is transferred?

 The trial team at the recruiting site will need to establish a link with staff at the new hospital who can provide them with the necessary information (e.g, over the phone) when the recruiting site need to complete the follow-up form. These links are important so please discuss them with your PI and identify suitable staff at the new hospital. Your LCRN may be able to help. Completing the follow-up form would only require a short telephone call to collect the necessary pieces of information.

Should study treatment continue at the new hospital?

This depends on whether the transfer is “step-up” (ie, for escalation of acute care such as ventilation), “step-across” (ie, for ongoing acute care) or “step-down” (ie, for rehabilitation after the acute illness). If the transfer is “step-up” or “step-across” then ideally treatment would continue. The new hospital is likely to also be a RECOVERY site so they will have stocks of the study treatments so they can be prescribed by a doctor at the new hospital and continued (still for the total of 10 days). If the new hospital is not a RECOVERY site please inform the Coordinating Centre, but treatment may not be able to be continued. 

If the transfer is “step-down” (including transfer to a community hospital) then that should be considered “discharge from acute care” so the study treatments should be stopped according to the protocol.
Is transfer to a new hospital considered “discharge”?

This depends on whether the transfer is “step-up” (ie, for escalation of acute care such as ventilation), “step-across” or “step-down” (ie, for rehabilitation after the acute illness). “Step-up” or “step-across” transfers would not be considered discharge, but step-down transfers would be. 

FOLLOW-UP AND ADVERSE EVENTS
When should a Follow-up form be completed?

 

 Please complete a Follow-up form at the EARLIEST of the participant’s discharge, death or reaching 28 days after randomisation.
Who can complete a Follow-up form? A group of people have been nominated for each site and given access to the OpenClinica system on which these forms are completed. If other people need access, please contact the trial team via email.
What is the Follow-up form collecting? The form collects simple information on medication received during the hospitalisation, dates of discharge (or death), use of ventilation and renal replacement therapy. An example form can be downloaded from the Follow-up page.
How do I record the drugs?

We would like you to indicate if the participant received any of the drugs listed on the form after they were randomised (regardless of whether it was their trial allocation or not). If you indicate a drug was given, then you will be asked to enter how many days they took it for. If they take any dose on any day, that day would count.
What if a participant wants to withdraw from the trial? 'Withdrawal' means different things to different people. Participants may wish to discontinue their study treatment (or their doctors may wish them) which can be done without withdrawing any consent. They may decline to provide information for the Follow-up form, but we would still like to collect information from NHS registries. They can withdraw consent for that too, but this would be unusual. If a participant does wish to withdraw from follow-up in some way, please email the trial team.
What adverse events need to be recorded? The trial protocol specifies that adverse events only need to be recorded if they are BOTH (i) serious; and (ii) believed – with reasonable probability – to be related to study treatment. Other adverse events do not need to be recorded.
What is considered a 'serious' adverse event? Serious Adverse Events are defined as those adverse events that result in death; are life-threatening; require in-patient hospitalisation or prolongation of existing hospitalisation; result in persistent or significant disability or incapacity; result in congenital anomaly or birth defect; or are important medical events in the opinion of the responsible investigator (that is, not life-threatening or resulting in hospitalisation, but may jeopardise the participant or require intervention to prevent one or other of the outcomes listed above). As all RECOVERY participants are already in hospital, the major criteria to consider are whether the event prolongs admission or requires intervention to prevent something worse happening. Known side-effects of the treatments (e.g.  diarrhoea with colchicine) are not necessarily serious unless they require significant intervention (e.g. more than just stopping the medication) or prolong the hospitalisation.
How should we assess 'relatedness'? The key phrase is “with reasonable probability”: there needs to be some evidence that the drug caused the event (not that this can necessarily be known for sure). It is not correct to report an SAE as related just because a relationship cannot be excluded.
Do re-admissions need to be reported as SAEs? Re-admissions only need to be reported if they are thought to be probably related to study treatment. We will capture readmission information through our linkage with NHS Digital so this information will not be missed.

DOCUMENTATION

Where can I obtain all of the documentation required for the RECOVERY trial?

All documents relating to the trial will be placed on the trial website at http://www.recoverytrial.net which is intended to be a single point of access for everything.

What contracting requirements does the RECOVERY Trial have?

The Study Information Pack contains an agreement signed by Oxford, which should be signed and returned to the Study Team. There is no capacity for renegotiation and no OID is needed.

Will the RECOVERY Trial require an ISF to be sent to each site?

No, the only documentation generated by the trial as investigator site files are consent forms which should be scanned and stored electronically (if possible), with originals kept on site. In addition, pharmacy may need to keep accountability records for particular IMPs (which will be described in the pharmacy manual). If any significant protocol violations occur a copy of the report may be sent to the site to be stored locally.

Do PIS/ICF and other associated documents require localisation?

We do not wish you to localise because we will maintain version control through our website.

 

 

Would it be possible for the PIS and ICF to be provided in other languages?

There are a limited number of translations of the PIS and ICF on the Randomisation page.  If the translation you need is not available and the patient is unable to speak English, an English-speaking family member, or legal representative, may be engaged to obtain consent.

 

 

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