Conducting randomized, controlled trials. Experience with the dysfunctional uterine bleeding intervention trial.
OBJECTIVE
To conduct a randomized, controlled trial (RCT) to examine issues associated with therapeutic alternatives to standard hysterectomy for women with dysfunctional uterine bleeding.


METHODS
Participants were to be randomly assigned to one of three treatment groups: hysterectomy, endometrial ablation and medical management. Recruitment was targeted at 375 women.


RESULTS
Despite multiple recruitment strategies, recruitment was weak, with only five women enrolled after six months. Providers and women screened for eligibility often expressed discomfort with randomization. The protocol was amended to an elective treatment cohort design with a randomization component. Recruitment improved, with 37 women enrolled after four months.


CONCLUSIONS
The success of RCTs may be affected by multiple factors. Acceptance of the protocol by patients and providers is essential. The RCT may present providers with a conflict between the goals of research and of providing optimal individualized care. Thus, RCTs may not always be appropriate for studies designed to examine best treatments in clinical practice, and nonrandomized designs may provide appropriate alternatives in some cases.
Rolnick
S J
SJ
HealthPartners Research Foundation, 8100 34th Avenue South, P.O. Box 1524, Minneapolis, MN 55440-1524, USA. cheri.j.rolnick@healthpartners.com
Flores
S K
SK
Fowler
S E
SE
Derman
R
R
Davidson
B
B
D002985:Clinical Protocols; D004717:Endometrium / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D017060:Patient Satisfaction; D018579:Patient Selection; D016032:Randomized Controlled Trials as Topic; D014592:Uterine Hemorrhage / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*